What it is
Veins carry blood up the leg against gravity, helped by one-way valves and the squeeze of the calf muscle. In superficial venous disease those valves fail in the veins just beneath the skin — most often the great or small saphenous vein — and blood falls backward instead of climbing. That backward flow is called reflux, and the pressure it creates is what produces every symptom below.
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Bulging, ropey, or twisted veins; clusters of spider veins
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Aching, heaviness, throbbing, or itching, worse after standing
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Ankle swelling; skin discoloration or hardening near the ankle
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Night cramps and restless legs
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When advanced, a venous ulcer →
Superficial disease and deep venous disease look similar from the outside and are treated very differently. Sometimes both are present. Sorting out which is driving your symptoms is the first job.
Why it matters
Varicose veins are not only cosmetic. Untreated reflux raises pressure in the lower leg year after year, and that pressure is what eventually breaks the skin down. The most advanced stage of superficial venous disease is an open ulcer at the ankle.
Risk Factors
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Family history — the strongest single predictor
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Prolonged standing or sitting; occupations that require either
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Pregnancy, and each subsequent pregnancy
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Obesity; older age; female sex
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Prior DVT or leg injury in that limb
Diagnostic Testing
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Venous duplex reflux study, performed standing or on a tilted table — gravity is the thing being tested, and a supine study underestimates reflux. Venous ultrasound →
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Mapping of the saphenous veins and perforators, to plan which vein is actually driving the problem.
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Assessment of the deep system, because treating surface veins in a leg whose real problem is upstream does not fix the leg.
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Ankle-brachial index before any compression is prescribed — compression can do harm when significant artery disease is present.
Treatment Options
Medical & Conservative Therapy
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Graduated compression stockings, once the arteries have been checked.
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Leg elevation and regular walking — the calf muscle is the pump.
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Weight management, which lowers venous pressure directly.
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Skin care to prevent the breakdown that becomes an ulcer.
Conservative care controls symptoms well in early disease and is where most patients start. It does not close a refluxing vein.
Invasive Treatments
All same-day, through tiny punctures or injections, with no general anesthesia.
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Endovenous ablation — closing the refluxing vein from the inside.
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Sclerotherapy for smaller veins and spider veins.
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Ambulatory microphlebectomy for bulging surface veins.
Frequently asked questions
For referring providers — We welcome referrals for symptomatic varicose veins, chronic venous insufficiency, and leg swelling. We map reflux with standing duplex and check an ABI before compression is recommended. Refer: (918) 943-5303 · fax (855) 312-3594.
When to refer: symptomatic varicose veins, leg heaviness or swelling, or skin changes at the ankle. Full referral guide →