Most varicose veins are not a health issue, but they shouldn’t be ignored. Varicose veins can cause fatigue of the legs, swelling, general discomfort and can be a warning of long-term health risks.
Approximately 1 in 4 adults in the United States are thought to be affected by varicose veins. In most cases, varicose veins are harmless; however, they may eventually result in a blood clot or be a sign of other circulatory problems.
Any vein may become varicose, but the veins most commonly affected are those in the legs and feet due to the increased pressure in the lower body veins from standing and walking.
Varicose veins are enlarged, swollen, and twisting veins that bulge from pools of blood in them. They happen when valves in the veins do not work correctly and fail to circulate blood effectively. The blood pools or flows in the wrong direction and causes the veins to bulge. As veins continue to bulge, they become visible through the skin, often appearing blue or dark purple.
Varicose veins can occur anywhere in the body but are more common in the legs and feet. The veins rarely need treatment for health reasons but can cause considerable discomfort. In severe cases, a varicose vein may rupture or develop into varicose ulcers (open sores) on the skin and require treatment.
Small “spider veins,” a milder form of varicose veins, also can appear on the skin’s surface. These often look like short, fine lines in “starburst” clusters or a web-like maze. Spider veins are most common in the thighs, calves, ankles, and feet. They may also appear on the face.
What Causes Varicose Veins?
Varicose veins are caused by increased blood pressure in the veins near the surface of the skin (superficial). Arteries carry blood from the heart to the rest of the body. Veins return blood to the heart so that the blood can recirculate. To return blood to the heart, the veins in the legs must work against gravity. Muscle contractions in the lower legs act as pumps, and elastic vein walls help blood return to the heart. Within the veins are tiny valves that open as blood flows toward the heart, then close to stop the backflow of blood.
In some instances, the absence or weakness of valves in the veins may cause poor circulation. In other cases, a weakness in the vein wall may cause pooling of the blood. The enlarged and engorged veins form spider veins, which lead to varicose veins.
Varicose veins can also result from a disease such as phlebitis (inflammation of the veins) or congenital abnormalities of the veins.
Some of the factors that may increase blood pressure and cause varicose veins include:
Age. As we get older, veins tend to lose elasticity, causing them to stretch. The valves in the veins may become weak, allowing blood that should be moving toward the heart to flow backward.
Female. 70 to 80% of patients treated for varicose veins are women.
Inactivity. Standing or sitting for a long time, especially with legs bent or crossed, may raise the risk for varicose veins. Staying in one position for a long time may force the veins to work harder to pump blood to the heart. However, just crossing your legs or wearing high heels does NOT cause varicose veins.
Family history. Varicose veins may be more common in some families (inherited). About half of all people who have varicose veins have a family history of them.
Hormone changes. Changes in hormone levels brought on by puberty, contraceptives, pregnancy, menopause, and hormone replacement therapy are risk factors for varicose veins.
Leg injury. Previous blood clots or traumatic damage to the valves in your veins can weaken their ability to move blood back to the heart, increasing the risk for varicose veins.
Obesity. Being overweight places added pressure on the veins. Anything that increases pressure in the abdomen can lead to varicose veins.
Pregnancy. Some pregnant women develop varicose veins. Pregnancy increases the volume of blood in the body but decreases the flow of blood from the legs. This circulatory change is designed to support the growing fetus but can produce enlarged veins in the legs. Changes in hormones during pregnancy also may play a role. Varicose veins that develop during pregnancy generally improve without medical treatment 3 to 12 months after delivery.
Smoking. The nicotine in cigarette smoke raises blood pressure and heart rate, narrowing arteries and hardening their walls, which can result in varicose veins.
What Are the Symptoms of Varicose Veins?
Varicose veins often cause no symptoms or signs other than a visually distinct, undesirable, cosmetic appearance. Varicose veins may not cause any pain. However, some individuals may experience problematic symptoms that include swelling, throbbing, aching, burning, itching, heaviness, tingling, or cramping of the legs. People who suffer from varicose veins often find they cannot stand on their feet for extended periods of time, and their legs often feel achy. Individuals can also develop a brown discoloration of the skin and skin ulcers.
