True varicose veins are abnormal superficial veins under the skin that become dilated and twisted. They are often bulging and appear swollen and knotted. Despite their often unsightly appearance, they may or may not cause actual physical symptoms.

Varicosities result from falty valves in the vein.  In a healthy vein, the valves can open and close, allowing  blood to return to the heart.  When valves are abnormal there is pooling of blood in the legs. This is made worse by the effects of gravity during prolonged standing or pregnancy. This leads to abnormal increased pressure in the superficial veins, which causes them to dilate, elongate, become tortuous, bulge, and become twisted.

There are many causes of varicose veins. The following factors may contribute to their development.

• Gender- females are affected four times as often as men
• •Age- development is progressive and tends to advance as we get older
• Genetics- this contributes greatly to the development of vein disorders
• Pregnancy- hormonal factors and increased circulating blood volume predispose toward development of varicosities. After delivery, the veins may regress.
• Occupation - prolonged standing and sitting can accelerate any underlying tendency toward the development of varicose veins
• Lifestyle- obesity and a sedentary lifestyle have been implicated as significant contributing factors, as well as chronic constipation, high heels, binding clothing, heat, birth control pills or hormone replacement therapy

• Maintain ideal body weight
• Avoid prolonged sitting and standing
• Compression stockings
• Elevate your legs whenever possible
• Frequent walks, regular exercise
• Avoid prolonged hot baths or lengthy hot tub sessions
• Lay on left side while sleeping when pregnant
• Wear compression stockings throughout entire pregnancy

Typically, once a vein has been cleared, the treated vein should not come back. However, factors (genetic, hormonal, occupational…) that originally predispose one to developing vein problems may cause new veins to dilate if the underlying factors aren’t resolved. Therefore, all sources of reflux should be addressed to minimize the probability and extent of recurrences. New veins that appear in the same location need to be evaluated for the underlying cause.

Varicose veins and spider veins often appear during pregnancy. The cause is multi-factorial; however, both hormonal changes and pressure effects of the fetus play some role. Occasionally, the veins may resolve after birth. Treatment should not be undertaken until 6 months postpartum, if the veins have not spontaneously resolved. Definitive management is ideally timed after future child-bearing is no longer desired, for optimal results.

During subsequent pregnancies, women should wear compression stockings to minimize development of new veins and minimize symptoms caused by the veins.

The vast majority of all varicose veins and spider veins represent abnormal pathways of blood flow that develop over time because of abnormal function of vein valves and increased pressure in the superficial veins. When these veins are removed, overall circulation may actually be improved due to less blood pooling in abnormal veins in the legs and the improvement in venous blood flow back to the heart.

Superficial bulging varicose veins are predisposed to development of blood clots. This is called “superficial thrombophlebitis”. This is particularly true if a patient has other risk factors for blood clots, such as: obesity, smoking, oral contraceptives, or family history of venous disease.
Occasionally, people may develop varicose veins from prior blood clots in the deep veins, or even a traumatic injury to the legs.   Superficial veins with pain and swelling can result from  “post-phlebitic syndrome” from chronically damaged and obstructed deep venous drainage pathways.  This is another reason comprehensive evaluation of the veins as well as a deep venous ultrasound may be suggested prior to initiating treatment.