Varicose Veins


Varicose veins are the bulging blue and purple veins that typically appear in legs.

Approximately 20 percent of adults in western countries have them.

Dr. Amy Coulter and Dr. Michael Zammit, vascular surgeons with EvergreenHealth Heart and Vascular Care, dispel some common myths about the causes of varicose veins and discussed how these veins are treated.


What are varicose veins?

Dr. Michael Zammit:  Varicose veins are the blue or purple tube-like visibly obvious veins that can appear in men and women, most often on the legs, beginning as early as the age of 25.

While varicose veins are considered to be the most common chronic condition of the venous system, their presence is most often a cosmetic nuisance and doesn’t pose a threat to patients’ health.

It is estimated that approximately 20 percent of adults in western countries have varicose veins.

In over two thirds of patients with the condition, varicose veins first appear before the age of 25 and up to 75 percent are found to have a family member with the condition as well.


What causes varicose veins and can they be prevented?

Dr. Amy Coulter:  Any vein may become varicose, but the condition most frequently occurs in veins in the legs and feet that send blood back to the heart.

They occur when vein valves fail and there is an increased amount of pressure on the venous system, which causes the veins to swell up and become “stretched out” over time to accommodate the increased pressure and blood flow.

Factors that increase the risk of developing varicose veins can include old age, pregnancy and hormonal changes, family history, obesity, and sitting or standing for long periods of time.

For women who develop varicose veins during pregnancy, they often disappear within 12 months of giving birth.

A commonly held myth is that sitting with crossed legs can promote varicose veins – numerous studies have shown that to be false.

However, there are lifestyle factors that can contribute to the condition, including weight-gain and long periods of sitting and standing.

Patients might experience pain, but not always – symptoms might be purely cosmetic.

However, painful symptoms can include aching, burning, throbbing, muscle cramping, itching and swelling of the lower legs.

These are good indicators that you should consult with your doctor.


What are the treatments for varicose veins?

Dr. Zammit:  At EvergreenHealth, doctors specializing in vascular care meet with patients to evaluate their symptoms and recommend a treatment plan, which often begins with simple self-care measures.

Exercising, wearing loose clothing or compression socks, elevating the legs and avoiding long periods of standing or sitting can help ease pain and prevent the condition from worsening.

As part of the evaluation, providers use diagnostic imaging, including ultrasound, to check for the presence of upstream obstruction, patterns of normal and reversed blood flow, and overall valve function.

The goal of the evaluation is to determine all points of underlying high pressure reflux that feed each region of varicose veins.

Proper varicose vein treatment really means treating the entire path of abnormal venous pressure from beginning to end.

If varicose veins continue to worsen after taking self-care steps, your doctor may recommend further minimally invasive treatments that aim to seal or close-off the vein with injections or laser treatment, and in the most advanced cases, surgery may be recommended.


Image of Dr. Amy Coulter, a vascular surgeon with EvergreenHealth Vascular Care in Kirkland, WA.

About Amy Coulter, MD

Dr. Amy Coulter is a board-certified vascular surgeon with EvergreenHealth Vascular Care, specializing in the diagnosis and treatment of peripheral vascular disease.

Read Dr. Amy Coulter's full profile

Visit the EvergreenHealth Vascular Care website


Image of Dr. Michael Zammit, a fellowship trained vascular surgeon doctor specializing in aortic aneurysm at EvergreenHealth Vascular  Care in Kirkland, WA.

About Michael Zammit, MD

Dr. Michael Zammit is a board-certified vascular surgeon with EvergreenHealth Vascular Care, specializing in ultrasound, percutaneous endovascular therapies and wound care.

Read Dr. Zammit's full profile

Visit the EvergreenHealth Vascular Care website