Varicose veins can be a major concern, especially for women. The protruding veins in the legs not only create an uncomfortable appearance but can also negatively impact quality of life by causing pain. Left untreated, varicose veins may even lead to serious health problems. The good news is that effective treatments are available to help manage and eliminate varicose veins.
Varicose veins are a condition with a history as old as humanity itself, evident even in sculptures that date back to 400 BC. Varicose veins are superficial veins that become elongated, curved, and enlarged”most commonly appearing in the legs due to the effects of gravity. This condition affects around 25% of the global population, or one in every four people. While there are no exact statistics for our country due to limited research, it is estimated that about 10 million people experience varicose veins to varying degrees. Fortunately, effective treatments are available, and it is possible to resolve varicose veins quickly when addressed promptly, as delayed treatment can lead to more serious health complications. Here, we answer some of the most frequently asked questions about varicose veins, a condition particularly common among women.
How Varicose Veins Occur?
Varicose veins develop when the veins responsible for returning blood from the body to the heart are not able to function efficiently. These veins contain valves that typically ensure blood flows in one direction”toward the heart. If these valves become damaged, blood can begin to leak backward and pool in the veins of the legs. Over time, as blood accumulates and pressure increases, the veins lose their elasticity, widen, and become visible beneath the skin's surface.
Common Symptoms of Varicose Veins
Varicose veins typically present as visibly enlarged and twisted veins. Other symptoms may include swelling in the legs, pain that worsens later in the day, sensations of heaviness or fullness, cramps, itching, and burning in the soles of the feet. In more advanced cases, symptoms can progress to include edema, skin discoloration, and the development of wounds.
Potential Health Complications of Varicose Veins
Although varicose veins are often regarded as a cosmetic issue, they can lead to serious health complications if left untreated. Over time, untreated varicose veins may result in persistent wounds that are difficult to heal, and in rare cases, blood clots can form within the affected veins. This can potentially lead to life-threatening conditions. For these reasons, preventing varicose veins and seeking early treatment are crucial for protecting both your health and well-being.
Who Is at Risk for Varicose Veins?
Certain groups of people are at increased risk for developing varicose veins. These include individuals with a family history of varicose veins, those who are overweight, and people who work in positions that require prolonged standing or exposure to gravity. Additional risk factors include the use of estrogen-containing medications, experiencing difficult or frequent pregnancies, and regularly wearing high heels taller than 5 centimeters. Professionals such as teachers, bankers, flight attendants, hairdressers, sales staff, clerks, and healthcare workers are also at higher risk due to the nature of their work. Finally, individuals with a congenital partial or complete absence of intravascular valves are especially susceptible to developing varicose veins.
Why Is It More Common in Women?
Hormonal factors, particularly the female hormone estrogen, play a significant role in the development of varicose veins. Estrogen causes the veins to dilate, making women more susceptible, especially during pregnancy or with long-term use of birth control medications. After childbirth, varicose veins that developed during pregnancy often regress within a year, as blood volume normalizes, flow improves, and hormonal balance is restored. However, if a second pregnancy occurs before this process is complete, new or persistent varicose veins may develop and become permanent. For this reason, it is advisable for women to allow a two-year interval between pregnancies to support vascular recovery.
What Are the Behaviors to Avoid?
To help prevent varicose veins, it's important to avoid weight gain, stay physically active, stop smoking, and limit alcohol consumption. Bathing in very hot water, or spending time in saunas, spas, under the hot sun, or on hot sand, can dilate veins and slow blood flow, causing varicose veins to worsen more quickly.
Wearing tight clothing or belts around the waist should be avoided, as should tight pantyhose, as these can restrict blood circulation. Office workers and homemakers should be mindful not to sit with their legs crossed for long periods. Sitting this way, especially for women, can contribute to the development of varicose veins behind the knees.
Is There a Relationship Between Varicose Veins and Nutrition?
Nutrition also plays an important role in the prevention and management of varicose veins and venous insufficiency. To support vein health, it's best to avoid or minimize the intake of animal fats. Focus on eating fruits and vegetables at least five times a day, and drink at least 2 liters of water or unsweetened tea (with green tea as a great option) daily. Additionally, foods like rice, pasta, muesli, as well as alcohol and coffee, should be consumed in moderation.
Diagnostic Methods for Varicose Veins
A visual examination alone may not provide a complete assessment for varicose veins. Therefore, accurate diagnosis requires the use of color Doppler ultrasonography. This imaging technique evaluates whether the veins are enlarged and checks for any loss of valve function. Doppler ultrasonography can also determine the severity of this valve dysfunction”classifying it as mild, moderate, or severe. Additionally, it can identify issues such as the congenital absence of intravascular valves or the underdevelopment of certain vessels that might hinder blood flow. Based on these findings, the degree of venous insufficiency can be graded, and the most appropriate treatment plan can be determined according to the results of the Doppler ultrasonography examination.
