Society for Clinical Vascular Surgery
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Questions every patient should ask their doctor
prior to signing a consent for vascular intervention.

Sponsored by the SCVS Ad Hoc Committee on Patient Advocacy.


  1. What is the cause of my varicose veins and why does my family have large bulging veins and other people only have spider veins?

    Bulging veins are frequently caused by valvular insufficiency. Valves act as one-way shutters to keep the blood moving back toward the heart. Patients may also have a large amount of swelling if they have a component of obstruction or blockage. Some of the smaller vessel dilatation is due to hormones while larger bulging veins are most often due to valvular dysfunction. Some patients have a decreased number of valves and some patients have decreased function of the valves.

  2. Why do I have swelling at the end of the day?

    Swelling at the end of the day may be caused by fluid leaking outside of the veins and into the soft tissues. Initially this will come and go and resolve with elevation and rest overnight. However, eventually there will be a buildup of fluid and protein in the soft tissues causing darkening of the skin and loss of shape, which then may become irreversible. Compression stockings can help to delay and slow down this progression. Weight loss and exercise are also helpful.

  3. What can be done for my bulging veins and also what can be done for my spider veins?

    There are basically three ways to treat varicose veins. You can remove them completely with stripping or avulsion, you can injure the vein by using laser or radiofrequency causing heat injury, or you can inject them with foam or sclerotherapy which causes chemical injury to the cells lining the veins. Each of these treatment options will have different benefits and risks as well as recurrence and recovery periods. It is important to clarify with your doctor what the treatment plan is and what the recovery and restrictions will be. Some treatments may result in worsening swelling.

  4. Will insurance pay for my varicose vein treatment? What is fee splitting and how does the determination for the medically necessary and cosmetic portions work?

    The answer is critically important for everyone. The answer is variable. There is fee splitting that may be done dividing the treatment into a medically necessary portion and a cosmetic portion so that a part of the treatment may be covered by your insurance and part may require out-of-pocket expenditure. It is very important to clarify what the costs are, what the insurance is expected to pay, as well as what your out-of-pocket costs will be.

  5. What are my post treatment restrictions and limitations? How active can I be? Is this going to be done in the office or in the hospital? What type of sedation or anesthesia will be required? Will I need more than one treatment?

    The answers to these questions are varied. All of these questions need to be answered. Make sure your expectations are realistic.

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