Varicose veins in the legs are diseased veins that arise due to valve dysfunction. Valves in the veins function like ladders as blood rises to the level of the heart. The proper opening and closure of these valves allows essentially unidirectional flow of the blood. With valve dysfunction, the blood falls backwards or refluxes into the lower legs. This results in dilation of the veins and symptoms of heaviness, pain,cramping. The medical condition that results is known as venous insufficiency.
Early stages of venous insufficiency can be asymptomatic or show subtle signs such as the development of spider and varicose veins. Untreated, this can lead to more progressive issues including leg pain, edema, skin discoloration, ulcerations and deep vein thrombosis.

Early Treatment For Vein Disease :

Symptoms or signs of vein disease allow for early detection of disease. However, it's not uncommon to see patients present late with stasis dermatitis, leg edema, or ulcerations due to poor referral patterns. Many times, your primary care physician may not recognize early symptoms of vein disease. They may also have little awareness of where to send patients for optimal treatment.
As such, many patients seek out a vein center with self referrals. A proper evaluation includes careful history and examination along with a duplex venous ultrasound when medically appropriate. The key is to identify the root cause of your symptoms and visible veins.
The confirmation of symptomatic vein disease should be treated early with compression stockings, leg elevation, and exercise.
Advanced stage disease or patients who have continued symptoms despite conservative measures may benefit from vein closure procedures. This is far different than vein stripping procedures of the past.
RF vein ablation is the gold standard now for venous insufficiency treatment. It is both safe and effective for treatment of the underlying cause of varicose veins. In comparison to vein stripping, ablation has improved long-term results, faster recovery and improved quality of life compared.
Other popular and effective treatments include sclerotherapy and varithena 1% formulated polidocanol for large, tortuous veins. More dilute concentrations can be applied to spider and reticular veins. Phlebectomy and clarivein also have complimentary roles within a vein practice and are performed by skilled vein doctors.
If you have identified an issue, please consider asking your primary care physician or specialists for any preferred vein specialist centers. Don't be shy about conducting your own research about the right vein doctor for you.


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Why is sclerotherapy performed?

Sclerotherapy and laser treatments for spider veins are the foundations of phlebology care. Many patients want to treat telangiectasias (spider veins on the legs), reticular veins and varicose veins. While most patients are worried about the physical appearance of their spider veins, a comprehensive assessment will demonstrate only a fraction having purely cosmetic veins. These individuals often have underlying venous insufficiency that will require treatment prior to sclerotherapy for telangiectasias.

Who should be performing sclerotherapy?

Sclerotherapy is routinely performed for spider vein treatment, but should be reserved for a board-certified vein specialist.  Ideally, these vein doctors will have been recognized by their peers in medicine.  Popular platforms include Top Doctor, Castle Connolly and Leap Frog Awards.

In many states, registered nurses are allowed to perform sclerotherapy, as well as physician assistants and nurse practitioners, with proper training. It is expected that physicians should be skilled at sclerotherapy and understand the benefits and risks of the treatment.


Without hands-on training, it is difficult to become skilled at practicing sclerotherapy. While one can learn the theory, benefits and risks of sclerotherapy through literature, the skills needed to perform the procedure are learned only through direct experience.

What is used for sclerotherapy?

The liquid agents that are commonly used include, hypertonic saline, sodium tetradecylsulfate, glycerin, and polidocanol. Regardless of what agent is used, one should be thoroughly familiar with the appropriate concentrations and volumes of liquid for safe and effective results. There is a direct relation with the pressure used to inject, the volume of sclerosant and the concentration used to obtain successful results. The liquid can be converted to foam sclerosant for increased potency using the Tessari method. This involves taking a small concentration of the liquid sclerosant and mixing it with air in a 3:1 to 4:1 ratio. Given the increased potency of foam, a smaller volume and concentration is needed for effect.

Where to have sclerotherapy?

