Varicose veins are one of the most common vascular conditions in the United States, affecting an estimated 35 percent of adults. While many people view them as a cosmetic concern, varicose veins can signal underlying venous insufficiency — a progressive condition that, left untreated, can lead to pain, swelling, skin changes, and even leg ulcers.
Understanding when varicose veins require medical attention and knowing what treatment options are available can help you take control of your vascular health before complications develop.
What Causes Varicose Veins?
Veins carry blood back to the heart from the rest of the body. In the legs, this means working against gravity. To prevent blood from flowing backward, veins contain one-way valves that open to let blood pass upward and close to prevent backflow.
When these valves become weakened or damaged, blood can pool in the veins, causing them to stretch, twist, and become visible beneath the skin. This condition is known as chronic venous insufficiency (CVI), and varicose veins are its most visible symptom.
Several factors increase the risk of developing varicose veins, including age, family history, prolonged standing or sitting, pregnancy, obesity, and hormonal changes. Women are more likely to develop varicose veins than men, partly due to hormonal influences and pregnancy-related vascular changes.
Symptoms That Signal It Is Time to See a Specialist
Not all varicose veins require treatment. Small, painless varicose veins that cause no discomfort may be monitored over time. However, certain symptoms indicate that it is time to consult a vascular specialist or interventional radiologist:
- Aching or heaviness in the legs — especially after standing or sitting for extended periods
- Swelling in the ankles or lower legs — that worsens throughout the day
- Throbbing or cramping — particularly at night
- Itching or burning — around the affected veins
- Skin discoloration — darkening or reddening of the skin near the ankles, which can indicate advancing venous disease
- Skin texture changes — hardening, thickening, or scaling of the skin on the lower legs
- Restless legs — an uncomfortable urge to move the legs, especially at rest
- Bleeding from a varicose vein — which requires immediate medical attention
- Open sores or ulcers — on the lower legs or near the ankles, typically indicating severe venous insufficiency
If you are experiencing any of these symptoms, a consultation with a specialist can help determine whether your varicose veins require intervention and which treatment approach is most appropriate for your situation.
How Varicose Veins Are Diagnosed
Diagnosis begins with a thorough physical examination and medical history review. The specialist will examine your legs while you are standing to assess the extent and pattern of visible varicose veins.
A duplex ultrasound is the gold standard diagnostic tool for evaluating varicose veins. This non-invasive imaging test uses sound waves to visualize blood flow through the veins and identify which valves are functioning properly and which are allowing blood to flow backward (reflux). The ultrasound map guides the treatment plan by showing exactly which veins need to be addressed.
Modern Treatment Options for Varicose Veins
Today’s varicose vein treatments are minimally invasive, performed in an outpatient setting, and allow patients to return to normal activities quickly. Gone are the days of surgical vein stripping, which required general anesthesia, large incisions, and weeks of recovery.
Endovenous Laser Treatment (EVLT)
EVLT is one of the most widely used treatments for varicose veins caused by saphenous vein reflux. During the procedure, a thin laser fiber is inserted into the affected vein through a tiny needle puncture under ultrasound guidance. Laser energy is delivered to the vein wall, causing it to seal shut. Blood naturally reroutes to healthy veins, and the treated vein is gradually absorbed by the body over time.
The procedure takes approximately 45 to 60 minutes, is performed under local anesthesia, and patients can walk immediately afterward. Most people return to work within one to two days.
Radiofrequency Ablation (RFA)
Similar to EVLT, radiofrequency ablation uses heat energy to close diseased veins. A radiofrequency catheter is inserted into the vein and delivers controlled thermal energy to the vein wall. RFA is known for producing consistent results with minimal discomfort during and after the procedure.
Sclerotherapy
Sclerotherapy involves injecting a specialized solution directly into the affected vein, causing it to collapse and eventually be reabsorbed by the body. This technique is particularly effective for smaller varicose veins and spider veins. Foam sclerotherapy, which uses a foamed version of the sclerosing agent, can treat larger veins as well.
Sclerotherapy sessions are quick — typically 15 to 30 minutes — and require no anesthesia. Multiple sessions may be needed depending on the number and size of veins being treated.
Ambulatory Phlebectomy
For bulging surface varicose veins, ambulatory phlebectomy removes the veins through tiny micro-incisions that typically do not require stitches. The procedure is performed under local anesthesia and produces excellent cosmetic results with minimal scarring.
What to Expect After Treatment
Recovery from modern varicose vein treatment is remarkably quick. Patients are encouraged to walk immediately after their procedure and can resume most normal activities within 24 to 48 hours. Compression stockings are typically worn for one to two weeks to support healing.
Mild bruising, tenderness, or tightness along the treated vein is normal and resolves within a few weeks. Follow-up ultrasound appointments are scheduled to confirm that the treated veins have closed successfully.
Results are long-lasting. Once a diseased vein is treated, it does not return. However, because the underlying tendency toward venous insufficiency may remain, new varicose veins can develop in other locations over time. Regular check-ups and healthy lifestyle habits — including exercise, maintaining a healthy weight, and avoiding prolonged sitting or standing — help reduce this risk.
Why Choose an Interventional Radiologist for Vein Treatment
Interventional radiologists are uniquely trained in image-guided, minimally invasive procedures. They use real-time ultrasound to visualize veins during treatment, ensuring precision and safety. Their expertise in catheter-based techniques and vascular anatomy makes them ideally suited to diagnose and treat the full spectrum of venous disease.
At Fabio Komlos, MD, we offer comprehensive vein care including EVLT, radiofrequency ablation, sclerotherapy, and ambulatory phlebectomy. Every treatment plan begins with a thorough ultrasound evaluation to identify the root cause of your vein symptoms, not just the visible surface veins.
Schedule Your Vein Evaluation
If varicose veins are affecting your comfort, confidence, or quality of life, a specialist evaluation is the first step toward relief. Early treatment can prevent the progression of venous disease and help you avoid complications like skin damage and leg ulcers.
Contact Fabio Komlos, MD at (650) 404-8445 to schedule your vein evaluation. Our Mountain View, California practice provides expert, compassionate vein care for patients throughout the Bay Area.
