Varicose Veins

What Causes Varicose Veins?
Veins, especially those in the legs, have to pump the blood “up hill” to the heart, against gravity. Inside the veins are one-way valves that help with pumping action and prevent blood from flowing backward. These valves allow blood to flow in only one direction, toward the heart. Varicose veins develop when the valves become weakened, damaged, or don’t work well.
Weakness in the valves may be due to weakness in the walls of the veins. This weakness tends to be associated with certain factors, including increasing age, a family history of varicose veins, or high pressure inside veins due to overweight or pregnancy.
When the walls of the veins are weak, they lose their normal elasticity, like an overstretched rubber band. This makes them longer and wider and causes the flaps of the valves to separate. Blood is then able to flow backward through the valves, filling the vein and stretching it even more. The vein becomes enlarged, swollen, and often twisted trying to squeeze into its normal space.
Who Is At Risk for Varicose Veins?
Populations Affected
About 25 million Americans are affected by varicose veins. They are most common in people aged 30 to 70.
Risk Factors
Risk factors for developing varicose veins include:
Genetics. Having a family member with varicose veins may increase the risk for developing them. Approximately half of the people who get varicose veins have a family history of them.
Age. The normal wear and tear of aging may cause valves to weaken and not work as well.
Gender. Women are two to three times more likely to develop varicose veins than men. Up to half of American women have varicose veins. Changes in hormones due to puberty, pregnancy, menopause, or taking birth control pills may increase a woman's risk of developing varicose veins.
Pregnancy. During pregnancy, the growth of the fetus increases the pressure on the veins in the legs. Varicose veins that occur during pregnancy usually improve within 3 to 12 months following delivery.
Overweight and obesity. Having extra weight on the body can put additional pressure on the veins.
Prolonged standing or sitting, particularly with legs bent or crossed. When standing or sitting with legs bent or crossed, the veins have to work harder to pump the blood up to the heart.
What Are the Signs and Symptoms of Varicose Veins?
Common signs and symptoms of varicose veins include:
Enlarged veins that are visible on your skin
Mild swelling of your ankles and feet
Painful, achy, or "heavy" legs
Throbbing or cramping in your legs
Itchy legs, especially in the lower leg and ankle (sometimes incorrectly diagnosed as dry skin)
Discoloration of your skin surrounding the varicose veins
Complications
Only a small percentage of people have complications from varicose veins. Complications may include dermatitis and thrombophlebitis.
Dermatitis
Dermatitis is an itchy rash that can occur on the lower leg or ankle of a person with varicose veins in the legs. It can sometimes cause bleeding or a skin ulcer to develop if scratched or irritated.
Thrombophlebitis
This is a blood clot (thrombus) that occurs in a vein. There are two types of thrombophlebitis:
Superficial thrombophlebitis is a blood clot that occurs in a superficial vein and usually causes only minor problems that are limited to the area of the affected vein. Clots in varicose veins are usually of this type. Infections, chemical irritation, or other conditions that cause irritation and inflammation of the veins also can lead to superficial thrombophlebitis.
Deep vein thrombosis is a blood clot that develops in veins deeper in the body. It can be life threatening if the clot breaks off and travels to the lungs, which is called pulmonary embolism. This type of thrombophlebitis does not occur in varicose veins.
How Are Varicose Veins Diagnosed?
Varicose veins are often diagnosed based simply on the appearance of the veins. For varicose veins in the legs, your doctor will examine your legs while you are standing or seated with your legs dangling. Your doctor may also ask you to describe pain or any other symptoms. Some diagnostic tests may be done to rule out other disorders or conditions.
Specialists Involved
The following specialists may be involved in your medical care if you have varicose veins:
A vascular medicine specialist or vascular surgeon (blood vessel system specialist)
A dermatologist (skin specialist)
Diagnostic Tests and Procedures
Your doctor may order a Doppler ultrasound to evaluate the flow of blood in your veins and to look for blood clots. During a Doppler ultrasound, a handheld device is placed on your body and passed back and forth over the affected area. A computer converts sound waves into a picture of the blood flow in the arteries and veins.
