Treating varicose veins

Twisted, bulging varicose veins occur when the valves in veins just under the surface of the skin malfunction, allowing blood to back up and pool. They're usually not serious since other veins deeper in the leg compensate for the reduced flow. But they can cause pain, sores, swelling, tender lumps, and other symptoms.

There are many pills and lotions that claim to help the problem, but there is little solid evidence to back up most of those claims. And while there are several proven medical treatments, they all pose some risks and may not be covered by insurance. So people with varicose veins should start with these lifestyle measures:

• Don't cross your legs while sitting, and get up and move every half hour or so.
• Avoid standing for long periods; if you must, shift your weight from leg to leg.
• Elevate your legs when resting.
• Avoid tight clothing around your groin, legs, and waist.
• Walk, jog, or do other leg exercises.
• Lose excess weight.
• Cut back on salt to limit swelling and eat lots of fiber to prevent constipation, which may worsen varicose veins.
• Wear compression stockings, which help reduce pooling and swelling.

If self-help steps aren't sufficient, talk with a doctor about these treatments for varicose veins:

Liquid sclerotherapy involves injecting a chemical into the affected veins, causing them to collapse and be absorbed into the surrounding tissue. But it only works on small veins and is typically done for cosmetic purposes.

Foam sclerotherapy, used on larger veins, mixes the chemical with air to make a foam. But in very rare cases it may travel through the blood to the eyes, impairing vision, or possibly even to the brain, triggering a stroke.

Thermal ablation is the most common treatment for severe varicose veins. A doctor makes a tiny incision and inserts a thin tube into the vein that seals it off with heat from radio waves or a laser. If necessary, the doctor can extract remaining varicose veins using hooks passed through skin punctures.

Conventional surgery requires admission to a hospital or surgery center and general anesthesia. A surgeon makes one cut to tie off the vein and another cut to pull it out. Get a second opinion if your doctor recommends surgery instead of one of the simpler procedures described above.

• Ask your physician to recommend a comprehensive varicose vein center, because you may need a combination of therapies.
• Avoid treatment if you have peripheral artery disease or are pregnant or less than three months postpartum. Breast-feeding women should postpone sclerotherapy.
• Ask your insurance company if the procedure you're considering will be covered. Insurers may view a procedure medically necessary—and therefore reimbursable—for certain vein problems but cosmetic or experimental for others, in which case it would be denied.

Without coverage, you might pay $300 to $400 for liquid sclerotherapy, $1,500 for foam injection of a large vein, $4,000 to $5,000 for thermal ablation, and $12,000 or more for surgery.