Severe varicose veins may eventually produce long-term mild swelling that can result in more serious skin and tissue problems, such as ulcers and nonhealing sores. The ulcers can lead to soft tissue infections. Varicose veins can also develop blood clots within the veins (superficial thrombophlebitis). Localized bleeding from varicose veins also can occur.
The following are the most common symptoms of varicose veins. However, people may experience symptoms differently.
Veins that are dark purple or blue in color.
Veins that appear twisted and bulging, often like cords on the legs.
Color changes in the skin.
Sores on the legs.
Sensations in the legs, such as a heavy feeling, burning, and aching.
When painful symptoms occur, they may include:
A painful cord in the vein with red discoloration of the skin.
A shiny skin discoloration near varicose veins, usually brownish or blue in color.
An achy or heavy feeling in the legs.
Bleeding from the varicose veins.
Burning, throbbing, muscle cramping, and swelling in the lower legs.
Irregular whitish patches (atrophie blanche) that look like a scar on the ankles, a serious form of vascular disease that requires medical attention.
Itching around one or more of your veins.
Leg cramps when suddenly standing up.
Lipodermatosclerosis – fat under the skin just above the ankle can become hard, resulting in the skin shrinking.
Many people with varicose veins also have restless legs syndrome.
Minor injuries to the affected area may result in more prolonged bleeding than normal.
Venous eczema (stasis dermatitis) is a long-term skin condition of the lower legs that is common with varicose veins. The affected area may be red, dry, and itchy.
Worsened pain after sitting or standing for a long time.
The majority of varicose vein cases have no complications. If complications occur, they may include:
Bleeding. Occasionally, veins very close to the skin may burst, which may cause minor bleeding. But, any bleeding warrants medical attention because there’s a high risk it can happen again.
Thrombophlebitis. This condition includes inflammation that causes a blood clot to form and block one or more veins, usually in the legs.
Chronic venous insufficiency. This condition results when veins are not working effectively, making it difficult for blood to return to the heart from the legs, often resulting in blood pooling or collecting in the veins.
How Are Varicose Veins Diagnosed?
Diagnosing varicose veins is a visual procedure. First, the doctor will do a physical exam that includes looking at the legs to check for swelling while the patient is standing. In addition to the physical examination, the doctor will want to know about the patient’s medical history, including:
Any pain or aching in the legs.
Recent illnesses or existing medical conditions, such as a heart condition or a history of blood clots.
Medications or supplements you take, especially aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), blood thinners, or herbal supplements.
Previous treatment for varicose veins and the results of the treatment.
In addition to the physical examination and medical history, diagnosing varicose veins may include:
Duplex ultrasound. A type of vascular ultrasound (“duplex” means two types of sound waves are used) to check blood flow and vein structure. In this noninvasive, painless test, a small hand-held device (transducer) is pressed against the skin, which allows viewing of the veins on a monitor.
Color-flow imaging (also called triplex ultrasound). Similar to duplex ultrasound, this procedure uses color to show the direction of blood flow.
Magnetic resonance venography (MRV). This diagnostic procedure uses magnetic resonance technology and intravenous (IV) contrast dye to visualize the veins. MRV can also help to diagnose other causes of leg pain.
How Are Varicose Veins Treated?
The treatment of varicose veins is often sought for cosmetic reasons. However, severe cases of varicose veins, especially those involving ulcers, typically require treatment. Frequently, the treatment for varicose veins is the elimination of “bad” veins. This forces blood to flow through remaining healthy veins. Various methods can be employed to eliminate the problem veins. The specific treatment depends on several conditions:
Patient age, overall health, and medical history.
The extent of the varicose vein condition.
The signs and symptoms.
The patient’s tolerance of specific medicines, procedures, and therapies.
In many cases, medical treatment is not necessary if there are no symptoms. However, varicose veins may become worse without treatment. Some self-care measures can help decrease the discomfort that varicose veins can cause. These same steps can help prevent or slow the development of varicose veins, as well. They include:
Avoid crossing legs. Some doctors believe this position can increase circulation problems.
