02.16.11 Dr. Paul McNeill Cosmetic

Veins That Don't Hurt Can Still Hurt You

I am sometimes astounded at the extensive large diameter varicose veins I evaluate. How could these large veins escape evaluation and how could this leg feel normal? Patients with large veins who say the legs "never have bothered me" may have become accustomed to the way venous insufficiency affects their leg. Perhaps they declined investigation in the past or were advised that the veins were considered cosmetic until they began to hurt. Even though a vein does not hurt, it can still hurt you!

Medically significant vein care is covered by insurance because we know the leg will get worse if venous insufficiency goes untreated. The basis for the formation of varicose veins lies inside the leg, away from view. It is venous reflux, detected on ultrasound exam, that is the cause of vein enlargement, leg swelling, skin changes, and aching tired legs. The size of the veins on the outside of the leg is not as important as what can be seen inside the leg with ultrasound. Moreover, dilated veins are prone to blood clot formation that is painful and can significantly affect ones health.

Patients initially claiming the leg with varicose veins does not hurt are often found by an expert to have leg swelling upon measuring the leg, evidence of prior phlebitis on exam, and signs that the pressure buildup in the veins is affecting the skin. Once the veins are treated, these same patients often exclaim that "My leg feels so much lighter! [elimination of high pressure in the leg veins]," "My leg swelling is gone," "I am sleeping so much better [relief of restless leg syndrome]" and "The dark skin on my ankles is fading [improved dermatitis]." If you see dilated veins on the leg, it is a good idea to have the leg evaluated by an expert. Early treatment prevents problems.

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