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Many treatment options are available for varicose veins

DEAR MAYO CLINIC: Is it possible to treat varicose veins? I have several that don't bother me much but a few that are slightly painful.

For many women, varicose veins are all too common. Although most look worse than they feel, varicose veins can cause aches and pains in the legs. In rare cases, they can lead to more serious problems. Lifestyle changes can help relieve pain and keep varicose veins from getting worse. A number of minimally invasive medical procedures also are available to close off or remove varicose veins.

Veins anywhere in the body can become enlarged and twisted (varicose). Varicose veins most commonly occur in the legs and feet. Age, pregnancy, obesity or work that involves standing for long periods can all increase the risk of developing varicose veins. So can genetics and your gender. If other family members had varicose veins, there's a greater chance you will, too. Women also are more likely to develop this problem than are men.

Varicose veins are sometimes viewed as just a cosmetic concern. Most varicose veins are dark purple or blue in color. They can also bulge out from under the skin, making them quite noticeable. However, varicose veins can cause other problems, including an achy or heavy feeling in your legs. Some people also experience throbbing, cramping or mild swelling in the lower legs -- especially after standing for long periods of time.

More-serious complications are rare. But varicose veins can sometimes lead to an itchy skin rash (dermatitis) and cause open sores (skin ulcers) to develop. Occasionally, blood clots may develop in a vein and cause pain, tenderness and swelling.

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Talk to your doctor if you have varicose veins and notice a change in how your legs feel, have skin discoloration, or have swelling in your legs. Skin ulcers and sudden, painful swelling should receive immediate medical attention.

Depending on your signs and symptoms, varicose veins may be treated with lifestyle changes, medical procedures or a combination of both.

Lifestyle changes are recommended for mild symptoms because they can reduce discomfort and keep varicose veins from getting worse. These include not staying in one position for hours on end; elevating your legs above your heart a few times a day; and doing any physical activity that gets your legs moving. Losing weight, if necessary, also may help. Your doctor also may recommend that you wear compression stockings. These create gentle pressure up the leg, and can keep blood from pooling in the legs and decrease swelling.

If your varicose veins don't respond to these treatments, or if your veins are causing severe problems, your doctor may suggest one or more of these procedures:

• Sclerotherapy uses a chemical injected into a varicose vein to cause irritation and scarring. Several treatments may be needed to completely close off a vein and allow it to fade.

• Laser therapy uses strong bursts of light directed at a vein, making it slowly fade and disappear. This is mostly used to close off smaller varicose veins.

• Endovenous thermal ablation uses the heat from lasers or radio waves to close off larger varicose veins.

• Vein stripping involves tying shut and removing large varicose veins through small cuts in the skin. Vein stripping was commonly used in the past. But now it's mostly recommended for people who aren't good candidates for endovenous thermal ablation.

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• Ambulatory phlebectomy involves making tiny cuts to remove small veins close to the skin's surface. It's often done at the same time as endovenous thermal ablation or vein stripping.

Another option, endoscopic vein surgery, is typically used only for varicose veins that are causing skin ulcers.

Although most procedures used to treat varicose veins can be done on an outpatient basis, be sure to ask about health risks, possible side effects and needed recovery time. It's also important to know what results you can expect. Although most procedures are effective, it's possible for varicose veins to recur or require several treatments.

You may also want to inquire about insurance coverage. Most policies don't cover the cost of purely cosmetic procedures. However, insurance may cover treatments used to relieve pain, swelling, or other signs and symptoms of varicose veins. — Robert McBane, M.D., Cardiovascular Diseases, Mayo Clinic, Rochester.

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