Alex Westerband, M.D.

Alex Westerband, M.D.

Warm weather and shorts season are well underway, and unless you’re a teenager, your legs may sport some of the telltale signs of aging; namely, varicose veins. Varicose veins can range from small spider veins to swollen, bulging and rope-like veins. Aside from their unattractive appearance, varicose veins can also cause discomfort and, in severe cases, health problems ranging from skin ulcers to blood clots.

Symptoms of varicose veins include: enlarged veins visible just under the surface of the skin; mild swelling of the ankles and feet; painful, achy or heavy-feeling legs; Throbbing or cramping in the legs; Itchiness, particularly on the lower leg and ankle; discolored skin in the area surrounding the varicose vein.

Varicose veins are very common. Around 55 percent of women and 45 percent of men in the U.S. suffer from some type of vein problem. These enlarged veins – caused by weak or damaged valves in the veins – most often appear in the legs, due to body weight and the force of gravity. Because the veins in the legs carry blood the longest distance from the lower extremities of the body back up to the heart, they also bear the greatest pressure. This pressure can sometimes damage the valves in the veins, and cause blood to back up and pool in the leg veins – a condition known as venous insufficiency. Over time, this overfilling of the superficial veins closest to the surface of the skin causes the veins to stretch, bulge and become prominent.

Half of people over age 50 have varicose veins. The primary causes are heredity, advancing age, pregnancy, being overweight or obese, and being sedentary. People who sit or stand for a large part of the day or engage in heavy lifting as part of their occupation have an increased risk of varicose veins. Women have a greater risk than men due to hormonal changes during puberty, pregnancy, and menopause, as well as increased pressure on leg veins during pregnancy.

Spider veins are a smaller, milder form of varicose veins, and involve the capillaries – the smallest blood vessels in the body. Often red or blue, spider veins can appear on the legs or face, closer to the surface of the skin than varicose veins, and look like a spider web or tree branch. This type of vein is usually only a cosmetic concern.

Varicose veins that need medical attention are those that become swollen, red, warm or tender to the touch, or begin to bleed. Also, watch for sores or a rash in the ankle area; thick or discolored skin in the area around the affected vein; or if leg pain and discomfort begin to interfere with daily activities.

Varicose veins can cause complications such as leg pain; dermatitis, an itchy rash that can cause bleeding or skin ulcers when scratched or irritated; or a condition known as superficial thrombophlebitis, a blood clot in a vein. This type of blood clot can cause pain in the affected area.

Varicose veins are typically diagnosed through a physical exam and an ultrasound imaging test to look for blood clots or other blockage, and to determine if the valves are working properly. Treatment depends on the severity and can include lifestyle changes, compression or support hose, or surgery. Techniques for eliminating or closing off varicose veins include laser therapy, sclerotherapy (the injection of saline solution into the vein to cause it to collapse), or radiofrequency or endovenous laser ablation – a minimally invasive procedure which uses intense heat to close off and destroy the vein from the inside. Sclerotherapy and topical laser treatments are most effective for smaller spider veins.

Depending on the severity of your varicose veins, your doctor may refer you to a dermatologist, a vascular medicine doctor/surgeon, or a phlebologist, a vein specialist, for treatment. You should check with your health insurance plan to determine coverage for treatment, as many plans only cover varicose vein therapies that are considered medically necessary, rather than cosmetic.

Lifestyle changes are the first step in preventing varicose veins, or slowing down their progression, as well as decreasing pain and other symptoms.

Wear sunscreen to protect your skin every day to limit the development of spider veins on the face.

Exercise regularly to improve leg strength, circulation and vein strength. Focus on activities that target your legs, such as walking or running.

Maintain a healthy weight to avoid placing too much pressure on your legs.

Don’t stand or sit for long periods. If you must stand for a long time, shift your weight from one leg to the other every few minutes. If you must sit for long periods, stand up and move around or take a short walk every 30 minutes.

Don’t cross your legs for long periods.

Elevate your legs when resting, as much as possible.

Avoid wearing high heels for long periods.

Eat a low-sodium, high fiber diet. Eating fiber helps with digestion and reduces constipation, which can contribute to varicose veins. Eating less salt can reduce the possibility of swelling that often accompanies varicose veins.

(Editor’s Note: Alex Westerband, M.D. is a board-certified vascular surgeon practicing with Northwest Allied Physicians.  His can be reached at 901-6230 or

(1) comment


I tried a lot of ways to prevent varicose veins the first couple of months of my pregnancy including a lot of the things you listed. Unfortunately I ended up getting them anyways[sad] towards the end of my pregnancy I started looking up different treatment options and procedures to get done to get rid of them without having to get surgery. I found there they used a laser to permanently and painlessly get rid of my varicose veins. Besides that my veins are completely gone now, my insurance ended up paying for it 100%. I had a great experience, and definitely recommend them!

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