Rapid City, S.D. – Leg pain, swelling, and bulging veins are problems many people quietly live with for years. At a recent Doc Talk Live event at the Matthews Opera House Arts Center, a local surgeon explained that those symptoms are far more common than most people realize, and often very treatable.

During a live question-and-answer session, Dr. Nicholas Czosnyka, a general surgeon with Spearfish Clinic, spoke with a Rapid City audience about vein health, focusing on the causes of varicose veins and the minimally invasive procedures now used to treat them.

The discussion centered on vein ablation, a modern treatment for chronic venous insufficiency, a condition where blood struggles to move efficiently out of the legs.

“Varicose veins are extremely common,” Czosnyka told the audience. “When you talk about big varicose veins you can see across the room, maybe twenty percent of people have something like that. But smaller spider veins or veins becoming more prominent over time may affect eighty or ninety percent of people.”

When Veins Stop Working Properly

Czosnyka explained that veins play an essential role in returning blood to the heart. In the legs, that job is especially challenging because blood must travel upward against gravity.

Inside the veins are small one-way valves that keep blood moving in the right direction. Over time, those valves can weaken or stretch, allowing blood to flow backward and pool in the legs.

“When blood is returning out of your limbs, it’s pumping up against gravity,” he said. “Those valves help blood move step by step back toward the heart. When veins stretch and the valves stop working well, that’s when we start seeing venous insufficiency and varicose veins.”

As pressure builds in the veins, patients may notice aching legs, swelling, restless legs at night, skin discoloration, or in severe cases, wounds that struggle to heal.

Symptoms Matter More Than Appearance

One of the key points Czosnyka emphasized during the event was that treatment decisions are based primarily on symptoms rather than appearance.

“The most important factor when assessing a patient’s need for treatment is their symptoms,” he said. “If we don’t have a symptom that we’re making better, then the desire to have veins not be there isn’t usually considered a good medical indication for intervention.”

That means the first steps in treatment are often conservative.

Doctors typically recommend simple lifestyle adjustments, such as elevating the legs during rest or taking breaks from standing for long periods. Compression stockings are also commonly used to help support veins and improve circulation.

“If symptoms are mild and compression stockings help, that can be a great endpoint,” Czosnyka said. “Sometimes nothing more needs to be done.”

When Procedures Become an Option

If symptoms persist despite conservative treatment, physicians may evaluate patients for minimally invasive procedures.

Czosnyka outlined three primary treatments used for vein disease:

• Sclerotherapy, an injection that scars small veins closed
• Phlebectomy, a minor surgical procedure that removes segments of visible veins
• Vein ablation, a technique that closes problematic veins from the inside

Before recommending any procedure, patients typically undergo an ultrasound exam to identify where blood is flowing incorrectly in the veins.

“We want to know where the reflux is happening and how extensive it is,” he said. “That helps us determine which treatment makes sense.”

How Vein Ablation Works

The most common treatment for larger vein problems today is radiofrequency vein ablation, a same-day procedure performed in a clinic setting.

During the procedure, a small catheter is inserted into the vein using ultrasound guidance. The device heats the inside of the vein, causing it to collapse and seal shut.

“Instead of physically pulling the vein out like older vein stripping procedures, ablation burns the vein closed from the inside,” Czosnyka explained.

Once the damaged vein is closed, blood naturally reroutes through healthier veins nearby.

Patients remain awake during the procedure and typically return home the same day.

Recovery and Results

Recovery is generally measured in days rather than weeks. Most patients manage discomfort with over-the-counter medications and can return to normal activity quickly.

“There will be bruising and some healing that takes place over a few weeks,” Czosnyka said. “But most people tolerate the procedure very well.”

Long-term outcomes are strong, with success rates typically in the high 90 percent range for improving symptoms and reducing problematic veins.

Why Vein Problems Are So Common

During the audience Q&A portion of the event, one attendee asked why varicose veins appear so frequently.

Czosnyka said modern lifestyle patterns likely play a role.

“If you combine sedentary lifestyles with weight gain and jobs that don’t require us to move, those are probably two of the biggest issues,” he said. “Our muscles help push blood out of our legs, so when we don’t move, blood doesn’t move as well either.”

A Treatable Condition

The takeaway from the evening was that vein disease, while common, does not have to be something people simply live with.

Patients experiencing persistent leg pain, swelling, or visible vein changes can begin by discussing symptoms with a primary care provider or contacting a vein specialist directly.

“If conservative treatments don’t work and there’s evidence of reflux, ablation is a very successful and very tolerable procedure,” Czosnyka said. “Most patients see real improvement.”

For many people, that improvement means something simple but meaningful: legs that feel better at the end of the day.