Rarely, your doctor may order an angiogram to look at blood flow through your blood vessels. The procedure involves injecting a dye into your veins that can be seen using x ray. An angiogram can help to rule out other diagnoses besides varicose veins.
How Are Varicose Veins Treated?
Goals of Treatment
The goals of treating varicose veins may include easing symptoms, avoiding complications, and improving cosmetic appearance. Although treatment can target existing varicose veins, it can't keep new varicose veins from forming.
Who Needs Treatment
Varicose veins that cause few signs and symptoms usually don’t need to be treated. Instead, your doctor may recommend simple self-care measures. Varicose veins causing more severe signs and symptoms may need medical or surgical treatment. Treatment may be recommended when the varicose veins are causing skin ulcers, serious skin conditions, blood clots, significant pain, or disruption of daily life activities. Some people with varicose veins may choose to have medical or surgical treatments to improve the cosmetic appearance of varicose veins.
Types of Treatment
Self-Care Measures
Self-care measures are a common option for treating varicose veins. If self-care measures are called for, your doctor may ask you to:
Avoid excess amounts of standing when possible. Take frequent breaks during prolonged periods of standing.
Elevate your legs when sitting, resting, or sleeping. Elevating your legs above the level of your heart is very important.
Wear compression stockings. These are typically worn all day long. Doctors may prescribe special-strength stockings or over-the-counter support stockings, which may be available at pharmacies and medical supply stores.
Exercise. Exercise gets the legs moving and improves muscle tone, which helps the circulation of blood through your veins.
Lose weight. Taking off extra pounds may help with blood circulation and pressure on your veins.
Avoid wearing tight clothes. Tight clothes, especially those that are tight around your waist, groin (upper thighs), and legs, can make varicose veins worse.
Medical and Surgical Treatments
Medical and surgical treatments are used to either remove varicose veins or close them. Removing or closing varicose veins usually doesn’t create circulation problems because the blood reroutes itself through other veins. These therapies range from approaches that don’t involve incisions or injections to those that are surgical procedures. It may be necessary to combine therapies, depending on your condition and lifestyle.
Sclerotherapy. This procedure uses a liquid chemical to close off the vein. The solution is injected into the vein to cause irritation and scarring inside the vein, which causes the vein to close off and fade away. It’s usually used to treat smaller varicose veins and spider veins. Sclerotherapy is usually done in the doctor’s office, while you stand. You may need several sclerotherapy treatments to close off a vein completely. In this case, treatments are typically given every 4 to 6 weeks. Following treatments, your legs are wrapped in elastic bandaging to help healing and decrease swelling.
Microsclerotherapy. This procedure is used to treat spider veins and other very small varicose veins. It involves injection of small amounts of a liquid chemical using a very fine needle. The chemical causes scarring in the inner lining of the veins, causing them to close off.
Laser surgery. This procedure uses no incisions or injections. Light energy from a laser is used to make the vein fade away. Laser surgery is typically used to treat smaller varicose veins. With new technology, lasers are more effective than they used to be.
Endovenous ablation therapy. This procedure uses an energy source (either laser or radiowave) to create heat to close off the vein. A tiny incision is made in the skin, and a small catheter (tube) is inserted into the vein. A device at the tip of the catheter heats up the inside of the vein, which causes it to close off. You’re awake during the procedure, but your doctor numbs the area of the vein. You can usually go home on the same day. You may experience less pain and recover more quickly with this procedure than with some of the others.
Endoscopic vein surgery. This procedure uses a tiny camera at the end of a thin tube to move through the varicose veins. A surgical instrument at the end of the camera is used to close the veins. Endoscopic vein surgery is currently only used in severe cases in which there are skin ulcers due to the varicose veins. Only small incisions are required for this procedure.
