Unlike arteries in the leg, veins are thin-walled, low pressure tubes that return blood from the periphery to the heart. Vein branches, that sit directly under the skin frequently are subjected to higher vein pressures and enlarge over time. In addition, these enlarged veins often follow typical patterns of appearance and can remain symptomless despite growing huge and complex. The reasons for veins being subjected to increased pressure are numerous but can be narrowed during an evaluation by a vein surgical specialist. Genetics and to a lesser extent increasing age, occupation, obesity and multiple pregnancies contribute predisposing factors to varicose vein development and elevation of vein pressure. Strangely, large and symptomatic varicose veins can develop in the late teenage years, suggesting that genetics plays an important role in varicose development. Varicose veins do often become painful or ache contributing to leg fatigue and a feeling of heaviness. More significant symptoms result from a clot forming in one of these superficial veins. Hot, tender and throbbing discomfort is typical when this occurs and is termed “superficial thrombophlebitis”. Although clots in these veins do not usually travel to the deeper vein systems or to the lungs, they do often signal problems with the deeper veins and should warrant an evaluation by a vein surgical specialist. Treatment of varicose veins are indicated when they become painful or ache or contribute to ankle and foot swelling. A more alarming event is when these veins get so large and tense they actually bleed through the thinned out skin covering them. This is often a medical emergency as the bleeding can be profuse and require suture closure for temporary control. This patient should be promptly referred to a vein surgical specialist for definitive therapy. While historically conservative measures such as compressive stockings, weight loss and exercise were recommended for the more minor symptoms, doctors and even now some insurance carriers are eliminating this requirement before recommending minimally invasive surgical treatments. These treatments take the form of closing off larger feeding veins with laser therapy and/or actual removal of the varicose veins with tiny incisions and local anesthesia. Use of scleroscent drugs injected into these veins is also a treatment option. Occasionally, patients request removal of these unsightly veins for cosmetic reasons. Regardless of the issue, Dr. Dworkin at Vein Specialists of Tampa uses a variety of minimally invasive techniques that result in a very satisfactory medical and cosmetic result. Occasionally, patients request removal of these unsightly veins for cosmetic reasons. Regardless of the issue, Dr. Dworkin at Vein Specialists of Tampa uses a variety of minimally invasive techniques that result in a very satisfactory medical and cosmetic result.