The cost of spider vein removal is variable and is an important consideration for most individuals, especially in light of recent economic downturns. However, we strongly recommend that sclerotherapy is only performed by board-certified and competent health professionals. The sclerotherapy procedure is office-based, but can be performed in procedure centers or hospitals depending on the physician preference.  

In the NYC metropolitan area, visit for treatment serviced by board-certified professionals.  The focus is on minimally-invasive treatments for spider and varicose vein treatment.  The centers most near to the metro area include locations in Clifton, Paramus and Wayne NJ.


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Varicose and spider veins can be hereditary, therefore, problem veins are usually around before we start thinking about getting treatment for them. But at what point should you seek treatment for varicose veins? Should it be when they start aching or swelling or itching?


As soon as you think you have varicose veins, you should consider a consultation with a local expert vein doctor to get an assessment and management plan. Symptoms can include leg pain, achiness, tiredness, and swelling. These represent progressive symptoms of vein disease that can be stopped. Remember, not all varicose veins on the legs are visible!
Healthy lifestyle choices and exercise can help manage some symptoms, however leaving vein disease untreated is not advised. Early recognition and management is the key to preventing vein disease from getting worse.


Do Compression Stockings Help Varicose Veins?
Along with general good health habits, compression stockings are recommended for visible varicose veins especially in the presence of symptoms. Varicose veins appear when the one-way valves in your veins fail and allow blood to leak backward. As a result, blood pools in the lower legs and dilates the veins to cause venous insufficiency. When you wear compression stockings, your veins are supported and enable the blood to flow more effectively. The external pressure improves blood flow by compressing refluxing veins and redistributing flow to the healthier parts of your venous system. In doing so, it can help to keep inflammation down and reduce the swelling and achiness in your legs.

A common complaint is they are uncomfortable to wear, especially during hotter weather. For this reason, it is just as important to choose the proper material and fitting. There are numerous types and manufacturers of compression stockings on the market today. Every patient can find an option tailored to treat his or her specific symptoms. A vein specialists can assist with recommendations. Gradient compression legwear is sold at different compression levels, and vein doctors in Princeton can help you with your purchase. That’s especially important given the fact that the wrong purchase can actually worsen your condition.

Keep in mind that wearing compression stockings is not a cure for varicose veins, but rather for symptomatic relief. Compression stockings undoubtedly help many patients find relief from varicose vein pains. With many patients, compression stockings can help avoid varicose vein surgery. However, there isn’t sufficient evidence to suggest that they’re an effective treatment on their own. And while managing the symptomatic pain is crucial to those suffering from venous reflux, it’s important to always seek the advice of a vein specialist when determining the best vein treatment for you. There are many new technologies available for varicose vein treatments, including a number of non-invasive procedures that can eliminate the symptoms of vein disease altogether.

If exercise and compression stockings are not helping, you need to seek professional treatment. Vein specialist centers should have board-certified vein doctors in both vascular surgery and cardiovascular specialties. Patients should be offered only the latest treatments. You will notice the difference in your vein consultation. 


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Many people are aware that varicose veins in the legs are associated with labor-intensive jobs that involve standing all day, or that they tend to affect people who have a family history with the condition. But those aren’t the only ways varicose veins become uncomfortable and aggravated — in fact, the way you work out could be putting you at risk.Though varicose veins shouldn't stop you from exercising, it’s important to know what you should make a habit of and what you should avoid.  The vein center near me and the surrounding areas are accustomed to seeing avid runners and can provide the best tips on how to get rid of spider veins and varicose veins.


Take It Easy and Avoid Impact:

Similar to how excessive standing can be problematic for the health of your veins, high-impact exercises can aggravate and worsen the condition for those predisposed to it. This includes activities like running, particularly on hard surfaces like concrete. It is recommended to wear comfortable shoes, wear compression stockings and sticking to softer surfaces like grass to help improve blood flow from the legs and decrease aches and pains. But if your body simply can’t handle the strain of running and other high-intensity activities, walking is a far safer alternative. It’s not too strenuous, and it might actually be the most beneficial physical activity for your circulation. If you’re at a job that involves extended periods of sitting, taking short breaks to walk around or climb stairs has proven extremely helpful. That being said, even walking can be a difficult task for those already suffering from varicose vein pain. A good method to increase blood flow without straining yourself physically is to rotate your ankles and rock your legs back and forth. 

