context: Varicose veins are large, raised, swollen blood vessels that twist and turn. They usually develop in the legs and can be seen through the skin. Spider veins are smaller, red, purple, and blue vessels that are also twisted and turning. Spider veins are easily visible through the skin as well. They are most often seen on the legs, chest, or face. A number of factors predispose a person to varicose veins. These include: Heredity (passed on from a parent to a child through genes) Occupations that involve a lot of standing, such as seen among nurses, hair stylists, teachers, and factory workers Obesity Hormonal influences during pregnancy, puberty, and menopause The use of birth control pills Postmenopausal hormonal replacement A history of blood clots Conditions that cause increased pressure in the abdomen including tumors, constipation, and externally worn garments like girdles Other reported causes include trauma or injury to the skin, previous vein surgery, and exposure to ultraviolet rays. Varicose veins develop more often in women than in men. They increase in frequency with age. An estimated 30% to 60% of adults have varicose veins, but they are generally not a problem.. Many patients with varicose veins complain of pain, described as an aching or cramping in the legs. Other common symptoms include tiredness, restlessness, burning, throbbing, tingling, or heaviness in the legs. Pain caused by varicose veins is usually relieved by elevating the legs or by wearing support hose. In women, symptoms may be worse during certain parts of the menstrual cycle or during pregnancy. Patients also may develop swelling, ulcers (large sores), and an increase in the pigmentation or darkening of the color of their skin, especially in the ankle region. Occasionally, varicose veins can form a painful blood clot with inflammation of the vein called thrombophlebitis. Treatment options for varicose veins include: Wearing support stockings. The most conservative approach is simply to wear properly-fitting support hose, especially when the veins cause painful or uncomfortable symptoms. These stockings can generally be purchased at any surgical supply store and at some pharmacies. They come in below-the-knee, above-the-knee, and pantyhose styles. Making lifestyle changes. Good skin hygiene, weight loss (if needed), and walking can help treat varicose veins. Eating a low-salt diet helps reduce water retention and swelling. Sclerotherapy. This procedure, which has been available since the 1930s, uses a highly concentrated saline (salt) solution or a specially made detergent that is injected directly into the vein, causing the vein to disappear gradually over three to six weeks. The procedure is simple, relatively inexpensive, and can be performed in an outpatient setting. Endovenous laser treatment. A small laser fiber is inserted into the vein so that pulses of laser light can be delivered inside the vein, which causes the vein to collapse. The procedure is done as an outpatient under local anesthesia. Radiofrequency occlusion. During this procedure, a small catheter is inserted into the vein to deliver radiofrequency energy to the vein wall, causing it to heat, collapse, and seal shut. The procedure is generally done in an outpatient or in-office setting and may be done under local anesthesia. Surgery. Surgical techniques to treat varicose veins include ligation (tying off of a vein) and stripping (removal of a long segment of vein), ambulatory phlebectomy, which allows for the removal of large surface veins through very small incisions that do not need stitches, and endoscopic vein surgery. Surgery may be performed using local, spinal, or general anesthesia. Most patients return home the same day as the procedure. Surgery is generally used to treat large varicose veins. Endoscopic vein surgery uses a small camera to see inside and remove veins. Lasers and intense pulsed light. These devices use heat energy to selectively damage or destroy abnormal veins. An advantage of these treatments is that no needles or sclerosing solutions are required; however, there may be some minor discomfort. Side effects do occur, including discoloration or staining and blister formation. Examples include Vasculight and Photo Derm. Not all patients need treatment for their varicose veins. Many people have no pain or other symptoms. For these individuals, no treatment is necessary, unless they want the veins removed for cosmetic reasons. Many insurance companies do cover the cost of treating deeper varicose veins, but generally not superficial or spider veins. Check with your insurance company to determine which treatment option may be covered under your plan.