Treating varicose veins: What you need to know

Varicose veins - those bulging, twisted veins often seen in the legs - are a common condition that affects about 1 in 4 adults in the United States. While they can be uncomfortable or unappealing, they don't always lead to serious health problems. Still, many people are interested in learning about treatment options.

To help explain what causes varicose veins and how they can be treated, we spoke with Mimmie Kwong, an associate professor of vascular surgery at UC Davis Health. She shared her insights on this common condition and the latest treatment options available.

What are varicose veins, and why do they happen?

Varicose veins happen when veins (typically in the legs) don't work the way they should. This can happen in two main ways.

One way is when a vein gets blocked by a blood clot. This can occur deep inside the leg muscles or in veins close to the skin.

Another way is when tiny one-way doors inside the veins, called valves, stop working. These valves help blood move in the right direction - toward your heart. If they don't work, blood can get stuck or pool in the vein.

The blockage or backup of blood makes the veins stretch and swell, which causes varicose veins.

When should someone seek treatment for varicose veins?

Varicose veins don't always need treatment. If they don't hurt or bother you, they're usually not dangerous. But if they cause pain, swelling, or start to affect your daily life, that's a suitable time to talk to a doctor.

Some people also choose treatment because they don't like how the highly visible veins look. If the veins are very noticeable or make you feel uncomfortable, it's OK to consider getting them treated for that reason, too.

How are varicose veins traditionally treated?

Treatment for varicose veins starts with first-line treatments - elevating your legs when able, staying active and wearing compression socks. Many patients still have symptoms or concerns despite medical therapy, and we consider surgery for them. When treating varicose veins, I think of them in two main groups. One group is the long, straight veins called axial veins. The other group is the smaller, twisty branches.

For the longer, straighter veins, we have traditionally used heat, like radiofrequency or laser, to close the vein from the inside. For the smaller or twisty veins, we can inject a medication to shut down the vein (sclerotherapy) or we can make small cuts to remove the veins (phlebectomy).

What are some new techniques UC Davis Health offers to treat varicose veins?

Our newest developments in the treatment of varicose veins aim to decrease pain and speed up recovery from procedures. For the longer, straighter veins, one of the best new techniques is Venaseal, which uses medical-grade glue to seal the veins shut so blood does not get stuck in it anymore.

This treatment is much less painful than heat-based lasers or radiofrequency ablation because it doesn't need lots of numbing shots, which can be uncomfortable.

For the smaller or twisty veins, we inject a foam, Varithena, which is a great new treatment option. The medical foam irritates the vein, causing it to collapse and be absorbed by the body. This method also doesn't require cuts or surgery.

All these treatments can be done during an outpatient visit in a doctor's office. They cause little pain and help you recover quickly, so you can get back to your normal routine fast. UC Davis Health is one of the few medical providers to offer several different treatment options the older, tried-and-true methods and the newer, more minimally invasive options. We believe patients should make their treatment choices based on their needs and comfort.

How long does it take to see results after treatment?

The veins are closed on the same day as the treatment, so most patients notice a difference right away.

With thermal treatments, your body must deal with the numbing medication and related swelling, which can take a few days or even a week to go away. But with the newer non-thermal options (Venaseal and Varithena), most people feel fine the same day or the next, and they often notice improvement right away.

Who is a good candidate for non-thermal vein treatments?

Some patients worry about the pain that can come with heat-based treatments that require injections of numbing medication. Non-thermal options are a smart choice for people who are sensitive to pain. Also, for treatments that don't use heat, there's less risk of damage to nearby nerves or skin. This is especially helpful for people whose veins are close to the skin or near important nerves, like those below the knee. In those cases, heat could cause burns or nerve injury. Glue treatments, however, safely close the vein without affecting the tissue around it. They're also a good option for people with tricky vein anatomy or a lot of disease in the lower leg.

However, glue isn't right for everyone. We usually avoid it in patients with sensitive skin or a history of allergies to medical products. That's because the glue is a man-made material, and in rare cases can cause allergic reactions like skin rashes or irritation.

How can someone learn more or schedule a consultation?

Your primary care doctor or provider can send a referral to the UC Davis Health Vascular Center. We are one of the only vein centers in Northern California accredited by the Intersocietal Accreditation Commission (IAC). This special recognition means we meet the highest standards for safety, quality, and patient care.

We're always happy to see patients from within our health system, but we also welcome patients from outside our network.