The Gym: What to Do and What to Avoid:

For starters, the elliptical and the stationary bike are great, low-impact exercise implements that help you burn calories and increase blood flow without putting too much strain on your body.If exercise machines aren’t your style, swimming is another excellent choice to log some physical activity that won’t have your veins regretting it afterward. That’s because swimming places the legs in a horizontal position, rather than straining them through interaction with a tough surface.On the flip side, it may be wise to stay away from heavy lifting. Weight-lifting has a similar effect on the body to running in that it can interfere with or restrict blood flow from the legs to the heart, causing blood to pool in the veins and enlarge them. This is a result of the straining and increased abdominal pressure that the exertion involved in lifting heavy objects requires. Sit-ups, lunges, squats, and even yoga can have a similarly strenuous effect on varicose veins.  


For greater discussion on the effects of exercise on veins, consider visiting a varicose veins doctor near me.  Or better yet, fill out an online vein consultation and consider a video chat or photo submission to start your journey.  


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Varicose veins and spider veins are often confused with each other and used synonymously by many people. However, there are a lot of differences. Here we will explain those differences so you can identify what you have, and what is the best vein treatment plan.

Varicose veins are veins that are large, swollen, twisted, and are protruding from under the skin. Sometimes they are visible with the naked eye, but many times, they are not visible with simple examination.

Telangiectasia (aka Spider veins) are tiny capillaries right on the surface of the skin. These usually form tiny networks or "webs" (hence the term "spider veins") and can be either pink/purple or red in color.

What do Varicose Veins and Spider Veins have in common?

1. They are both unsightly and are of a cosmetic concern for most patients

2. They can both cause symptoms of heaviness, aching and tiredness

3. They both are often the result of an underlying cause

4. They can both be treated with the latest technological advancements in Venous Disease

The big differences between the two is in appearance:

1. Varicose veins are large, swollen blood vessels that are twisted. They form in the legs.

2. Spider veins are smaller and have a more web-like appearance. Also, spider veins can form on the legs, chest, and even on the face.

Patients with varicose veins and spider veins can be treated in the same manner many times. If you think you have either of these, you should find the best vein clinic new jersey and have a thorough examination and detailed assessment. Screenings with advanced technology to diagnose vein disease such as a Duplex Ultrasound Machine can determine the extent of venous disease.

One should never assume that spider veins or varicose veins are only on the surface of the skin and not part of a larger medical issue. Spider veins and varicose veins are usually an indicator of severe underlying venous disease. It is troubling to see patient after patient receive no formal evaluation of their veins despite obvious symptoms. This is not only counter-productive and costly but also dangerous.

The rule should be to always have your legs properly assessed before any vein treatment---a simple ultrasound can help you find a cure with the best treatment plan.

Living with varicose and spider veins can be unsightly, painful, and can have longterm health effects. It is important to get your vein disease assessed and diagnosed by a a varicose vein doctor nj who specializes in endovascular procedures.


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We all have experienced some sleepless nights at some point. We are affected by many things in our lives and stress plays a large role in our sleep pattern. However, there are also several other factors that can affect the quality of our sleep.

In this article, we will discuss the issue of varicose veins and what affect the condition can have on your sleep. We will also provide some simple things you can do at home to improve your condition and hopefully get a good night’s rest.

Varicose Veins and The Impact on Sleep

Varicose veins and muscle cramps go hand in hand. However few patients and even some physicians are unable to put the two conditions together. Doing so, may help you find the solution you need.

To begin with, varicose veins are more common than you think. In fact, 25% of the population has some form of vein disease. Given the large array of symptoms associated with varicose veins ,it is no surprise that restless legs and muscle cramps associated with vein disease is one of the most common causes of poor sleep.

