Up to 55 percent of women suffer from some type of vein problem, according to the U.S. Department of Health and Human Services Office on Women’s Health. 

That’s 10 percentage points higher than the share of men who have similar issues, and varicose veins affect about half of Americans 50 years and older, federal statistics say.

Dr. Lindsay Gates, a vascular surgeon with Rockwood Health System here, agrees with those figures, saying, “In the U.S., 50 percent of adults have some sort of vein pathology, and a fourth of those have underlying pathologies that are more concerning, but are treatable.” 

Gates started at Rockwood in August and says about 80 percent of her patients are women. She says while vein issues can affect patients at any age, women of childbearing age, as well as those in their 40s and 50s, tend to notice them first. 

 “A lot of vein issues are genetic, or related to hormone changes and pregnancy,” she says. “Part of it is that women tend to be more cognizant of cosmetic issues, versus men, who won’t come in unless something is really bothersome.”  

Gates says she mostly sees patients at the Rockwood Heart and Vascular Center, located within the Deaconess Health and Education Center, at 910 W. Fifth. She also sees patients at the Rockwood Clinic facility at 1414 N. Houk, in Spokane Valley. 

According to Gates, most patients first come in because they’ve started to notice cosmetic vein issues, such as swelling, bulging, and discoloration, most often in the lower extremities. 

“This goes beyond just whether your legs look good or not,” she says. “When a patient comes in with these first signs, what we want to do is focus on ruling out any possible underlying problems.” 

Leg veins in particular, Gates says, are responsible for carrying blood back to the heart, pushing it up from the lower body against the flow of gravity. 

“When I talk about veins, I like to use the example of a freeway system,” she says. “The venous system is the freeway, and superficial veins are like side streets. When blood flow starts to be impeded in the deeper system, it backs up onto those side roads, creating varicose veins. Our goal is to redirect that flow back to the main freeway.”

She says varicose veins and spider veins are two of the most common vein issues for which patients initially seek treatment.

Gates describes varicose veins as enlarged veins that often are swollen, or bulging, and seem raised above the skin’s surface. She says they can appear to be blue or red in color, and are commonly found on the thighs, backs of the calves, or inside of the leg. 

“All veins have valves, or doors that prevent blood from flowing backwards as it moves up the legs,” she says. “When those valves are damaged, blood can leak back into the veins, pooling and causing swelling, aching, and pain.”

She says spider veins tend to affect smaller, superficial veins, but also are caused by similar issues with the backup of blood. They also can be red, blue, or purple in color, appearing on the surface of the skin in places like the ankles, and the back of the leg. 

In addition to outward cosmetic signs like skin discoloration, damaged veins also can be accompanied by symptoms such as aching, swelling, itching, and heaviness in the legs.  

While the majority of her patients are women, Gates says anyone noticing discolored veins, bulging veins, or other symptoms should speak with a doctor. 

 “We see many of these symptoms in people with jobs that involve standing or sitting for long periods,” she says. “They start to notice aching or a heaviness in their legs after long periods. That only gets worse over time.” 

As for treatment, Gates says she usually starts by recommending compression therapy, which typically involves wearing socks or stockings that are specially designed to support veins and increase circulation in a patient’s legs. 

“Compression therapy can help decrease swelling and improve circulation. We usually start by fitting the patient for compression stockings and consulting with them about lifestyle changes.”

She says lifestyle changes can include things such as increased exercise, weight loss, adding breaks during work to get up and move around, or elevating the legs in the evening. 

Most patients who begin compression therapy and follow through with lifestyle changes don’t need to seek further treatment, but varicose and spider veins also can point to deeper issues, Gates says.

“As part of the diagnostic process, when we see varicose or spider veins, we make sure to do an ultrasound as well to check for underlying issues that may require more in-depth treatment,” she says.

She says underlying conditions that can be found using an ultrasound include deep venous system malformations, blood clots or a malignancy putting pressure on veins in the abdominal or pelvic areas. Another potential cause is a rare condition called May-Thurner syndrome in which the main vein in the pelvis is compressed, causing pain and clotting. 

“These are issues we do find fairly routinely using ultrasound evaluations,” she says. “Many people aren’t aware of the underlying cause of their symptoms and are surprised to realize how big a difference treatment makes in their overall lifestyle.” 

Gates says most surface treatments for veins are considered cosmetic and aren’t usually covered by insurance. 

However, if after a trial period of compression therapy and lifestyle changes, the patient is still experiencing symptoms, insurance typically will cover more invasive vein treatment procedures. 

She says the most common treatments of vein issues include endovenous techniques, in which a catheter is inserted into the vein and either radiofrequency or laser energy is used to heat the vein and to seal it off; and sclerotherapy, which uses a needle to inject a chemical into the vein that causes it to swell and seal shut.

Gates says she usually recommends that patients undergo a combination of the endovenous radiofrequency procedure and sclerotherapy for best results. 

“I prefer the radiofrequency to the laser option, because I’ve found patients respond better,” she says. “Over the long term, the results are fairly equivocal, but occasionally laser treatments can cause side effects like skin discoloration.”

While no treatment is free of potential complications, she says most vein-focused treatments are low-risk, outpatient procedures that can be completed within 30 minutes.

“A high percentage of our patients are able to find relief from symptoms, and get back to enjoying life and work,” she says.

Gates says surgical options such as phlebectomy and vein stripping are available to treat larger varicose veins. In both of those treatments, problem veins are tied shut and completely removed from the leg. Because they are more invasive, such procedures need to be done in an operating room using general anesthesia, and can include a short recovery period.  

As for preventing vein issues, Gates says patients should be aware of any genetic factors, medical history, and lifestyle habits that may put them at greater risk. 

“If your family has a history of vein issues, or you’re a woman who’s had multiple pregnancies, you should be keeping an eye out,” she says. “I’ve seen many women who start to notice these issues following a pregnancy.” 

She says when someone first begins to notice symptoms, starting to wear compression stockings or hosiery can go a long way toward preventing further issues. 

“I recommend putting them on the morning before you start work, and taking them off when you get home at night,” she says. “Small lifestyle changes like getting up and moving around occasionally can help too. Overall, the key is to remember to be consistent.” 

Originally from Ohio, Gates attended medical school at Wright State University School of Medicine in Dayton, Ohio, and completed her surgical training at Yale New Haven Hospital in New Haven, Conn.

She says what she likes about Rockwood Health’s approach to vein care is that it’s both comprehensive and efficient. 

 “Services are integrated so patients can visit their primary care physician about symptoms, obtain an ultrasound image and evaluation from a vascular surgeon, identify the root problem, and obtain treatment quickly,” she says. 

“We cover the whole realm of vascular surgery here, including both minimally invasive and larger surgical procedures, working as a team to help patients have the best chance at improving their life.”