Vein Health

Understanding Vein Health

What are varicose veins and what are the causes?

Varicose (VAR-i-kos) veins are swollen, twisted veins that you can see just under the surface of the skin. These veins usually occur in the legs. That's because standing and walking upright increases the pressure in the veins of your lower body. However, they also can form in other parts of your body.

The primary predisposing factor for varicose veins is heredity. Other causes of varicose veins include aging, prolonged standing, obesity, leg injury or prior deep or superficial vein thrombosis. Women are more likely than men to suffer from varicose and spider veins and have a 50 percent chance of developing them in their lifetime. Varicose veins may result from increased hormone levels, blood volume and pressure from the enlarged uterus during pregnancy. Varicose veins that develop during pregnancy generally improve without medical treatment within 3-12 months after delivery.

What are symptoms of varicose veins?

Varicose veins are a common condition. They usually cause few signs or symptoms. In some cases, varicose veins may cause complications, such as mild to moderate pain, blood clots, or skin ulcers.

Signs you may have varicose veins include:

  • Veins that are dark purple or blue in color
  • Veins that appear twisted and bulging; often like cords on your legs
  • When painful signs and symptoms occur, they may include:
    • An achy or heavy feeling in your legs
    • Burning, throbbing, muscle cramping and swelling in your lower legs
    • Worsened pain after sitting or standing for a long time
    • Itching around one or more of your veins
    • Bleeding from varicose veins
    • A painful cord in the vein with red discoloration of the skin
    • Color changes, hardening of the vein, inflammation of the skin or skin ulcers near your ankle, which can mean you have a serious form of vascular disease that requires medical attention

How are varicose veins treated?

Varicose veins are treated with lifestyle changes and medical procedures. The goals of treatment are to relieve symptoms, prevent complications, and improve appearance.

Medical procedures are done either to remove varicose veins or to close them. Removing or closing varicose veins usually doesn't cause problems with blood flow because the blood starts moving through other veins. Fortunately, treatment usually doesn't mean a hospital stay or a long, uncomfortable recovery. Thanks to less invasive procedures, varicose veins can generally be treated on an outpatient basis.

What are the long term effects of varicose veins?

Leaving varicose veins untreated can lead to a variety of serious medical conditions. Most patients with varicose veins report symptoms of itchiness, fatigue, pain and discomfort in the legs, and swelling of the skin. In most cases, these symptoms will only get worse if the patient chooses not to see a medical professional. Individuals that suffer from the condition should schedule a consultation with a board certified Vascular surgeon to learn more about their specific condition, treatment options and recommendations.

Once these varicose veins are removed what is going to happen to my overall health?

Since none of the treatment methods involve large incisions, there are no sutures to worry about. Patients may need to wear bandages and/or compression stockings for a few days following the treatment, but there is very little downtime involved. Most people are back at work within a couple of days. Though there are few activity restrictions after varicose vein procedures, your board certified vascular surgeon will give you specific instructions about how to care for yourself properly following treatment. Your physician may have short term lifting, exercise, or travel limitations based on your history and procedure(s) performed. Click here for post-surgery FAQ

What should I expect when I come in for a consult at the CSA Vein Center of Mid-Missouri?

Our vein doctor is a Board Certified Vascular Surgeon specially trained in the area of vein diagnosis and treatment. Our initial goal in is to identify and understand the causes of a patient's leg pain and swelling, and to inform them of the available treatment options. Whether or not you are bothered by the cosmetics of varicose veins, you should schedule a consultation to learn about all of your treatment options by a board certified and skilled Vascular Surgeon. Sometimes tests or procedures are done to find out the extent of the problem and to rule out other disorders.


First make sure any patient forms including medical history are filled out to the best of your ability before your scheduled appointment begins.

First make sure any patient forms including medical history are filled out to the best of your ability before your scheduled appointment begins.

Physical Examination
During your appointment, we will examine specific areas of concern. This initial screening focuses on your family and vascular history, leg and vein symptoms, and to identify the affected areas. In order to properly examine problem areas, we will have you wear a pair of shorts if possible.

The ultrasound is an important step in gathering information about your veins. This highly specialized examination provides our physicians with a precise map of your venous insufficiencies, so we can tailor procedures specifically for you. The ultrasound and exam allows us to be able to pinpoint the exact cause of your vein related concerns and any leg pain you may be having. A portion of this exam will be done with you standing.

Surgeon Interpretation
Lastly, our board certified specialist will review the ultrasound findings and customize a treatment plan that will have you feeling better as quickly as possible. During this doctor visit, you'll discuss your diagnosis, treatment options, procedures and post-procedure instructions if applicable. One of our office staff can also walk you through details of cost, insurance criteria and answer any questions you may have.