Ambulatory phlebectomy. In this procedure, small varicose veins are removed through small incisions in your skin. Ambulatory phlebectomy is typically used to treat varicose veins close to the surface of the skin. You’re awake during the procedure, but your doctor numbs the area of the vein. You can usually go home the same day.
Vein stripping and ligation. In this procedure, veins are tied shut (ligation) and removed (stripping) through small incisions. The procedure is typically used in severe cases, in which the varicose veins cause pain or skin ulcers. You’re given medicine to sleep so that you don’t feel any pain during the procedure.
What To Expect After Treatment
Recovery times vary based on the specific procedure that’s performed. Vein stripping and ligation requires more recovery than most other procedures. Activity is not significantly limited following most other procedures. In fact, walking is often recommended during recovery. Some treatments may require that you wear compression stockings or bandages for a period ranging from a couple days to a few weeks following the procedure.
Common side effects immediately following a procedure may include bruising, swelling, skin discoloration, cramping, and itching. Swelling and skin discoloration may last for several months. Less common side effects include blood clots or nerve damage. An uncommon side effect of sclerotherapy is liquid chemical leaking out of the vein, which could cause tissue damage or ulcers.
How Can Varicose Veins Be Prevented?
Varicose veins can't be prevented from forming, but there are ways to reduce the severity of existing varicose veins and the risk of getting new varicose veins. To decrease the risk for and severity of varicose veins, you can:
Exercise. Moving your legs by walking or other forms of exercise can help move blood through your body.
Control your weight. If you are overweight or obese, losing weight will reduce pressure on your veins.
Avoid high heels and tight clothes. Flat or low-heeled shoes give your calf muscles a better workout, which will help to improve muscle strength and blood circulation. Avoiding tight clothing will reduce unnecessary pressure on your veins.
Avoid excessive standing or sitting with your legs bent or crossed. This will help blood flow and avoid additional pressure on your veins. During long periods of standing, try to take sitting breaks often.
Elevate your legs. Elevating your legs when sitting, resting, or sleeping can help the flow of blood, especially if your legs are raised above the level of your heart.
Living With Varicose Veins
Varicose veins can typically be treated with self-care. If medical procedures are necessary, they are generally very effective, and treated veins eventually fade or disappear. But the treatments don't prevent new varicose veins or other vein problems. It's possible for the same varicose veins to reappear after treatment, but this is uncommon.
Ongoing Health Care Needs
Although it's not possible to completely prevent new varicose veins from forming, following the steps in the "How Can Varicose Veins Be Prevented?" section can help keep developing or worsening varicose veins under control. Watch for skin ulcers or other complications that may develop, and consult a doctor if this happens.
Key Points
Varicose veins are enlarged and twisted veins close to the surface of the skin. They usually don't cause medical problems, but occasionally require treatment for complications, including pain, skin ulcers, and blood clots.
Varicose veins are usually the result of damaged or improperly working valves in the veins, which cause blood to back up and make the vein swell.
Varicose veins can affect any vein, but are most common in the legs.
Varicose veins are more common in women than in men. Family history and increasing age also are risk factors for varicose veins.
Common signs and symptoms of varicose veins include enlarged veins visible on the skin, swelling, and sometimes pain or throbbing in the legs. More serious complications can occur, such as skin ulcers and blood clots, but these are usually the result of problems with deeper veins.
Varicose veins are usually diagnosed simply on the appearance of leg veins when you're standing or seated with your legs dangling. Medical tests are usually not needed for the diagnosis.
Most varicose veins don't require treatment. Doctors may recommend simple self-care measures, including exercise, weight loss (if you're overweight), and avoiding long periods of sitting or standing.
In cases where signs and symptoms are more severe or there are complications such as skin ulcers, medical treatment may be necessary. Treatments also are done for cosmetic reasons. Varicose vein treatments are typically very effective.
Goals of treatment include easing symptoms, avoiding complications, and improving cosmetic appearance.
Although there's no way to completely prevent new varicose veins from forming, existing varicose veins can be kept under control with simple self-care measures