The symptoms are worse at night with varicose veins when some of the circulation starts to improve with getting our feet up. All the swelling, pooled blood, and toxic metabolites start to circulate and with less distraction, the discomfort becomes more apparent.

We often attribute the condition to restless leg syndrome. The body senses the imbalance in your body and creates involuntary movements and contractions of your legs to promote some of the blood movement. The symptoms of RLS and vein disease are blurred with aching, throbbing, cramps and uncontrolled leg movements.

Treatment becomes directed at restless leg syndrome rather than addressing the underlying issue that is vein disease. However, unlike RLS, vein disease is very treatable. A vein doctor New Brunswick NJ can help provide the diagnosis if varicose vein disease is suspected.

How to Sleep With Varicose Veins

The first steps are conservative and in many instances, very effective. We review some simple steps you can take at home to help alleviate sleepless nights from vein disease.

Compression Stockings

The foundation of good vein treatment is the use of compression stockings. Many individuals will purchase compression stockings for use at home and work. Ideally, they are appropriately sized and fitted by a qualified vein doctor Edison NJ. The typical strength is 20-30 mmHg and they can be obtained as knee-high or thigh-high depending on the condition. For patients with bothersome symptoms on both sides, waist level compression stockings can also be considered. The primary goal of compression stockings is preventative.


Flush your system out before you go to sleep. This keeps toxic local metabolites from building up in the legs during the daytime that lead to cramps and muscle twitching.

Elevate Your Legs

This goes for both the day and night time. The more you can keep the swelling down in your legs by elevating your feet and compression stockings, the less likely you are to experience symptoms of vein disease.

Stretching and Massage

Before going to sleep, give your muscles a stretch to help them relax. Massaging your legs can also help settle any tension you have in your legs.

Vein Treatment

This can only be considered in consultation with a vein center New Brunswick NJ providing specialty consultation for vein disease. The diagnosis depends on a careful history and examination to look for clues of vein disease. If medically appropriate, an ultrasound will evaluate the size and direction of blood flow in your legs. This provides important information about the likelihood of vein disease potentially causing symptoms of restless leg syndrome.

Modern vein treatments are simple and safe using minimally-invasive techniques. RF vein ablation and sclerotherapy are the primary tools and target poorly circulating veins. Diseased veins are collapsed from within and healthy circulation is promoted by the re-direction of blood. This stops blood from pooling up in your legs and causing symptoms of vein disease.


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Pelvic Congestion Syndrome

It is estimated that nearly a third of all women experience chronic pelvic pain during their lifetime. Chronic pelvic pain or pelvic congestion syndrome is defined as pain lasting greater than six months.

The condition is notoriously difficult to diagnose because of the absence of any visible abnormalities on routine tests. In the most common situation, a woman experiencing symptoms consistent with pelvic congestion syndrome will have seen several specialists before arriving at a diagnosis. Clearly, a complete evaluation by a gynecologist is primary. Some general clues include chronic pelvic pain that is worse when sitting or standing (similar to varicose veins), relieved with lying down, and the presence of vulvar varicose veins Paramus NJ.

The causes of pelvic congestion syndrome

  • Primary disease is secondary to varicosities in the pelvic and ovarian veins. This is more common with multiparous women, obesity, and genetic

  • Secondary conditions such as Nutcracker syndrome, May-Thurner Syndrome, and other obstructing syndromes

Chronic pelvic pain caused by reflux or obstruction of the gonadal, gluteal, or peri-uterine veins is called pelvic congestion syndrome. Incompetent venous valves in the pelvic veins can lead to reflux and development of pelvic varices. These dilated veins may sometimes be seen with ultrasound, CT, or MRI. These enlarged and abnormal veins are more common on the left, more likely in women who have had multiple pregnancies, and very similar in cause to lower extremity varicose veins.