When Are Varicose Veins Socks on the Agenda?
Compression stockings come in three types”knee-high, thigh-high, and pantyhose”and are available in low, medium, and high pressure levels. By applying pressure to the legs, they help prevent excessive vein expansion and the accumulation of blood, particularly when standing or sitting for long periods. As a result, they can effectively reduce symptoms such as pain, swelling, and a feeling of heaviness associated with varicose veins.
Compression stockings are recommended as a preventive measure for individuals with visible varicose veins, those diagnosed with valve dysfunction in the deep or superficial veins through ultrasonography, and individuals at high risk”especially those who spend much of the day on their feet. When worn properly and consistently, compression stockings can significantly reduce symptoms and slow the progression of varicose veins. However, it's important to note that while stockings help manage symptoms and prevent worsening, they do not cure varicose veins; symptoms may return if their use is discontinued.
Can Stockings Be Taken Indiscriminately?
Compression stockings should be purchased from trained professionals or specialized stores, and only upon a doctor's recommendation. The correct type and size must be chosen, considering factors such as the severity of the patient's varicose veins and ultrasonography results. If stockings are too small, they can be overly tight and difficult to wear; if too large, they may be loose and fail to provide the necessary therapeutic pressure.
How Often Should Socks Be Changed?
Research has shown that even the highest-quality compression stockings begin to lose their effectiveness after three months and do not maintain the desired level of pressure beyond six months. Therefore, it is recommended to replace compression stockings every six months if they are being worn regularly.
What Are the Treatment Methods for Varicose Veins?
Varicose veins can vary greatly in severity and appearance. In some cases, only the small capillaries are affected, while in others, larger veins may protrude noticeably. The choice of treatment depends on the stage of the varicose veins, the symptoms experienced by the patient, and the overall impact on quality of life. Treatment may target only the superficial veins just beneath the skin, the deeper main veins, or both. Common treatment methods include radiofrequency ablation, laser therapy, sclerotherapy, and, when necessary, surgical intervention.
What Are the Treatments Performed Externally Through the Skin?
Varicose vein treatments can include radiofrequency ablation or laser therapy, which use heat to close off problem veins. Another option is sclerotherapy, a procedure in which a special medication is injected directly into the varicose veins to collapse and ultimately eliminate them.
When Are Laser and Radiofrequency Treatments Most Effective?
Laser and radiofrequency treatments are particularly effective for blue and red capillary veins that are less than 1 millimeter in diameter. In laser therapy, targeted beams are used to burn and eliminate these tiny varicose veins. The radiofrequency method involves inserting a needle thinner than 1 millimeter into the vein and delivering radio waves to 'burn' the affected area. Depending on the severity and extent of the condition, most patients require about 3 to 4 treatment sessions, each lasting approximately 30 to 45 minutes. Typical success rates range from 60% to 80%, though results may vary based on individual skin characteristics. After laser sessions, patients are advised to avoid sun exposure for 6 to 8 weeks to prevent skin discoloration, a precaution that is not necessary with the radiofrequency method.
How Is Sclerotherapy Performed?
Sclerotherapy is typically used for veins with a diameter of 1“2 millimeters or larger. This procedure involves injecting a specialized medication directly into the problematic vein using very fine needles, causing the vein to close and eventually fade. Treatment typically requires 3“4 sessions, each lasting around 30 minutes, though the exact duration may vary between individuals. After each session, compression is applied to the treated area with an elastic bandage or compression stockings for 10 days to enhance results. Patients can generally resume their normal daily activities immediately after treatment.
A newer technique, known as 'foam sclerotherapy,' involves mixing the medication into a foam before injection. This approach offers greater effectiveness with smaller doses and fewer side effects compared to the traditional method.
Do Treatments Applied on the Skin Offer a Permanent Solution?
While sclerotherapy generally yields high success rates, it is crucial to first identify and address the underlying causes of varicose veins before proceeding with any skin-level treatments. Superficial procedures, when performed without investigating the root cause, may initially seem effective. However, if the source of the problem remains, healthy veins can become affected and new varicose veins may develop within 6 to 12 months of treatment. For long-term success, it is essential to undergo a thorough examination and, when necessary, treatment directed at the underlying cause before beginning sclerotherapy or similar procedures.
When Are Surgical Treatments Necessary?
When disorders occur in the main superficial vein system and its branches”located a few centimeters beneath the skin and responsible for the development of superficial varicose veins”treatment of these veins is essential in addition to surface interventions. Surgical procedures can be performed in several ways, and most often, a combination of techniques is necessary to achieve optimal results.
