Venous insufficiency is a very common condition resulting from decreased blood flow from the leg veins up to the heart, with pooling of blood in the veins. Varicose veins are a symptom of venous insufficiency where prominent, elongated veins appear rope-like and bulging just under the skin's surface. The word varicose comes from the Latin root varix, which means "twisted". Any vein in the body may become varicose, but the most common varicose veins occur near the skin surface in your legs. The squeezing of leg muscles pumps blood back to the heart from the lower body. Veins have valves that act as one-way flaps. These valves prevent the blood from flowing backwards as it moves up the legs. If the one-way valves become weak, blood can leak back into the vein and collect there. Pooled blood enlarges the vein and it becomes varicose. Spider veins can also be caused by the backup of blood. Throughout the day our legs remain in the dependent position (standing or sitting) which increases the pressure in the veins of our lower body due to gravity. Compared with other veins in the body, leg veins have the toughest job of carrying blood back to the heart. They endure the most pressure. This pressure can be stronger than the veins' one-way valves.

About 50 to 55% of American women and 40 to 45% of American men suffer from some form of vein problem. Varicose veins affect 1 out of 2 people age 50 and older. Many factors increase a person's chances of developing varicose or spider veins. These include increasing age, heredity, hormonal changes, pregnancy, standing or sitting for long periods of time, and obesity. Varicose veins can be harmful to a patient's health because they may be associated with the development of one or more of the following conditions: phlebitis or inflamed, tender vein; thrombosis or a clot in the vein; and venous stasis ulcers or open sores from inadequate tissue oxygen and fluid retention.

Symptoms of Varicose Veins

Most varicose veins have no symptoms other than the appearance of purplish, knotted veins on the surface of the skin. A physician should be consulted and treatment may be required if there is:

• Pain or heaviness in the leg, feet and ankles,
• Swelling, 
• Sores or ulcers on the skin, or
• Severe bleeding if the vein is injured.

Treatments

Sclerotherapy

Sclerotherapy is considered the gold standard treatment for removing spider and some varicose leg veins. It is a very cost-effective procedure that seldom leaves a scar or produces adverse effects.  A concentrated saline or specially developed chemical solution is injected with a very small needle into the spider or varicose vein. The solution causes the vein to close up or collapse and become scar tissue that is eventually absorbed by the body. The work of carrying the blood is shifted to other healthy blood vessels nearby.
Sclerotherapy generally requires multiple treatment sessions. One to three injections are usually required to effectively treat any vein. The same area should not be retreated for four to six weeks to allow for complete healing, although other areas may undergo treatment during this time. Walking and moderate exercise helps to speed recovery. Although sclerotherapy works for existing spider and varicose veins, it does not prevent new ones from developing, but may decrease this risk.

There is no down time and most patient report  minor, if any, side effects, which usually disappear in time. Temporary reactions can include a slight swelling of the leg or foot, minor bruising, pigmentation, the temporary appearance of new blood vessels, redness and mild soreness.

Endovenous Laser Treatment

Endovenous Laser Treatment, or EVLT, is an alternative to surgical stripping of certain underlying veins that are the source of surface varicose veins. Endovenous Laser Treatment is done in-office under local anesthesia. It works by heating the inside of the vein, which causes it to seal shut and disappear. It is simple, effective, and is the first choice of patients and physicians. The treatment takes less than an hour to eliminate varicose veins.

The EVLT technique requires that a very thin laser fiber be inserted into the damaged underlying vein. To perform the procedure, the doctor uses an ultrasound machine to map the vein, and then numbs the area with local anesthesia. The doctor places a needle into the lower end of the diseased underlying vein, through which a small sheath is put into the vein. The laser fiber is then placed through the sheath and advanced to the upper end of the diseased vein. Local anesthesia is then delivered to the entire vein. The laser fiber heats the inside of the vein as it is slowly withdrawn back down the vein.

After the endovenous laser treatment, any remaining residual surface varicose veins may be treated with either sclerotherapy or ambulatory phlebectomy.

Most physicians advise you to wear compression stockings and walk a lot after treatment. As a result of the treatment, the blood re-routes through the remaining normal veins much more efficiently, thereby reducing the abnormal pressure on the remaining veins.

Endovenous laser is a widely accepted procedure with a very high success rate and low complication rate. Possible side effects of the endovenous laser procedure include but are not limited to areas of skin numbness, blood clots and phlebitis, an inflammation of a vein. Contraindications to treatment include but are not limited to very tortuous (twisty) veins. EVLT is covered by most insurance carriers.