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What Are Varicose Veins?

Varicose veins are enlarged, twisted, rope-like veins that appear just beneath the skin surface, most commonly on the legs and feet. They develop when the one-way valves within the veins become damaged or weakened, allowing blood to pool and the vein walls to stretch and bulge. Varicose veins affect an estimated 23% of adults in the United States and are more common in women, older adults, and individuals who stand for extended periods. While often considered a cosmetic concern, varicose veins can cause significant discomfort and may be associated with chronic venous insufficiency — a more serious underlying vein disease.

Symptoms of Varicose Veins

Pain and Aching — Many patients experience aching, heaviness, or throbbing in the legs — especially after prolonged standing or at the end of the day. Elevating the legs typically provides relief by promoting venous drainage.

Leg Swelling — Ankle and calf swelling (edema) from venous congestion is common with varicose veins and may worsen in warm weather or after long periods of standing.

Skin Changes — Chronic venous insufficiency can cause skin discoloration (lipodermatosclerosis), itching, and thickening of the skin around the ankles. Venous stasis ulcers — open wounds that are slow to heal — may develop in advanced cases.

Restless Legs and Cramping — Nighttime leg cramps and restless leg symptoms are reported by many patients with varicose veins and may improve significantly after vein treatment.

Superficial Thrombophlebitis — Inflammation and clotting in a superficial varicose vein causes localized pain, redness, and a firm, tender cord along the affected vein. While distinct from deep vein thrombosis (DVT), evaluation is important to rule out concurrent DVT.

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Diagnosis: Venous Duplex Ultrasound

Venous duplex ultrasound is the cornerstone of varicose vein evaluation. This noninvasive, real-time imaging study maps the venous anatomy of the leg, identifies incompetent (leaking) saphenous vein valves, measures reflux duration, and rules out concurrent deep vein thrombosis. Ultrasound findings guide treatment planning by identifying the specific refluxing vein segment responsible for the patient’s varicosities. At Cross County Cardiology, vascular duplex ultrasound is performed in-office at our cardiology centers throughout northern New Jersey.

Treatment Options for Varicose Veins

Compression Therapy — Graduated compression stockings are the first-line conservative treatment for varicose veins. They reduce venous pooling, improve symptoms, and may slow disease progression. Most insurance carriers require a trial of compression therapy before approving interventional treatment.

Endovenous Ablation — Endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) are minimally invasive office-based procedures that use thermal energy delivered through a thin catheter to close incompetent saphenous veins. Performed under local anesthesia, they have replaced traditional surgical vein stripping. Recovery is rapid, with most patients returning to normal activities within 1–2 days.

Sclerotherapy — Injection of a chemical solution (sclerosant) directly into the varicose vein causes the vein wall to scar and close. Ultrasound-guided sclerotherapy is used for larger veins; foam sclerotherapy increases efficacy for more complex cases. Spider veins are treated with visual sclerotherapy.

Ambulatory Phlebectomy — Large surface varicosities that are not adequately treated by ablation alone are removed through tiny incisions using a hooked instrument. This is typically performed in conjunction with endovenous ablation at the same visit.

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Why Choose Cross County Cardiology?

• Board-Certified, FACC Cardiologists — Fellowship of the American College of Cardiology credentialed physicians
• Affiliated with Mount Sinai & Hackensack Meridian Health — Academic medical center connectivity for complex vascular referrals
• 5 NJ Locations — Secaucus, Edgewater, Teaneck, Hoboken, and North Bergen
• Same-Week Appointments Available — Fast access without long waits
• In-Office Vascular Duplex Ultrasound — Comprehensive venous mapping for accurate diagnosis and treatment planning on-site

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Frequently Asked Questions

Are varicose veins dangerous?

Most varicose veins are not dangerous and are primarily a comfort and cosmetic issue. However, advanced venous insufficiency can lead to skin ulcers that are difficult to heal. Superficial thrombophlebitis — clotting in a varicose vein — is painful and occasionally associated with deep vein thrombosis (DVT). Venous duplex ultrasound evaluation is recommended for symptomatic varicose veins to rule out concurrent DVT and to assess for chronic venous insufficiency that requires treatment.

Does insurance cover varicose vein treatment?

Insurance coverage for varicose vein treatment depends on the carrier and whether symptoms are medically significant. Most insurers require documentation of symptoms (pain, swelling, skin changes), a trial of conservative therapy with compression stockings (typically 3–6 months), and an abnormal venous duplex ultrasound showing significant reflux before approving endovenous ablation or sclerotherapy. Purely cosmetic treatment of spider veins is typically not covered. Our team will work with your insurance to maximize coverage.

What is the difference between varicose veins and spider veins?

Varicose veins are large, bulging, twisted veins typically located on the legs that represent pathologic reflux in the deep or superficial venous system. Spider veins (telangiectasias) are small, red, blue, or purple veins visible just under the skin surface — typically 1–3 mm in diameter. Spider veins are primarily cosmetic, while varicose veins may cause symptoms and complications. Both can be treated with sclerotherapy; larger varicose veins require endovenous ablation.

How long does recovery take after varicose vein treatment?

Endovenous ablation (laser or radiofrequency) is an office-based procedure performed under local anesthesia. Most patients return to light activities the same day and resume normal activities within 1–2 days. Walking is encouraged immediately after the procedure. Compression stockings are worn for 1–2 weeks post-procedure. Strenuous exercise and prolonged standing are restricted for 1–2 weeks. Sclerotherapy recovery is similar — patients walk out of the office and resume activities the same day.

Will varicose veins come back after treatment?

Treated veins do not return, but new varicosities can develop over time — particularly if underlying venous insufficiency is present in other vein segments. Long-term follow-up with periodic venous duplex ultrasound is recommended to detect recurrence early. Wearing compression stockings regularly, maintaining a healthy weight, staying active, and elevating the legs when possible reduces the risk of new vein development after successful treatment.