More than 25 million Americans have varicose veins, and more than 6 million are living with advanced chronic venous insufficiency (CVI), the progressive stage of vein disease that causes leg swelling, skin changes, and eventually open wounds, according to AHA Circulation. Yet most people diagnosed with it arrive at the doctor's office after years of symptoms that went unrecognized, dismissed, or incorrectly attributed to something else entirely.

That delay is not random. It follows a pattern. Men, younger working-age adults, and women of color each carry a disproportionate share of venous disease while remaining among the least likely to be evaluated, diagnosed, and treated early.

To understand why, we consulted Sanjiv Lakhanpal, MD, FACS, Founder, President, and CEO of Center for Vein Restoration (CVR), the nation's largest physician-led vein practice with 130+ locations across 23 states. Over decades of clinical practice, Dr. Lakhanpal watched preventable venous disease progress in patients who were never told they were at risk. That experience shaped CVR's founding mission: to bring specialist-level venous care to every patient who needs it, not just those who fit the classic profile.

If you have been told your leg symptoms are "just aging," "just your job," or "nothing serious," keep reading. What you learn here may change what happens next.

Venous Disease by the Numbers: Who Is Really at Risk

Most people picture a patient with venous disease as an older woman with visible varicose veins. The honest answer to who really gets venous disease is far more people than that, and far younger, more diverse, and more male than the standard profile suggests. That gap between perception and reality has real consequences for the millions of people who don't fit the classic picture.

A 2023 multi-institution study published in the Journal of Vascular Surgery: Venous and Lymphatic Disorders, analyzing 2,346 patients across four major U.S. hospitals, found that male sex, Black race, and low socioeconomic status are each independently associated with more advanced venous disease at the time of first presentation. In other words, the patients arriving with the most serious disease are not the ones the standard clinical profile predicts.

A separate analysis of more than 66,000 patients presenting for venous disease evaluation found that skin changes and venous ulcers were disproportionately common in African American patients, and that pain as a first symptom was more prevalent among African American, Asian, and Hispanic patients than White patients. These are not minor statistical differences. They point to a systemic gap between those who actually carry the burden of venous disease and who are evaluated early enough to prevent the worst outcomes.

According to the NIH/NLM, CVI is a progressive condition, meaning it worsens over time without treatment. Every year that passes without a diagnosis is a year the disease is likely to advance.

Do You Have Vein Disease Symptoms? Find Out Before They Get Worse
If you recognize any of the symptoms above, a venous evaluation is the right next step, and it does not require a referral or a long wait. CVR's vein specialists provide comprehensive duplex ultrasound assessments at 130+ locations across 23 states. 

📍 Find a Center for Vein Restoration near you 
📞 Speak to a CVR Patient Services Representative at 240-249-8250
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If You Work on Your Feet, Your Risk May Be Higher Than You Think

Most people assume venous disease is something that happens with age. The research tells a different story.

Occupation is one of the strongest independent risk factors for venous disease, and it operates regardless of age, weight, or family history. A landmark prospective study of more than 1.6 million Danish workers, published in PubMed, found that workers who stood for more than 75 percent of their workday had a risk ratio of 1.85 for varicose vein hospitalization among men and 2.63 among women, compared with workers in other positions. A 12-year follow-up study of more than 9,600 workers, also published in PubMed, confirmed these findings and estimated that prolonged occupational standing accounts for more than one-fifth of all varicose vein cases in working-age adults.

The reason is mechanical. When you stand for long periods without walking, the calf muscle pump, the body's primary mechanism for pushing blood back toward the heart, cannot do its job. Blood pools in the lower leg. Pressure builds in the veins. Over time, that pressure damages the valves inside the veins, setting the progression of CVI into motion.

The occupational groups at highest risk include:

• Nurses, medical assistants, and hospital staff
• Teachers
• Retail and hospitality workers
• Factory and warehouse workers
• Food service workers
• Hairdressers and stylists
• Surgeons and operating room staff

These are not niche professions. They represent tens of millions of working Americans, many of them in their 20s, 30s, and 40s.

