Without treatment, a minor problem with your veins can get much worse. So it’s important to see a doctor, whether to treat a potentially life-threatening condition, such as preventing blood clots in the deep veins, or to find relief from pain and sores.
Once your condition has been diagnosed, you will have options for treatment to consider and a variety of medical professionals to treat you. Discuss your options with your doctor and ask questions. You can also print Questions to Ask Your Doctor about Leg Vein Problems and take it with you on your next visit to help you remember your key questions and to take notes.
Who Treats Vein Problems?
Your doctor may recommend some things you can do on your own to treat the problem and prevent more serious problems. Or, if something more serious is suspected, your doctor might refer you to someone who specializes in treating veins.
The treatment of veins has come a long way in the past 10 to 20 years. Procedures that were once only performed in hospitals are now performed on an outpatient basis in the office by a variety of professionals. You may want to talk with your doctor about the type of specialist you should see and if he or she can recommend someone. You may also want to consider a second opinion, depending on the seriousness of your condition and the recommended treatment.
A phlebologist specializes in treating veins, but he or she is not required to take specialty training. While phlebologists may be very skilled at treating veins, because they may not be trained in surgery or interventional procedures, they may only treat problems with the superficial veins, such as varicose and spider veins. Phlebologists come from a variety of fields, for example, dermatology and internal or general medicine.
Surgeons and vascular interventionalists complete additional training, which may make them the better choice for more serious vein conditions and to diagnose the severity of your condition in the first place. They include:
- vascular surgeons
- general surgeons
- interventional cardiologists
- interventional radiologists
Types of Treatment
How to treat vein problems depends on the nature and severity of the problem. You can do things at home to alleviate symptoms and possibly prevent more serious problems, especially if you have problems in the superficial veins (the veins close to the skin). Other problems, such as blood clots in the deep veins, may require immediate medical attention, such as blood thinners, surgery, or interventional procedures. The spectrum of treatments is listed and described below from least to most invasive.
Wear It Well:
The Ins and Outs of Compression Stockings
- Follow your doctor’s instructions about pulling them up to the right height.
- Buy stockings with the correct pressure (as prescribed by your doctor).
- Shop around for the best price. You don’t have to buy them at the doctor’s office. Check your local pharmacy and online.
- Get them in the right style, length, and color for you.
- Smooth out wrinkles and creases.
- Do not sleep in your stockings unless your doctor told you to do so.
- Buy new stockings every 4 to 6 months, sooner if they become loose.
You can make changes now that may relieve some of your symptoms and reduce your risk of more problems in the future:
- Lose weight—excess weight puts additional strain on veins and legs.
- Exercise for strength and flexibility and to help the blood move from your legs to your heart.
- Move your feet and legs whenever you’ve been sitting for long periods of time, for example, sitting at your desk or when traveling.
If you have pain and discomfort in your legs you can:
- Wear compression stockings to reduce and prevent swelling and decrease risk of blood clots
- Elevate your leg
- Apply warm and moist compresses
Your doctor may prescribe medication to give you relief from symptoms and to treat the problem. It is extremely important that you follow your doctor’s instructions about taking the medication and continue taking it until he or she says you can stop. Some of the medications used to treat vein problems and relieve symptoms include:
- Anti-inflammatory drugs such as aspirin or ibuprofen to reduce swelling and relieve pain
- Pain killers
- Blood thinners (anticoagulants) to reduce the risk of clots getting bigger and the development of new clots
- A thrombolytic to dissolve clots in some cases
- Antibiotics to treat infection
Medical Procedures to Close or Remove a Problem Vein
Sometimes a problem in the vein is so serious and causes such discomfort that the best treatment is to eliminate it. Removing or closing the damaged vein prevents blood from accumulating there and causing discomfort. The blood finds a new path to the heart through healthy veins, and the old vein shrivels up and disappears.
Specific Treatment Considerations:
The Ins and Outs of Compression Stockings
- Deep vein thrombosis (DVT) should be treated as soon as possible. Otherwise, it can develop into a pulmonary embolism, one of the most preventable causes of death among hospital patients in the United States.
- Pulmonary Embolism (PE)
If diagnosed and treated in time, deaths from pulmonary embolism can be reduced from approximately 30 percent to less than 10 percent.
Advances in technology have made it possible to treat veins with minimally invasive procedures that are generally less painful, have fewer complications, and require less time for recovery. Treated veins can reappear, but taking steps such as regular exercise and wearing compression stockings may make it less likely and reduce the risk of new problems in the veins.
Two of these minimally invasive procedures commonly used to treat varicose and spider veins are sclerotherapy and venous ablation.
Sclerotherapy is the injection of either a liquid or foam solution to shrink the vein until it eventually disappears. This procedure is typically performed in a doctor’s office and does not require anesthesia. It is primarily used to treat smaller varicose veins and spider veins that are too small or twisted for catheter-based treatment. Sclerotherapy can require multiple treatments every four to six weeks to eliminate the problem veins. Some stinging and redness may occur at the site of the injection as well as bruising and swelling, but in most cases patients can return to their normal activities immediately after the 20- to 30-minute procedure.
Venous ablation uses lasers or radio waves to close a vein that is not working. This type of procedure can also be performed in a doctor’s office but with local anesthesia. A narrow, flexible tool called a catheter is inserted into the vein to guide a probe that uses laser or radio waves to close the vein. This procedure may not work for smaller veins but if they are connected to a larger vein that is receiving treatment, they may disappear too. Most varicose veins treated with this procedure will not reappear; but it’s not guaranteed. There is some risk of bruising and numbing with this procedure, but most patients experience little or no pain before and after the treatment, and they can return to their normal activities immediately after the procedure, which typically takes less than an hour.
When the problem is in the deep venous system, interventional procedures may be used to:
- Insert and open a small balloon in the vein that will open it wider to allow blood to flow more freely through the vein. A stent may also be inserted to prop the vein open.
- Place filters inside the major vein in the abdomen to catch blood clots that break free from leg or pelvic veins before they reach the heart and lungs.
Surgery is an option for treating severe problems in the veins. Depending on the nature of your problem and other considerations your surgical options may include:
- Removing a vein, part of a vein, or a vein valve. During this surgery, often called vein stripping and ligation, the vein is removed with a tool inserted into a small incision just below the vein. The remaining vein is ligated, or tied off to redirect blood flow to healthy veins;
- Bypassing the vein problem by transplanting healthy vein to create a new pathway for the blood to travel; or
- Repairing a valve in the vein.
- Pregnancy can cause varicose veins to become larger and more obvious and painful. While it is important to be on the lookout for blood clots, your doctor may recommend that you treat the problem with home care, such as warm compresses, for symptom relief until you do not plan to have any more children. That’s because varicose veins commonly reappear with each pregnancy.
A Final Word on Treatment
Vein problems may or may not be life threatening, but you won’t know for sure unless you see your doctor. Treatment from a qualified medical professional could save your life, or at the very least, make your life much more pleasant.