Avoid long periods of sitting or standing. Make a point of changing the body’s position frequently to encourage blood flow. If it is necessary to sit or stand for an extended period, occasional flexing (bending) of the legs can help keep blood circulating.
Elevate the legs. To improve blood circulation in the legs, elevate the feet above the level of the heart 3 or 4 times a day for about 15 minutes at a time. Lie down with lower legs resting on three or four pillows. For mild to moderate varicose veins, elevating the legs can help reduce leg swelling and may also relieve other symptoms.
Exercise. Get moving. Walking is a great way to encourage blood circulation in the legs.
Weight and diet. Shedding excess pounds takes unnecessary pressure off the veins. In addition, a low-salt diet can help prevent swelling caused by water retention.
Shoes and clothing. Avoid high heels. Low-heeled shoes work calf muscles more, which is better for the veins. Also, avoid wearing tight clothes around the waist, legs, and groin that can reduce blood flow to the legs.
Compression (support) stockings. These elastic stockings squeeze the veins and prevent blood from pooling, and are an easy way to help alleviate mild symptoms. Compression stockings are most effective if worn daily.
If varicose veins don’t respond to self-care treatments or the condition is more severe, medical treatments are available. Fortunately, medical treatment usually doesn’t mean a hospital stay or a long, uncomfortable recovery. Thanks to less invasive procedures, varicose veins can generally be treated on an outpatient basis. Some of the procedures available include:
Ambulatory phlebectomy. Smaller varicose veins are removed through a series of tiny skin punctures. Only the parts of the leg that are being pricked are numbed in this outpatient procedure.
Catheter-assisted procedures using radiofrequency or laser energy. A thin tube (catheter) is inserted into a varicose vein. The tip of the catheter is heated using either radiofrequency or laser energy. As the catheter is pulled out, the heat destroys the vein by causing it to collapse and seal shut. Once destroyed, the vein is no longer able to carry blood.
Sclerotherapy. A common procedure performed in the doctor’s office effective in eliminating most spider veins and some varicose veins. The procedure requires no anesthesia. Instead, a liquid solution is injected directly into the affected vein, which causes the vein to collapse and eventually fade away. The treated vein no longer carries blood, and other veins take over.
Foam sclerotherapy. A foam sclerosant is injected into a blood vessel to close it, which results in the blood rerouting itself through healthy veins, restoring more normal blood flow.
Laser therapy. A laser closes off smaller varicose veins, making the vein slowly fade and disappear.
High ligation and vein stripping. This procedure involves tying off a vein and removing the vein through a small incision. This is typically an outpatient procedure. Removing the vein won’t adversely affect circulation in the leg because veins deeper in the leg take care of the larger volumes of blood.
After treatment for small varicose veins, expect to see definitive results in usually three to six weeks. Larger veins may require three to four months. However, multiple treatments may be necessary to achieve desired results. Generally, veins that respond to treatment generally don’t come back, but new varicose veins may appear.
Varicose veins that develop during pregnancy generally improve without medical treatment within 3 to 12 months after delivery.
Is It Possible to Prevent Varicose Veins?
Venous disease is generally progressive, and there is no way to completely prevent varicose veins. However, improving circulation and muscle tone can reduce the risk of developing varicose veins. In addition, the same home remedies for treating the discomfort from varicose veins can help prevent varicose veins. These include:
Exercising, including walking. If a majority of the day is spent sitting at a desk or in front of a computer, get up regularly to exercise your legs. If sitting or standing for most of the day, exercise your calf muscles by raising up on the balls of your feet and then lowering yourself back down.
Maintain a healthy weight.
Eating a high-fiber, low-salt diet.
Avoid high heels and tight hosiery.
Elevating the legs.
Change sitting and standing positions regularly.
Novus Spine & Pain Center
The vein clinic at Novus Spine & Pain Center specializes in treating varicose veins. By using a comprehensive approach and cutting-edge therapies, we work together with patients to restore function and regain an active lifestyle while minimizing the need for opiates.