Ovarian vein embolization is a minimally invasive treatment for pelvic congestion syndrome due to enlarged faulty veins causing congestion and pain.  Pelvic congestion syndrome, also known as ovarian vein reflux, is a painful condition resulting from the presence of varicose veins in the pelvis.  Similar to varicose veins in the legs , the cause of ovarian vein reflux is due to weakened valves that impair the return of blood to the heart causing bulging veins.  The increased pressure inside the pelvic veins leads to typical symptoms of pelvic congestion syndrome including pain.   The diagnosis of the pelvic congestion syndrome can be made in one of several ways: pelvic venography, magnetic resonance imaging (MRI) or  pelvic and trans-vaginal ultrasound.

Pelvic congestion syndrome treatment is divided into medical and procedural. Minimally-invasive techniques have supplanted traditional surgery and increased the use and success rates of the curative solutions.

Ovarian Vein Embolization? 
During this procedure, the vein doctor NJ performs a minimally-invasive procedures inside a radiology or procedure room.  Using a percutaneous technique, a catheter is inserted into the leg vein and guided towards the faulty veins in the pelvics. Using fluoroscopic guidance, the catheter is able to deliver coils that seal the faulty vein re-directing blood to the healthier parts of your circulation.  Increasingly, vascular surgeons are using medicated foam agents to treat even the smallest diseased veins similar to varicose veins in the legs.

The length of the procedure is generally 30 minutes to several hours depending on the complexity of the condition and skill of the pelvic congestion syndrome doctors near me.

Pros and Cons of Treatment



  • High Success rates with coil embolization for treatment
  • Minimally invasive procedure with same day discharge. Reduced risks of complications vs traditional surgery
  • There is no need for sutures post procedure
  • General anesthesia is not required



  • Contrast material should be used cautiously in patients with renal disease
  • Contrast material has a small risk of allergic reactions
  • Risks of bleeding, infection or damage to the vein are rare but possible complications.

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Are you currently suffering from large unsightly varicose veins in New Jersey? If so, you are not alone in seeking vein doctor, and you will want to explore the latest treatments available before making a decision. Leg veins — both spider veins and varicose veins — usually occur because of an underlying vein disease called chronic venous insufficiency. This is a medical condition in which the valves in the veins are dysfunctional due to a host of issues. Mainly, the circulation becomes impaired and early signs can include the development of spider and varicose veins. If left untreated, vein disease can lead to progressive conditions like swelling, skin discoloration and even deep vein thrombosis.

Previously, treatment was far more involved and required surgical procedures like vein stripping. Today, due to the tremendous advances in technology, minimally invasive techniques have become the gold standard at NJ vein treatment, including radiofrequency ablation, endovenous laser treatment, venaseal, and sclerotherapy. In this article, we will provide an essential guide to the unique technologies being incorporated in the best vein clinics in NJ, but also across the country.

Radiofrequency Ablation
RF ablation is a minimally-invasive procedure that is the gold standard in current treatments for venous insufficiency. It involves direct insertion of a small catheter into the unhealthy vein. The catheter is designed to deliver heat energy into the vein causing it to collapse and ultimately reroute blood to the numerous healthy veins in your legs. The procedure is done within the office setting and can be completed with just local anesthesia. Most patients are able to continue their normal activities soon after treatment.

Endovenous Laser Treatment
Endovenous laser treatment is similar to radiofrequency ablation, but it uses laser energy instead of heat energy. Utilizing ultrasound guidance, a laser fiber is inserted into the problematic vein through a tiny incision in the skin. Laser energy is delivered directly into the vein to close it permanently. Over time, the vein is gradually reabsorbed by the body as opposed to being removed in typical stripping procedures. The major difference is the quick-recovery time and improved long term results.

VenaSeal is the latest technology to receive FDA-approval for the treatment of varicose veins. In contrast to ablation, VenaSeal is a medical adhesive that is deposited to close-off diseased vein segments. The major advantage is eliminating the need for thermal treatments of the vein that usually require more local anesthetic. Additionally, there is no need for any post-treatment compression stockings due to the unique nature of VenaSeal. At this time, VenaSeal is a premiere service at NJ vein clinics and has more limited insurance coverage.