What should I expect during my varicose vein procedure?

Before the procedure starts, we will obtain a set of vital signs. Your entire leg will be prepped or cleaned with a cold orange solution that smells a bit like rubbing alcohol. Your leg will then be covered in sterile drapes. Depending upon your preference, we will talk to you as much or as little about what to expect and when to expect it throughout the procedure. If you are having a laser procedure, the surgeon will start by using an ultrasound and cool gel to view your veins. During this time the room lights are turned down and most patients respond well to the calming environment this creates. Once the vein has been studied and accessed, the surgeon will insulate the vein with numbing medication, usually from around the knee to the groin. This process usually takes several minutes. Once this is completed, the laser is used to close down the vein. Most patients do not feel anything during the laser treatment, which takes about 2 minutes. This procedure is performed through a tiny incision in the leg.

Once the laser portion of the procedure is completed, we will start performing the microphlebectomies if required. (For patients who do not require a laser treatment, this paragraph will describe the microphlebectomy portion of the procedure.) The microphlebectomies will interrupt portions of the visible varicose veins that sit just under the skin. The surgeon will inject numbing medication in the area of the incision(s) and then remove portions of the vein through a very small incision. You should not expect to feel anything painful once the area is numb, but it is common to feel pressure and "tugging." The incisions are too small for a suture, so steri-strip or butterfly bandages will be applied over each tiny incision. The number of microphlebectomies required will depend upon your specific situation. You may have anywhere from 1 to over 30 tiny incisions, but most patients will have somewhere between 10-15. 

At the conclusion of the microphlebectomies, dressings will be placed on your leg and then your leg will be wrapped in an ace bandage, usually from the toes to the groin.

What are my sedation options for varicose vein procedures and what is the recovery process?

The choice of anesthesia is a decision made between the patient and the surgeon based upon your individual preference. In general, these procedures are designed to be minimally invasive, including reduction of risks and down time. This is very much the case in vein procedures which most often can be performed as an outpatient under local anesthesia.

Our patients are offered a full range of anesthesia options:
Locally injected anesthesia at the surgical site. Some patients choose to have the procedure performed using only local anesthetic injected where the surgeon is working; these patients usually do quite well.

Oral sedative and locally injected anesthesia at the surgical site. Some patients choose to take an oral sedative like a valium or Ativan to "take the edge off" before their procedure in addition to the local anesthestic injected where the surgeon is working. These patients usually do quite well.

RN Conscious Sedation and locally injected anesthesia at the surgical site. Some patients who would prefer to be a little more sleepy and forgetful of their procedure, choose to have the procedure performed under a conscious sedation monitored by a Registered Nurse in addition to the locally injected anesthesia at the surgical site. These patients are breathing on their own and often take a little nap during the procedure. This option may require additional monitoring in the recovery room. This option will not allow for the patient to drive or make any important decisions for at least 24 hours following their procedure.

General anesthesia with a board certified Anesthesiologist. Some patients with conditions such as needle phobia will opt to have the procedure performed under a general anesthesia. This option will require additional monitoring in the recovery room. This option will not allow for the patient to drive or make any important decisions for at least 24 hours following their procedure.

Once my varicose veins are treated can they return?

No, they won't come back, but they will appear to return! Women who develop spider veins do so because they are prone to getting them. That is an undeniable and unfortunate fact. So when we get rid of the veins using injection laser ablation or microphlebectomy, that underlying propensity for the veins to develop is still there! Unfortunately, varicose veins or spider veins are, in large part, genetically determined.

What makes the CSA Vein Center of Mid-Missouri different?

The physicians at our vein center are Board-Certified Vascular Surgeons, ensuring you receive the highest possible level of education and training in the physician diagnosing and treating your varicose vein condition. Our goal is to get you back on your feet with minimal interruptions to your busy life, which is why most of our patients get everything done in one procedure per leg; for a total of 2 outpatient surgical visits.

Will my insurance pay for varicose vein procedure?

Ask your doctor if insurance will cover any of the medical cost for your treatment. If done purely for cosmetic reason, the treatment may not be covered. Most insurance requires a trial of conservative management such as use of compression stockings. After this trial, if your insurance requires a prior authorization, our office staff will handle this for you. Every effort will be made to work with your insurance company to arrange your procedure as soon as possible. Allow 6 weeks or longer to schedule the procedure.

To Make an Appointment
Your initial consultation gives you the opportunity to meet our team, learn more about our services and find out which treatment options will best meet your needs.

To schedule a prompt appointment with one of our Board-Certified Vascular Surgeons, please call Vein Center of Mid-Missouri at 573-256-1541

Dr. Salinas
Dr. Sanford
Dr. Adams