If you work in one of these fields and have noticed any of the following, venous disease may already be progressing:

• Leg heaviness or aching that gets worse as the day goes on
• Swelling in the ankle or lower leg that improves overnight but returns by afternoon
• Visible varicose veins or spider veins, even if they don't hurt
• Leg cramps, particularly at night
• Skin around the ankle that has darkened, itched, or begun to feel thicker than it used to

These are not symptoms to dismiss as occupational fatigue. They are signs that venous pressure is rising and that the window to prevent more serious disease, including skin breakdown and open wounds, remains open.

Beyond occupation, younger adults may develop venous disease earlier due to family history, a prior blood clot (DVT), obesity, or connective tissue disorders. As the NIH/NLM confirms, CVI is a progressive condition: catching it early produces the best outcomes. Waiting until symptoms are severe does not.

Men: Your Doctor May Not Have Considered Vein Disease 

Venous disease has long been thought of as a condition that primarily affects women. The data do not support that assumption, but it persists and has a measurable impact on how and when men are diagnosed.

The Edinburgh Vein Study found that varicose veins and CVI were actually more common in men than in women after adjusting for age. Despite this, men present for venous evaluation significantly later than women, and the research shows they arrive with more advanced disease when they do.

A 2023 multi-institution study of more than 2,300 patients, published in the Journal of Vascular Surgery: Venous and Lymphatic Disorders, found that male sex was associated with a 16 percent higher risk of advanced venous disease classification at the time of initial presentation compared to female sex. In other words, men are not getting venous disease less often. They are getting it diagnosed less often, and later.

Several factors drive this gap:

• Venous disease remains culturally associated with women, which reduces the likelihood that a man will identify his own symptoms as something worth reporting to a doctor.
• Men are more likely to attribute leg heaviness, end-of-day swelling, and fatigue to physical exertion, long work hours, or aging rather than to a vascular condition.
• Varicose veins can also be less visually apparent in men, particularly those with leg hair, darker skin, or more muscular legs, making self-detection less reliable.

The result is predictable. By the time many men present for venous evaluation, they have been symptomatic for years. The disease that could have been treated with a minimally invasive outpatient procedure has progressed to skin changes, chronic wounds, or more complex vascular pathology.

If you are a man and have been living with any of the following, venous disease deserves to be on your radar:

• Legs that feel heavy, tired, or achy at the end of the day
• Swelling around the ankle that comes and goes
• Leg cramps at night
• Varicose veins, even if they are not painful
• Skin on the lower leg or ankle that has changed color, texture, or thickness
• A wound on the lower leg that is slow to heal or keeps returning

Black Women Face Higher Venous Disease Risk and Lower Rates of Treatment

This section addresses something that health content has too often left unsaid: Black women face a compounded and documented risk for serious venous disease, including deep vein thrombosis (DVT) and pulmonary embolism (PE). Research consistently shows they are less likely to receive the specialist evaluation and treatment that risk warrants.

This is not a matter of opinion or anecdote. It is documented in peer-reviewed research published in some of the world's most respected medical journals.

Higher rates of deep vein clots and pulmonary embolism

Research published in Circulation documents that Black patients have 30 to 60 percent higher rates of venous thromboembolism (VTE), the umbrella term for DVT and PE, than White patients. A study published in PMC confirmed that Black patients have a higher incidence of VTE than White patients across multiple large population cohorts, with statistically significant differences found in multiple studies.

Do not wait for a scheduled appointment if you have sudden leg swelling, pain, warmth, or redness. CVR offers a DVT rule-out service for same-day or next-day diagnosis and treatment plans. Call our hotline number at 877-SCAN-DVT (877-722-6388).

For Black women specifically, the risk compounds further during and after pregnancy, a period when VTE risk is already elevated for all women. The research on sickle cell trait adds another layer: a prospective study published in PubMed found that sickle cell trait, present in approximately 7 to 8 percent of Black Americans, carries a twofold increased risk of pulmonary embolism. Many Black women carrying the sickle cell trait have never been told it affects their vein health.

More advanced disease at the time of diagnosis

A U.S. analysis cited in the original research found that Black patients present with more advanced venous disease at a younger age than White patients, including higher rates of ulceration and DVT at the time of first CVI presentation. Black race was independently associated with a 12 percent higher risk of advanced disease classification at presentation, even after accounting for other variables.

Research in PMC further confirms that Black race is associated with higher VTE rates even after adjusting for age, BMI, and other clinical variables, pointing to structural and biological factors that go beyond lifestyle alone.