Varithena is a specially formulated microfoam utilizing a common medication, polidocanol. It is often the perfect compliment to endovenous techniques such as ablation or VenaSeal. Residual segments of diseased veins are targeted by the microfoam for complete relief of symptoms. A typical session is completed in the vein clinic with direct injection of the medication into varicose veins. Varithena has also been used commonly in recurrent vein disease, particularly the difficult anatomies noted after a prior history of vein stripping.

Minimally Invasive is Newer, but is it Better?
Traditional surgical methods such as stripping have been largely eliminated in the practice of venous medicine. Newer techniques are less disruptive, better tolerated, and associated with improved long-term outcomes. Most importantly, they are safer! The following benefits are clear reasons to opt for minimally-invasive techniques at NJ vein treatment centers:

  • Minimally Invasive and Non Surgical: Endovenous techniques described above are done in the office and require little patient preparation. The procedure requires can be done without sedation and is virtually pain-free.

  • Safer: In the right hands, minimally invasive techniques pose minimal risks! As opposed to surgical methods, serious issues like DVT are very rare.

  • Increased success rates: Unlike stripping procedures of the past, the long term success rates with endovenous techniques are above 95%. Risk of recurrence is rare and difficult problems such as neovascularization are less common.

  • No Down-time: It's remarkable to see patients come in for treatments and return back to work the very same day! Although that may not be for everyone, it's an incredible statement on how far the procedure has come to improve patient well-being without disrupting normal routines.

Where to Find the Newest Treatments?

When looking for varicose vein treatment near me, it's important to find a vein treatment clinic that offers minimally-invasive treatment options. The information should be readily available on each clinic's website. And while some techniques are clearly favored more often due to physician preference, a reputable vein clinic should be able to answer questions on all different modalities. At the Princeton Vein clinics, there are the best vein doctors who specialize in all the latest modalities including radiofrequency ablation, endovenous laser treatment, venaseal, and varithena.
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Vein disease is quite prevalent in the US with nearly 1 out of every 4 Americans affected.  The disease is more common in females and is most often seen with an inheritance pattern. The most visible symptoms of vein disease are spider and varicose vein, however most suffering from vein disease are unaware of the other potential symptoms and signs related to venous insufficiency.  Having awareness of typical signs and symptoms of vein disease is important to avoid progression of vein disease and seeking early diagnosis at a reputable vein clinic NJ.

What Should Tip You Off to Vein Disease?

If you have vein disease it is common to experience some of these symptoms 

  • Leg pain
  • Leg heaviness
  • Leg cramps
  • Spider veins
  • Varicose veins
  • Skin discoloration
  • Restless leg syndrome
  • Leg Ulcers

Vein disease is characterized by stages known as the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) with the greatest attention given to the clinical manifestations.  This article will help educate the reader on the different stages of vein disease and proper identification to avoid later complications.

CEAP Class 1: Spider Veins

The presence of Spider or Reticular veins are typically the first signs of venous disease.

What Do Spider Veins Look Like?

Telangectasias (or spider veins) are tiny capillaries right on the surface of the skin. They usually form distinct networks or “webs” and can be either bluish/purple or red in color.  

What Do Reticular Veins Look Like?

Reticular veins appear as green or blue linear veins on the surface of the skin. They are smaller than varicose veins and do not bulge from the skin.  Many times, reticular veins will be noted to underlie a bed of spider veins and as such are referred to as feeder veins. Getting rid of such spider veins will also depend on treating these feeder (or reticular veins).
What Causes Spider and Reticular Veins?

