Understanding Varicose Veins
Varicose veins are swollen, rope-like blood vessels that twist and bulge just beneath the surface of the skin. They develop when the tiny one-way valves inside the veins of the legs become damaged or weakened, allowing blood to flow backward and collect instead of traveling efficiently upward toward the heart. Over time, this pooled blood stretches the vein wall outward, creating the raised, knotted cords that characterize varicose veins.
While any superficial vein can become varicose, the condition overwhelmingly affects the legs because standing and walking increase the pressure on veins in the lower body. The great saphenous vein—running from the ankle to the groin along the inner leg—is the vessel most frequently involved. Varicose veins affect an estimated 23 percent of adults in the United States, making them one of the most common vascular conditions encountered in clinical practice.
At Vascular Surgical Associates, our dedicated Vein Center has treated tens of thousands of varicose vein patients across metro Atlanta since the practice was founded in 1986. Our board certified Vascular Surgeons begin every evaluation with a comprehensive duplex ultrasound in our ICAVL-accredited vascular lab, ensuring that treatment targets the root cause—not just the veins you can see. We combine academic rigor with a compassionate, patient-first approach across all 7 of our conveniently located offices. We perform vein procedures at 4 dedicated offices, we do not perform them at all offices
Signs & Symptoms
Varicose veins produce a spectrum of symptoms that ranges from mild cosmetic changes to significant daily discomfort. Symptoms are often progressive and tend to worsen with prolonged standing, warm weather, and toward the end of the day. Even veins that initially appear to be only a cosmetic issue can eventually produce troublesome symptoms if the underlying venous reflux advances.
Enlarged, Twisted Visible Veins
Dark purple or blue veins that appear swollen, raised, and cord-like beneath the skin. They most often develop along the inner calf, behind the knee, and on the thigh.
Aching & Heavy Legs
A deep, dull ache or heaviness that builds throughout the day, particularly when standing for long periods. Elevation and movement typically provide temporary relief.
Burning & Throbbing
A burning, throbbing, or pulsating discomfort centered over or near the varicose veins. The sensation may intensify in warm weather as heat causes veins to dilate further.
Muscle Cramping
Involuntary muscle cramps in the calves, especially at night. These nocturnal cramps are a hallmark of venous insufficiency and may disrupt sleep quality.
Swelling in Lower Legs
Edema concentrated around the ankles and lower calves that worsens as the day progresses. Shoes and socks may leave deeper impressions than usual by evening.
Itching & Skin Discoloration
Persistent itching around varicose veins, along with gradual darkening or reddish-brown discoloration of the skin near the ankles. These skin changes indicate chronic venous hypertension affecting the surrounding tissue.
Bleeding From Veins
Varicose veins that lie close to the surface can bleed if the overlying skin is bumped or nicked, sometimes significantly. Any episode of varicose vein bleeding warrants prompt medical evaluation.
Risk Factors
Varicose veins arise from a combination of genetic predisposition and lifestyle factors that place chronic stress on the venous system. Understanding these risk factors allows for earlier detection and more proactive management.
Age
Natural wear and tear on vein valves accumulates over the decades. The incidence of varicose veins rises sharply after age 40, and the majority of affected individuals are diagnosed between their 40s and 60s.
Female Gender
Hormonal influences—particularly estrogen and progesterone—tend to relax vein walls, making women more susceptible to varicose veins. Hormonal fluctuations during menstruation, pregnancy, and menopause compound this effect.
Pregnancy
During pregnancy, blood volume increases substantially while the growing uterus compresses pelvic veins, hindering return flow from the legs. Each successive pregnancy further elevates the risk of developing permanent varicose veins.
Family History
If one or both parents have varicose veins, the probability of developing them yourself is significantly increased. Hereditary factors influence valve structure, vein wall composition, and the overall resilience of the venous system.
Obesity
Carrying excess body weight raises the pressure inside leg veins and impairs the effectiveness of the calf-muscle pump. Studies show that individuals with a BMI above 30 have a markedly higher prevalence of varicose veins.
Prolonged Standing
Standing for extended periods without breaks prevents the calf muscles from contracting and pushing blood upward. Over months and years, this sustained hydrostatic pressure accelerates valve failure in the superficial venous system.
Prior History of DVT
A previous episode of deep vein thrombosis can damage venous valves in both the deep and superficial systems. The resulting post-thrombotic syndrome often manifests as secondary varicose veins, swelling, and chronic leg discomfort.
How Varicose Veins Are Diagnosed
A thorough diagnostic workup is essential because the veins visible on the surface represent only part of the story. Effective, long-lasting treatment depends on identifying and addressing the underlying venous reflux that feeds the varicose veins. Our evaluation process combines expert clinical assessment with advanced vascular imaging.