When Is the Stripping Operation Recommended?
In the congenital anatomical structure of human beings, there are superficial main vein systems called long and short "saphenous vein running between the ankle and groin and between the ankle and knee socket. These veins are the veins that are removed to be used as bypass material in both coronary bypass surgery in the heart and bypass surgery in the treatment of diseases characterized by arterial occlusion in the legs, and are known as reserve veins among the people.
This superficial main system is responsible for 40 percent of the evacuation of dirty blood in the legs, while the deep main vein system, which runs deeper, is responsible for 60 percent. All surgical interventions and operations applied in varicose veins can be applied to this superficial main system and its branches extending to the skin. As a result of the expansion and loss of function of these main systems due to various reasons, these main veins turn into structures that accumulate dirty blood in them instead of moving the dirty blood to the body, which is their main task, and they need to be deactivated in some way. (I ask you to reduce the section I marked in red by at least half... How do these veins look from the outside?)
Until 10-15 years ago, small incisions were made in the groin and ankle, and the vein was removed by pulling the vein from bottom to top or top to bottom with wire or plastic catheters passed through the vein. This method was called "Stripping operation and was applied all over the world. After the technological developments in recent years, the frequency of this operation has gradually decreased, but it still needs to be performed in some patients. The patient stays in the hospital for 1 night after the operation and may need to wait 10 days to return to work.
How Are Mini Phlebectomies Performed?
Today, mini phlebectomy is performed by removing varicose veins through tiny 1“2 mm incisions, leaving minimal or no visible scars. This procedure can be done under local anesthesia, either on its own or in combination with other surgical treatments.
What Does Perforating Vein Ligation Provide?
The superficial and deep vein systems run parallel to each other along the entire leg and in the groin area the superficial system connects to the deep system. They transmit the dirty blood they collect to the deep system and then continue as a single vascular system from the groin to the trunk. In addition to the main connection point in the groin area, there are more than 10 smaller connection points between the ankle and groin, through which the superficial system transfers the dirty blood to the deep system. When the valves in these connecting vessels malfunction, the flow turns in the opposite direction and an intense blood flow starts from the deep system to the superficial system. Therefore, the load of the superficial system increases and varicose veins form. (I ask you to reduce the part I marked in red by at least half. How do these varicose veins look from the outside?)
Once this abnormality is detected, what needs to be done is to disable these connection points whose structures are disrupted. These vessels, whose locations are marked with ultrasound guidance, can be located and connected under the skin through 1-centimeter incisions in the skin under local anesthesia and this abnormal flow can be eliminated. The procedure can be performed on an outpatient basis with local anesthesia without the need for hospitalization, or it can be combined with other operations and can be performed with 100 percent success. Patients can go to work the next day.
What Are Endovenous Surgical Interventions (EVRA, EVLA)?
Thanks to technological advances, stripping operations that once required surgery can now be performed with radiofrequency and laser technologies, offering fewer side effects and very high success rates. Traditionally, the long and short saphenous veins were surgically removed. Today, a needle and catheter system is inserted into the diseased veins without making an incision. The catheters are advanced up to the groin area, and radiofrequency waves or laser energy are then used to close off ("burn") the affected veins, eliminating the need for conventional surgical removal.
What Are the Advantages of This Method?
When performed by experienced professionals, modern radiofrequency and laser treatments for varicose veins achieve nearly 100% success with minimal side effects. Complications like infection, bleeding, and bruising are extremely rare compared to traditional surgery. Overweight patients, especially those with abdominal obesity, benefit greatly from this incision-free approach, as it minimizes the risk of wound healing problems associated with surgical procedures in areas prone to sweating and irritation. Following treatment, most patients are discharged the next day and can quickly return to normal activities, including work.
Are Varicose Vein Treatments Suitable All Year Round?
Because most varicose vein treatments require wearing elastic bandages or compression stockings for a period afterward, and since sun exposure should be avoided for 6“8 weeks following laser procedures, it is generally recommended to schedule treatments during the cooler months”such as spring, fall, or winter.
Will Varicose Veins Recur After Treatment?
Since factors like genetics, gender, and occupation”many of which cannot be changed”can contribute to the development of varicose veins, new veins may still become affected over time. Adopting protective habits is essential for reducing this risk. Staying active throughout the day, maintaining a healthy diet, exercising regularly, avoiding heavy lifting, and using compression stockings all play an important role in prevention and long-term management.
* Liv Hospital Editorial Board has contributed to the publication of this content .
* Contents of this page is for informational purposes only. Please consult your doctor for diagnosis and treatment. The content of this page does not include information on medicinal health care at Liv Hospital .
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