Introduction

Varicose veins are often dismissed as a “cosmetic problem,” but for many patients, they are a source of pain, swelling, restless nights, and limitations in daily life. As a clinician, I frequently see patients whose quality of life is significantly impacted by untreated vein disease.

Today, I want to share the story of a patient who came to me struggling with large varicose veins, restless leg symptoms, and daily leg discomfort. Her journey demonstrates not only the real impact of chronic venous insufficiency but also the effectiveness of modern, minimally invasive treatments.

The Patient’s Story

A 52-year-old woman presented to my office with large varicose veins in both calves. She described her legs as:

• Cramping at night, often waking her from sleep
• Restless and uncomfortable, especially in the evenings
• Heavy, fatigued, and swollen by the end of the day
• Itchy and irritated, with skin changes around her ankles

What bothered her most was that her symptoms were preventing her from doing what she loved most: trail hiking. The combination of swelling, pain, and fatigue was keeping her from the outdoor activities that once brought her joy and stress relief.

This is a common theme in patients with venous insufficiency — the disease doesn’t just change how legs look, it limits how people live.

Clinical Evaluation

During her consultation, I performed a venous duplex ultrasound, the gold standard test for evaluating vein function. The results revealed:

• Bilateral great saphenous vein reflux – the main superficial veins in both legs were not functioning properly.
• Saphenous tributary reflux – smaller branches feeding into the great saphenous vein were also incompetent.
• Extensive reticular veins and spider veins – visible surface veins contributing to cosmetic concerns and discomfort.

On physical examination, additional findings included:

• Hyperpigmentation – brownish discoloration of the skin near the ankles from chronic venous pressure.
• Corona phlebectatica – clusters of small veins around the ankle, often a marker of advanced venous disease.
• Leg swelling – evidence of fluid buildup, particularly after prolonged standing.

Together, these findings confirmed the diagnosis of chronic venous insufficiency with symptomatic varicose veins.

Why These Findings Matter

It’s important for patients to understand that varicose veins are not just a cosmetic nuisance. When veins fail to move blood properly back to the heart, pressure builds in the legs, leading to a cascade of symptoms and complications:

• Pain, aching, and cramping
• Swelling and heaviness
• Restless leg symptoms
• Itching, skin changes, and discoloration
• Increased risk of venous ulcers if left untreated

In this patient’s case, her restless legs and nighttime cramping were directly tied to venous reflux. The constant pooling of blood was creating discomfort that disrupted her sleep and drained her daytime energy.

Treatment Plan

After reviewing her ultrasound findings and discussing treatment options, we designed a comprehensive, minimally invasive treatment plan tailored to her condition.

1. Endovenous Laser Therapy (EVLT)

EVLT was used to treat the great saphenous veins in both legs. This procedure uses laser energy delivered inside the vein to gently heat and close it, rerouting blood flow into healthier veins.

• Performed in-office under local anesthesia
• No incisions, only a small catheter entry point
• Walking immediately after treatment

2. Ultrasound-Guided Foam Sclerotherapy

Her saphenous tributaries were treated with foam sclerotherapy. Using ultrasound guidance, a medicated foam was injected directly into the faulty veins, causing them to close and eventually be reabsorbed by the body.

3. Visually Guided Sclerotherapy

To address her reticular veins and spider veins, we performed visually guided sclerotherapy. This targeted the smaller surface veins, improving both symptoms and cosmetic appearance.

The Results

Within one month of treatment, the transformation was remarkable:

• Her large varicose veins were gone.
• Nighttime cramping and restless legs resolved, allowing her to sleep through the night.
• Swelling and heaviness improved significantly, leaving her legs feeling lighter.
• The itching and skin irritation stopped.
• Most importantly, she was able to return to trail hiking — the activity that brought her the most joy.

Her post-treatment ultrasound confirmed successful closure of the refluxing veins, and her legs both looked and felt dramatically healthier.

Why Minimally Invasive Vein Treatments Work

Modern vein treatments like EVLT and sclerotherapy directly address the root cause of venous insufficiency — faulty valves and refluxing veins. By closing off the diseased veins and rerouting blood into healthy pathways, we relieve the pressure that causes pain, swelling, and skin changes.

Unlike older surgical vein stripping procedures, today’s treatments are:

• Performed in-office with local anesthesia
• Minimally invasive, requiring no major incisions
• Quick (30–60 minutes) with immediate walking
• Highly effective, with success rates above 90%
• Associated with minimal downtime — most patients return to normal activities within 24 hours

Lessons from This Case

This patient’s journey highlights several important points about chronic venous insufficiency:

1. Symptoms matter. If you have restless legs, swelling, or leg cramping, it may be more than fatigue — it could be vein disease.
2. Early intervention prevents complications. Left untreated, CVI can progress to skin damage, ulcers, and more serious problems.
3. Treatment is life-changing. Beyond cosmetic improvement, restoring healthy circulation improves sleep, energy, and overall quality of life.
4. Modern procedures are safe and effective. Patients no longer have to fear painful vein surgery — today’s options are comfortable, efficient, and long-lasting.

Practical Advice for Patients with Varicose Veins

If you are experiencing similar symptoms — aching legs, swelling, itching, cramping, or visible varicose veins — here are steps to take:

• Schedule an evaluation with a vein specialist. Only a venous ultrasound can confirm whether you have reflux and which veins are involved.
• Start conservative measures. Compression stockings, leg elevation, and regular walking can help temporarily relieve symptoms.
• Don’t wait. Vein disease is progressive. Early treatment prevents worsening symptoms and complications.
• Know your options. EVLT, radiofrequency ablation, and sclerotherapy are safe, proven treatments available in-office.

Conclusion

Chronic venous insufficiency is a common but often overlooked condition that can dramatically affect quality of life. For this 52-year-old patient, modern vein treatment eliminated her symptoms, restored her ability to stay active, and gave her back her quality of life.

Her story is a powerful reminder that vein disease is not just cosmetic — it’s medical. And with today’s minimally invasive options, patients no longer have to live with pain, swelling, or restless legs.

If you or someone you love is struggling with varicose veins or leg symptoms, a consultation and venous ultrasound may be the first step toward healthier legs and a healthier life.

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