A documented treatment gap

Research published in the Journal of the American Heart Association found that Black patients presented with more clinically severe pulmonary embolism than age- and sex-matched White patients yet were less likely to receive advanced interventional treatment after adjusting for clinical and socioeconomic factors. Disparity persists despite disease severity, not because of it.

When to Seek a Venous Evaluation (Even If No One Has Suggested It)

If you are a Black woman experiencing leg swelling, heaviness, skin changes, or pain, seek a formal venous evaluation even if your symptoms feel mild. A family history of blood clots, a prior DVT or PE, sickle cell trait, or a standing occupation each raises your risk further. Combined, they make early evaluation essential. You do not need a referral or a prior diagnosis to get answers.

What a Venous Evaluation Involves

The first step is a duplex ultrasound: a painless, 30-minute imaging test that maps blood flow through your leg veins, identifies faulty valves, and shows how far the disease has progressed. No preparation required.

At CVR, every evaluation begins there. When treatment is appropriate, our board-certified physicians offer minimally invasive outpatient procedures, most commonly endovenous thermal ablation or ultrasound-guided foam sclerotherapy, that close off faulty veins without surgery or significant downtime. Most patients return to normal activity the same day.

How CVR Treats the Vein Disease Behind Your Symptoms

Center for Vein Restoration is the nation's largest physician-led vein practice, with 130+ locations across 23 states. Our board-certified physicians are trained to recognize venous disease across the full spectrum of patients affected, not just those who fit the classic clinical profile.

If your symptoms remain unexplained or a wound is not healing as it should, we can help. Find a location, call 240-249-8250, or book online⬇️

Frequently Asked Questions

1. I am in my 30s and work as a nurse. Could I really have venous disease already? 
   Yes. Occupation is one of the strongest independent risk factors for CVI, and age alone does not protect you. Research shows that workers who stand for more than 75 percent of the workday have nearly double the risk of developing varicose veins compared to workers in other positions, regardless of age, weight, or family history.
2. My doctor has never mentioned venous disease. Does that mean I do not have it? 
   Not necessarily. Venous disease is significantly underdiagnosed, particularly in men, younger adults, and patients of color. Symptoms such as leg fatigue, end-of-day swelling, and mild varicose veins are often attributed to other causes.
3. Is venous disease in men different from venous disease in women? 
   The underlying biology is the same: faulty vein valves allow blood to pool in the lower leg, creating pressure that damages tissue over time. The difference is in how and when it gets recognized. Men present for evaluation later and, on average, with more advanced disease, which makes earlier detection more important, not less.
4. I am a Black woman and have been told my leg swelling is "probably lymphedema." Could it be venous disease? 
   It is possible, and the two conditions can coexist. Research consistently shows that Black women are at higher risk for both CVI and venous thromboembolism, and that they are more likely to present with advanced disease when they are finally evaluated. A duplex ultrasound is the definitive test to determine whether venous insufficiency is contributing to your symptoms, and it is worth requesting one if you have not had it.
5. What is sickle cell trait, and why does it matter for vein health? 
   Sickle cell trait means carrying one copy of the gene variant associated with sickle cell disease, not the disease itself. Research published in PubMed found it roughly doubles the risk of pulmonary embolism, and it affects an estimated 7 to 8 percent of Black Americans, many of whom don't know they carry it. If you haven't been tested, it's worth raising with your physician, especially if you have a personal or family history of blood clots.
6. Will insurance cover my venous evaluation and treatment? 
   When venous disease causes clinical symptoms, including leg swelling, pain, skin changes, or wounds, treatment is generally considered medically necessary and therefore is typically covered by Medicare and most commercial insurance plans. A CVR insurance specialist will review your specific coverage during your consultation.
7. What is the difference between spider veins and varicose veins, and should I be concerned about either? 
   Spider veins are small, web-like vessels visible just beneath the skin surface. Varicose veins are larger, raised, and often twisted or rope-like in appearance. Both can be signs of underlying venous valve dysfunction. Varicose veins, particularly those that cause symptoms like aching, heaviness, or swelling, are more likely to indicate CVI and warrant a formal evaluation. 

Sanjiv Lakhanpal, MD, FACS, is the Founder, President, and CEO of Center for Vein Restoration, the nation's largest physician-led vein practice with 130+ locations across 23 states. To schedule a consultation or find a CVR location near you, visit centerforvein.com.