What a varicose vein actually is
Veins in the leg have one job that gravity makes difficult: move blood upward, back to the heart. They do it with a series of one-way valves. When a valve stops closing properly, blood falls back down and pools in the vein below it. The vein stretches under the pressure, and a stretched vein is a varicose vein — the rope-like, raised, blue-green cords most people notice first on the calf or the inside of the thigh.
The visible vein is the symptom. The failed valve, usually further up the leg in the great or small saphenous vein, is the cause. This distinction decides everything about treatment: treat the bulge and leave the reflux, and the bulge comes back.
Why it is worth seeing someone
Plenty of people live with varicose veins for years, and some never need anything done. What changes the calculation is symptoms — legs that ache by three in the afternoon, ankles that swell into sock marks, cramps that wake you at night — or the skin changes that suggest pressure has been building for a long time: brown staining around the ankle, dry or itchy patches, skin that thickens and tightens.
Those skin changes are the early part of a path that ends in a venous ulcer, and an ulcer is far harder to treat than the reflux that caused it. Seeing someone while the problem is still “my legs are tired” is the cheap version of this.
How Dr. D’Alessio works it out
Nothing is recommended before the leg is mapped. A duplex ultrasound examination — painless, done standing, about half an hour — watches the blood in each vein segment and measures whether it falls back when it should not. That produces a map of which veins are competent, which are refluxing, and how far the problem extends.
That map is what makes the difference between a treatment plan and a guess. It is also what insurers require, and what tells us honestly whether your aching legs are actually a vein problem at all. Sometimes they are not, and you will be told so.
What treatment looks like
Once the map is in hand, treatment is matched to it:
- Radiofrequency ablation closes a larger refluxing vein — typically the saphenous — using controlled heat through a catheter, under local anaesthetic, in about an hour.
- Varithena® microfoam fills and collapses veins that are tortuous or awkwardly shaped, where a straight catheter is a poor fit.
- Sclerotherapy handles the smaller surface branches and the cosmetic remnants, usually after the underlying reflux has been dealt with.
All three are office procedures. No general anaesthetic, no hospital, no stitches. You walk out, and walking is encouraged — it is how the leg recruits its healthy veins.
What to expect afterwards
Compression stockings for a defined period, walking every day, and no strenuous lifting or hot baths for a short while. Bruising along the treated vein is normal and fades over a few weeks. The ache and heaviness commonly improve before the appearance does, which surprises people — the symptom relief comes from the pressure dropping, and that happens immediately.