Venous insufficiency and genetics are the most common culprits.  Venous insufficiency refers to dilated and incompetent veins underneath the surface of the skin related to either truncal veins or perforator veins.  Venous insufficiency is what is responsible for the symptoms of vein disease. The most common reasons for venous insufficiency are: 

  • Family history
  • Prolonged standing or sitting at work or home
  • Pregnancy (multiple increases risks)
  • Hormone changes or imbalances
  • Obesity
  • Smoking

Stage 1 disease is often cosmetic in nature and treated with sclerotherapy or vein removal.  However, a thorough examination by a qualified vein doctor will consider additional symptoms to explore venous insufficiency before cosmetic treatments.  

CEAP Class 2: Varicose Veins

Varicose veins are larger and more dilated veins that appear underneath the surface of the skin as twisted, enlarged veins. It is during Stage Two when individuals become bothered by the appearance and symptoms of vein disease.

  • Family history
  • Prolonged standing or sitting
  • Pregnancy or menopause
  • Hormone changes or imbalances
  • Obesity

More often than not, spider and reticular veins are treated as a cosmetic issue 

Stage Two: Varicose Veins

Varicose veins are larger and more dilated veins (> 3mm) that appear on and above the surface of the skin as twisted, dilated veins. This tends to be the most bothersome sign of vein disease because of the disturbing appearance.

Varicose veins don’t always cause pain or obvious symptoms, but educated patients will realize some of the symptoms may have been considered something else.  Proper attention requires a level of understanding that leads to early diagnosis and treatment of venous insufficiency.
Symptoms of Varicose Veins

  • Bulging, dark purple or blue veins
  • Burning or itchy legs
  • Pain and heaviness in the legs
  • Restless legs at night
  • Charlie horses
  • Pain after prolonged periods of standing
  • Skin discoloration near the varicose vein
  • Superficial phlebitis (inflammation of the vein causing pain)
  • Varicose vein bleeding

Causes of Varicose Veins

The problem involves veins in the lower extremities that suffer from high pressure from within.  Naturally, blood pools in these veins due to gravity, resulting in high pressure within the veins.  Over time, these vein walls can become damaged from the constant pressure and suffer from venous insufficiency.   This is when symptoms such as leg cramps, heaviness, and swelling should no longer be ignored.  

Risk Factors

The risk factors for spider veins and varicose veins are the same.  Again, the most important determinant is likely to be a family history of vein disease.

CEAP Class 3: Swelling

Stage three marks more advanced vein disease and is a strong reason to seek an evaluation.  Leg Swelling may be present without obvious signs of spider or varicose veins.  The cause of swelling is due to venous insufficiency and indicates increased venous pressures.  However, swelling is also a sign of other serious conditions such as hypertension, heart failure, renal or liver disease, malnutrition, lymphatic disease and blood clots.  These conditions should be properly considered along with venous insufficiency. 
Symptoms Accompanying Leg Swelling/Inflammation:

  • Leg heaviness
  • Skin indented from external pressure (socks, fingertips, etc.)
  • Itchy, dry skin
  • Muscle spasms
  • Leg ulcers due to significant leg swelling

These symptoms should prompt immediate attention from a health professional or your vein doctor. 
CEAP Class 4: Skin Discoloration/Pigmentation

At this stage of vein disease,  the appearance of your skin as skin becomes thinner and even some discoloration becomes visible.  This is due to the chronic venous hypertension and pooling of blood in the lower extremities that leads to inflammatory changes on the skin.   
Symptoms of Skin Discoloration

  • Brown or purplish discoloration of the skin (concentrated around the shins and ankles)
  • Skin thickening and/or hardening around varicose veins
  • Corona Phlebatica
  • Leg ulcers

For advanced stages of vein disease (CEAP class 4-6), it’s very important to receive attention from a qualified vein specialist and sometimes even a wound clinic to help manage the disease.  Treatment for venous insufficiency becomes paramount if detected by ultrasound.

