A web-like network of blue or purple veins begins covering your legs. The veins become gnarled and bulging. You feel self-conscious and start wearing pantyhose with every dress. You even avoid wearing shorts in the summer. And while your vanity may take a hit, this problem— known as varicose veins—can impact more than just your appearance. Pain, ulcers and blood clots are potential complications of the condition. Fortunately, there are many options for treating both the cosmetic and health aspects of varicose veins.

Understanding varicose veins
As your blood circulates through your vascular system and heads back toward your heart, small valves in your veins open up to allow it to flow forward with ease. However, when these valves stop working properly, blood can pool in the veins, causing them to enlarge. This phenomenon is what is known as varicose veins. While varicose veins can technically happen anywhere in the body, they are most likely to occur in the legs or feet. That's because standing, walking, gravity and distance from the heart all increase pressure on veins in the lower part of the body.

Risk factors
Varicose veins are a common health problem, particularly in people over 50. In fact, it's believed that one out of two people in that age category have this condition. Gender also plays a major role in risk. "Varicose veins affect about 40 percent of women in the United States, and about 25 percent of men," says Donna Mendes, MD, Associate Clinical Professor of Surgery at Columbia University. The hormonal changes women experience over time tend to make them more susceptible to varicose veins.

Other potential causes include heredity, obesity, lack of movement and a family history of varicose veins. "Varicose veins are a common problem," says Dr. Mendes. "Health factors and lifestyle can contribute to whether or not a particular individual will experience them."

Recognizing symptoms
If you have varicose veins, you probably know it. The gnarled-root appearance of the enlarged veins pressing against your skin is a telltale sign. And often, the veins show up as a vivid blue, purple or red. Spider veins, which are similar to varicose veins but smaller, can also can be visible on the legs and feet, but they are closer to the skin's surface. They get their name from the spider web-like appearance they create. Both varicose veins and spider veins rarely cause additional complications. But when they do, they can present with some of these symptoms:

• An achy or heavy feeling in the legs
• Burning, swelling, throbbing or cramping of the leg
• Worsened pain or swelling after long periods of sitting or standing
• Itching around a vein
• Darkening of the skin
• Skin ulcers or bleeding

However, you shouldn't wait for advanced signs of the condition to see your health care provider, says Dr. Mendes. "Although you may not have any painful symptoms, once you realize that you have some bulging in your veins, it is a good idea to talk with your health care provider," she suggests. "He or she can show you simple steps to control the varicose veins and avoid possible complications."

In rare cases, varicose veins can lead to superficial venous thrombosis (SVT), a type of blood clot that can form within the varicose veins of the legs.

Determining treatment
Treatment of varicose veins has several goals, which include: relieving pain and other symptoms, reducing risk of complications and improving appearance. Often, the recommended treatments are simple and involve lifestyle changes (weight loss, exercise and moving frequently throughout the day) and the clothing you wear (avoiding tight clothing and high heels). A common treatment is the use of elastic compression stockings. "Compression stockings are used because the calf muscles contract and gently squeeze the blood back toward the heart as we walk," explains Dr. Mendes. "Blood would pool in our legs unless we elevate them at the end of the day, walk so the calf muscles 'squeeze' the blood back to the heart and wear compression stockings, which act with the calf muscle to massage the blood back.

"Because compression stockings vary (ranging from support pantyhose to prescription- and over-the-counter gradient compression hose), your health care provider can help you find the right stocking for your particular needs," she continues. And it's not just people with existing varicose veins who should consider compression stockings. Anyone who has a job that requires long periods or sitting or standing may benefit from them as well, says Dr. Mendes. "By doing so, many of the symptoms from varicose veins can be decreased, and swelling that many people with or without varicose veins have at the end of the day may be lessened," she says.

Occasionally, varicose veins become so troublesome that additional treatments are necessary. The goal of such procedures is to remove the veins or close them so that the blood no longer can pool. After the problem veins are removed or closed, other veins deeper in the legs will continue managing blood flow.

• Sclerotherapy: This treatment involves injecting a liquid chemical into the vein to seal it shut.
• Surface laser treatments: For spider veins and smaller varicose veins, this treatment fades the veins.
• Endovenous laser and radiofrequency treatments: These methods target larger veins. In the procedures, a catheter is inserted into the vein to heat it up and close it off.
• Endoscopic vein surgery: Performed in worst-case scenarios, this treatment involves surgically closing and removing veins.
• Ambulatory phlebectomy: This treatment allows a health care provider to remove small varicose veins by making tiny punctures in the skin of the leg.
• Vein stripping: With this procedure, the vein is removed through small incisions.

Fortunately, laser and radiofrequency technology is the prevailing treatment of varicose veins, and these days it is preferred by physicians over the use of more complicated and invasive procedures. "Laser treatment is becoming the gold standard for addressing varicose veins," says Dr. Mendes. "Using lasers, we cauterize veins from inside to create a scar that closes the vein, removing its function. The blood re-routes using healthy veins," says Mendes. "It requires less recovery time than the traditional vein stripping, and it is less painful." If you suffer from varicose veins, schedule an appointment with a vascular specialist to discuss your treatment options