Physical Examination – Your vascular specialist will examine your legs while you are standing, noting the size, location, and distribution of varicose veins. The exam also includes palpation of the veins and assessment of the skin for signs of chronic venous disease such as discoloration, thickening, or early ulceration.
Duplex Ultrasound – Performed in our ICAVL-accredited vascular lab, a duplex ultrasound combines traditional imaging with Doppler technology to visualize blood flow direction and speed in real time. By measuring reflux duration after calf compression and release, the sonographer can identify precisely which valve segments have failed and quantify the severity of the disease. This is the gold-standard diagnostic study for varicose veins and is entirely non-invasive.
CEAP Classification – After ultrasound, your surgeon applies the CEAP classification system to categorize your venous disease based on Clinical appearance, Etiology, Anatomy, and Pathophysiology. This internationally recognized framework standardizes the severity assessment, guides treatment decisions, and provides the documentation that insurance carriers require when evaluating authorization requests for procedural intervention.
Treatment Options
Modern varicose vein treatment bears little resemblance to the surgical stripping procedures of the past. Today’s approaches are office-based, performed under local anesthesia, and produce outstanding results with minimal disruption to your daily life. Our Vein Center surgeons will recommend a combination of techniques personalized to the pattern and severity of your varicose veins.
Conservative Management
Graduated compression stockings, regular walking, weight management, and periodic leg elevation form the foundation of conservative care. These measures alleviate symptoms, slow progression, and are typically the first step before procedural treatment. Most insurance plans require documentation of a structured compression trial before authorizing surgery.
Endovenous Laser Ablation
A thin laser fiber is threaded into the refluxing trunk vein under ultrasound guidance. Precisely calibrated laser energy heats and seals the vein from the inside, redirecting blood into healthier vessels. The procedure takes about 45 minutes under local anesthesia. Patients walk out of the office and resume most daily activities within 24 hours, with closure rates exceeding 95 percent at five years.
Radiofrequency Ablation
A catheter delivers segmental radiofrequency energy to the vein wall, producing controlled heating that collapses and seals the incompetent vessel. The catheter’s feedback-controlled mechanism ensures consistent energy delivery along the entire treatment length. Post-procedure discomfort is typically mild, and the return-to-work timeline mirrors that of laser ablation.
Sclerotherapy
A sclerosing agent is injected into smaller varicose tributaries, reticular veins, and spider veins, causing the vessel walls to stick together and gradually disappear. Foam sclerotherapy extends this technique to larger-diameter veins. Sclerotherapy is frequently performed as a complementary procedure following trunk-vein ablation to achieve the best overall cosmetic and functional result.
Ambulatory Phlebectomy
Bulging surface varicose veins are removed through micro-incisions just a few millimeters long using specialized extraction hooks. Performed under local anesthesia, the tiny punctures typically heal without sutures and leave barely perceptible marks. This technique is ideal for large, tortuous branch varicosities that are too prominent for sclerotherapy alone.
VenaSeal Closure System
VenaSeal delivers a proprietary medical adhesive through a catheter to permanently bond the walls of the diseased vein shut. Because it uses no heat, there is no need for the multiple injections of tumescent anesthesia required by thermal methods. Patients can return to full activity immediately—including exercise—and compression stockings are generally not required after the procedure.
Varithena
Frequently Asked Questions
Yes. While the appearance of varicose veins is a common concern, they frequently cause significant symptoms including pain, swelling, cramping, and leg fatigue. Left untreated, the underlying venous reflux can progress to more serious complications such as chronic skin discoloration, superficial blood clots (phlebitis), and open wounds called venous stasis ulcers. A vascular evaluation can determine whether your varicose veins warrant medical treatment beyond cosmetic improvement.
When varicose veins are associated with documented venous reflux on ultrasound and the patient has symptoms such as pain, swelling, or skin changes, treatment is generally considered medically necessary and is covered by most insurance plans. A structured trial of compression therapy is typically required before procedural authorization is granted. Our billing team assists patients through the entire pre-authorization process to maximize coverage.
Both are highly effective methods for closing the refluxing trunk vein, but they work through different mechanisms. Endovenous laser ablation uses thermal energy to seal the vein and requires tumescent anesthesia (small injections of numbing fluid around the vein). VenaSeal uses a medical adhesive instead of heat, which eliminates the need for tumescent anesthesia and post-procedure compression stockings. Your surgeon will discuss which option is best suited to your anatomy, insurance coverage, and personal preferences.
Most patients return to desk-based or light-duty work within one to two days. Walking is encouraged immediately after the procedure. Strenuous exercise, heavy lifting, and prolonged high-impact activities are typically limited for one to two weeks to allow the treated vein to seal completely. Your surgeon will provide activity guidelines specific to the procedures performed during your treatment session.