CEAP Class 5 and 6: Healed and Active Ulcers

Leg ulcerations result from the chronic, untreated inflammatory condition that results from advanced venous insufficiency. This stage requires coordinated care from a vein specialist and wound clinic, especially with active ulcerations.  Most recently, a randomized study reported in the NEJM demonstrated the superiority of early endovenous ablation treatment for the healing of active ulcers in comparison to conservative treatment.  This has encouraged the early identification of superficial venous reflux disease in the treatment of leg ulcers.
Putting It All Together:

Spider veins and Varicose Veins represent a continuum of vein disease that culminates in more serious medical concerns with advanced, untreated venous insufficiency.
Awareness of all types of symptoms related to vein disease, especially in the presence of spider or varicose veins should prompt early attention by a vein specialist.
The importance of identifying vein disease was strongly supported by recent randomized data demonstrating more rapid healing of leg ulcers with modern vein treatments in comparison to compression stockings and delayed ablation.

Modern vein treatments seek to cure underlying venous reflux using catheter based techniques that are minimally-invasive and improved efficacy.  Early treatment for symptomatic vein disease at CEAP class 2 or greater is appropriate when conservative therapies have not alleviated symptoms.


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Varicose veins are a common problem and affects nearly 25% of the US population.  Most affected individuals are essentially asymptomatic and do not need to pursue any specific treatments. Instead, simple wellness measures including exercise, compression stockings, leg elevation when appropriate and smoking cessation.  However, for those with symptoms including leg pain, leg heaviness, itchy or discolored skin, and restless legs that are affecting their quality of life despite conservative measures, a vein evaluation is recommended. The goal is to find not only what kind of doctor do you see for varicose veins, but a vascular specialist that does it really well.  The best vein doctors will help you manage your symptoms and offer treatment alternatives that match your symptoms and can be done without disruption to your normal routine.  So let’s begin with some advice on selecting which doctor is best for you from your internet search:

Be certain that your vein doctor is board-certified and “trained” in vascular treatments.  So this goes beyond a piece of paper indicating completion of some test , but also informs you that the vein specialist completed a formal residency or fellowship in endovascular treatments. 

Vein evaluation is a must!  If you have no symptoms but are concerned about cosmetics, you do not need endovascular treatments.  Vein ablation is best suited to manage symptoms of venous insufficiency.  Receiving unnecessary treatments is not to your advantage and instead focus should be on cosmetic treatments available including laser or cosmetic sclerotherapy.

If you are having treatment for venous insufficiency, the most advanced techniques are endovascular ablation, foam sclerotherapy, and venaseal.  In some cases, MOCA or mechanochemical ablation can also be considered. Stripping is an older technique and is no longer the preferred or best treatment for underlying vein disease.  It has a higher level of complications and is less effective

Phlebectomy is still very useful for large protruding veins that are not suitable for ablation or sclerotherapy.  In fact, treating large protuberant veins with sclerotherapy can lead to longer healing periods with sometimes long lasting cosmetic skin discoloration.  Phlebectomy is a fast and efficient tool to eliminate large varicose veins without any large incisions. 

The above factors focus on being certain on the qualifications of your vein doctor and the breadth of their skills to offer various treatment solutions tailored to your symptoms, anatomy, and vein presentation.  The other qualities are more abstract and are the individual feeling you get about your interaction with the staff and vein specialist.   Being given appropriate time and patience to your questions and concerns reflects on how much value the vein clinic places on the individuals care.   We often see high volume centers in multiple settings that emphasize getting as many tasks done in one day, rather than focusing on quality. If you feel less than satisfied with the interactions, it’s very reasonable to consider a different vein clinic even if you have to travel extra miles.   Just remember if you can’t get the time and answers to your questions, what is the likelihood you will see the time and commitment given to your vein treatment. Getting high level care is difficult because the experience of a vein doctor is so variable and due to financial constraints, many clinics today are trying to fit as many cases in a limited daily schedule.  Something has to give and that generally is quality. The final results will make the extra commute worthwhile and that level of expertise can only be delivered by the very best vein clinics committed to continuing education, investment into new technology, and you the patient for time.


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