FAQ Varicose Veins

What causes varicose and spider veins?
Many factors cause varicose veins. Although some causes are unknown, heredity and family history causes are common. Other contributing factors are gender, trauma to the leg, age, obesity, and occupations and activities that involve lots of standing. In women, pregnancy and hormones (but not birth control pills or hormone replacement) can contribute.

Will my varicose veins get better on their own?
Unfortunately, once a vein has become damaged and has become a varicose vein it will never function properly again. Compression stockings and some treatments may improve pain and swelling, however, compression stockings will not improve or correct the actual condition of your varicose vein.

How are varicose veins treated?
There are many different treatments, and the best treatment may be different for each patient. Generally, smaller veins are injected and larger veins are either sealed closed or removed.

Can varicose veins come back?
Specific varicose veins that are treated effectively do not come back, but nothing prevents your body from forming new varicose veins. If new varicose veins do form and become a problem, they can be treated, too.

What happens to treated varicose veins?
Once a varicose vein is treated, it is absorbed by your body.

Where does the blood go after the veins are treated?
Your body has thousands of veins to help return blood to the heart. Blood flow in varicose veins is sluggish and not normal. Once the unhealthy varicose veins are treated, the blood will be re-routed into healthier veins and your blood flow will actually improve.

What happens to untreated varicose veins?
One thing we know is that varicose veins do not go away on their own. In fact, it is a progressive disease, so often they only get worse. We know that 20 percent of varicose veins worsen and may eventually cause skin damage and leg ulcers.

I have had my veins treated and stripped before. Why am I still having a problem?
The venous system in your legs is made up of thousands of interconnecting veins all aimed at directing blood from your legs to your heart. There are many reasons why the new veins are now abnormal and causing a problem. Veins that were previously normal may have become abnormal since your last procedure. There is a possibility that with your last procedure, you had abnormal veins that were not causing a problem then, but have now become a problem for you. Also, since your stripping procedure, your body may have made new veins that now may have also become abnormal.

Does crossing your legs cause varicose veins?
No, this is an old wives’ tale. Crossing your legs does not create enough pressure in your leg to cause your veins to become damaged.

Does wearing knee high stocking or socks with a tight band cause varicose veins?
No, this is another wives’ tale. Although a tight band across an existing varicose vein can be uncomfortable to existing varicose veins, the stocking or sock band does not create enough pressure to damage a vein.

Do I need my veins for heart bypass?
Abnormal veins are not useful to a heart surgeon. Any veins that would need vein treatment are already diseased and could not be used for heart bypass surgery and other options would be used.

How do I prevent varicose veins?
You may not be able to completely prevent varicose veins from occurring, but there are ways to decrease your chance of having them. A few things you can do: improve your overall health, exercise to help pump blood back to your heart (thus preventing the blood from pooling in your veins), and maintain a healthy weight.

How do I begin treatment?
After your initial consultation, depending on your examination and diagnosis, a treatment plan and options will be discussed. Your questions will be answered, and we will advise you about the best way to proceed.

How do I know which treatment is best for me?
There are many treatments, each aimed at effectively treating specific vein problems. After careful evaluation and diagnosis of your problem, the best treatments will be discussed and recommended. Treatment may include the combination or series of treatments.

Why do I need an ultrasound?
Frequently varicose and spider veins on the surface of the skin are caused by deeper veins that may be abnormal and the root of the surface vein problem. The ultrasound is able to look at larger veins you cannot see that lie beneath the surface of the skin. In fact, many patients who come in for cosmetic reasons actually have deeper veins that are abnormal and are the root of the problem. The ultrasound not only determines whether the deeper veins are functioning correctly -- it can map your deeper veins to help your doctor treat you more effectively.

Will my insurance pay for treatment?
Insurance reimbursements depend on your particular insurance company, as well as the specifics of your individual insurance policy. Not only is each policy different, the philosophy of each insurance company is also different. After completing your physical evaluation and diagnosis process, if treatment for your condition is recommended we will gladly submit a claim to your insurance company for you. After the claim is submitted, your insurance company decides whether the recommended treatment/claim is medically necessary and part of your individual coverage. Once the claim has been submitted for your insurance company’s approval, most insurance companies allow up to 30 days for their approval process to be completed.

Also, insurance companies may require different pre-certification prior to approval of the treatment. Some may require photographs of your venous condition be submitted with the treatment request/claim. Most require you have a trial of conservative treatment (compression stockings) for two to six months prior to their approval of the treatment.

If the ultrasound shows you have abnormal veins and you are having a medical problem like pain, swelling, severe skin changes, leg ulcers, etc., most insurance companies will eventually approve the recommended treatments. Also, treatment claims for more severe conditions, like leg ulcers, may actually be approved faster than usual. One thing to be clear about: none of the insurance companies will pay for cosmetic treatments.

Why do I have to wear compression stocking for three to six months before my treatment?
Most insurance companies require that you try conservative treatment first. This usually means wearing compressions stockings for three to six months. While compression stocking can make your symptoms better, they will not treat or improve the actual conditions of your veins.

Do I have to pay for my own compression stockings?
Compression stockings are available for purchase at the  Vein Clinic . They are also available at most medical supply stores. Usually, the patient is responsible for the costs of compression stockings. Under special circumstances, such as deep vein thrombosis (DVT) or lymphedema, certain insurances companies may offer compressions stockings as a covered benefit.

Will I need to be hospitalized or take time off of work?
All the treatments are outpatient treatments and are usually performed in the office setting. Occasionally, the procedure is done at Duke University Hospital, but it is still considered an outpatient patient procedure. Since you start walking immediately after the procedure, most of the time you can return to work the next day.

Is my activity limited after treatment?
Your activity after treatment depends on the treatment you receive. Usually there is no restriction in activity, especially for injection therapy. For the larger vein treatments, we usually advise postponing strenuous exercise for one week.

How long will treatment take?
Each treatment is slightly different and may vary from 30 minutes to 1 hour.

Does treatment hurt? Are the injections painful?
Since everyone’s pain tolerance varies, everyone responds differently to the same treatment. Also each treat is slightly different. Most people find most of the treatments are relatively painless or cause only a slight discomfort similar to a needle prick.

How many treatments will my legs need?
Your treatment plan depends on your diagnosis, what treatments are recommended, and how many treatments you will need. If your deeper veins need treatment, they are treated one deep vein at time and usually treated a few weeks apart. With superficial veins, many can be injected at one visit, but it may take three to six visits to complete the treatment process.

What do I need to do after treatment?
Most all the treatments require some form of pressure to the vein that was treated. The amount and time of pressure depends on the type of vein treated. Basically the larger the vein that is treated, the longer the pressure after treatment is required. Small superficial veins may only need a piece of gauze with tape, while larger, deeper veins may require a compression stocking for up to a week.