How the leg veins normally work
The superficial and deep veins return blood from the legs to the heart. Calf-muscle contraction acts as a pump, while one-way valves limit backward flow. Symptoms develop when valves fail, veins dilate, outflow is obstructed, or several mechanisms combine to create venous hypertension.
What is chronic venous insufficiency?
Veins in the legs return blood to the heart against gravity. One-way valves normally prevent blood from falling backward. When valves fail, blood can reflux and pool, increasing venous pressure. Over time this can produce dilated veins, aching, heaviness, edema, itching, skin discoloration, inflammation, and—in advanced disease—venous ulcers.
Common symptoms and signs
Symptoms
- Aching, heaviness or fatigue
- Swelling, especially later in the day
- Burning, itching or throbbing
- Night cramps or restless legs
- Tender varicose veins
Visible findings
- Spider or reticular veins
- Bulging varicose veins
- Ankle edema
- Brown skin pigmentation
- Lipodermatosclerosis or ulceration
How vein disease is diagnosed
A focused history and physical examination are usually followed by duplex ultrasound. Ultrasound can map superficial and deep veins, demonstrate reflux, identify prior thrombosis, and show which venous segments are actually responsible for symptoms. Treatment should be anatomy-driven rather than based only on appearance.
Treatment options
Not every patient needs a procedure. Treatment may include exercise, weight management, leg elevation, compression therapy, skin care, and treatment of associated edema. When symptomatic reflux persists, minimally invasive options may include thermal ablation, medical adhesive closure, mechanochemical ablation, foam or liquid sclerotherapy, and treatment of residual tributary veins.
Dr. Shiloh's publicly listed procedural experience includes endovenous laser therapy, VenaSeal, Varithena, ClariVein, ultrasound-guided sclerotherapy, and visual sclerotherapy.
What happens after treatment?
Most contemporary superficial venous procedures are outpatient treatments performed through a needle puncture or very small access site. Walking is generally encouraged soon afterward. The exact use of compression, activity restrictions, and ultrasound follow-up depends on the procedure and the individual patient's anatomy and risk profile.
When vein symptoms may signal something else
New one-sided swelling, sudden pain, redness, shortness of breath, chest pain, or a nonhealing wound deserves prompt medical evaluation because venous symptoms can overlap with deep-vein thrombosis, infection, arterial disease, heart or kidney disease, and other conditions.
Procedure Video
See an endovenous ablation procedure
Educational demonstration of endovenous ablation. Third-party educational video; technique and equipment vary.