Varicose Veins

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Introduction

What are varicose veins?

Varicose veins are veins that have become swollen with blood, leading to a tangled appearance and pain. The swelling in varicose veins arises from improper venous function, leading to inappropriate blood collection. Generally, varicose veins occur in the legs, but they can occur in other regions of the body as well.

Varicose veins arise from blood pooling, usually in the legs. Blood pooling can occur as a result of congenitally malformed venous valves or other conditions, such as pregnancy or thrombophlebitis (vein swelling due to a blood clot). Extended periods spent standing may increase your risk of developing varicose veins. Symptoms of varicose veins include visible, raised, swollen or malformed “tangles” of veins, leg pain, and swelling, and in severe cases, ulcers of the legs.

In most cases, varicose veins can be treated by avoiding excessive standing, sleeping with your legs elevated, or wearing support hose. In more severe cases, nonsurgical intervention such as laser ablation may be performed. If varicose veins are causing extreme pain or are at risk of rupturing, surgical vein stripping may be effective. Varicose veins may worsen with time if appropriate medical or home treatment is not obtained.

While complications are rare, varicose veins can be a serious condition. Seek prompt medical care if you, or someone you are with, experience severe leg pain, develop ulcers of the legs or ankles, or if varicose veins have become warm or tender to the touch. Seek prompt medical care if you are being treated or performing self-treatment for varicose veins and your symptoms do not improve.

Symptoms

What are the symptoms of varicose veins?

Symptoms of varicose veins include tangled, painful, or raised veins in the legs, buttocks, or other regions of the body. In mild cases, varicose veins can be treated at home. In more severe cases, swelling of the legs, excessive pain, or ulcers of the legs or ankles may occur, and you should obtain prompt medical treatment.

Common symptoms of varicose veins

You may experience varicose vein symptoms daily or just once in a while. At times any of these symptoms can be severe:

  • Enlarged veins
  • Feeling of heaviness
  • Hardened tissue under the skin
  • Leg pain and swelling
  • Rash
  • Skin discoloration such as bruising
  • Throbbing or cramping in the legs
  • Visible veins

Symptoms that might indicate a serious condition

In some cases, varicose veins can be a serious condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of these serious symptoms including:

  • Absent or diminished pulse
  • Bleeding
  • Excessive leg pain
  • Skin ulceration at the ankles
  • Tenderness
  • Visible blood clot
Causes

What causes varicose veins?

Varicose veins result from improper venous function, leading to blood pooling in the veins. In general, varicose veins can be caused by valve malformations, pregnancy, and thrombophlebitis, which is vein swelling due to a blood clot. Extended periods of time standing on your feet without motion can also lead to varicose veins. Varicose veins that are due to valve defects which are present from birth or have no known cause are called primary varicose veins, while those that develop because of another condition are considered secondary varicose veins.

What are the risk factors for varicose veins?

A number of factors increase the risk of developing varicose veins. Not all people with risk factors will get varicose veins. Risk factors for varicose veins include:

  • Age older than 50 years
  • Excessive sun exposure
  • Family history of weak venous valves or varicose veins
  • Female gender 
  • Hormone changes (e.g., menopause)
  • Medical history of weak veins or phlebitis
  • Obesity
  • Occupations that require prolonged standing
  • Pregnancy

Reducing your risk of varicose veins

Varicose veins are caused by pooling of blood in the veins. You can prevent blood from accumulating in your legs by:

  • Avoiding prolonged periods of standing
  • Eating a healthy, low-salt diet
  • Engaging in regular physical activity
  • Sleeping with your feet elevated
Treatments

How are varicose veins treated?

For most cases of varicose veins, noninvasive treatment can be performed to improve the appearance and feeling of the legs. Typical treatments include keeping your legs elevated when sleeping and wearing support hose. If you are experiencing serious leg discomfort from varicose veins, nonsurgical procedures such as scleropathy, radiofrequency treatment, and laser treatment can be performed. For severe cases, vein-stripping surgery may be used to entirely remove varicose veins. In most cases, varicose veins worsen over time unless you obtain medical care or perform self-treatment.

Lifestyle modifications for varicose veins

Most treatments for varicose veins are focused on lifestyle modifications designed to improve the condition, such as:

  • Avoiding excessive standing
  • Increased physical activity
  • Sleeping with your legs elevated to prevent pooling of blood in your legs
  • Wearing support hose to assist circulation

Nonsurgical treatments for varicose veins

In cases in which varicose veins have become painful or may lead to complications, nonsurgical intervention may be necessary including:

  • Laser treatment
  • Radiofrequency treatment
  • Sclerotherapy (chemical sealing of the veins)

What you can do to improve your varicose veins

Varicose veins can improve with self-treatment. If you experience varicose veins, certain practices may be beneficial, such as:

  • Avoiding excessive standing
  • Eating a balanced, low-salt diet
  • Sleeping with your legs elevated
  • Wearing support hose

What are the potential complications of varicose veins?

While varicose veins are not serious in most cases, serious complications can occur in severe cases. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of varicose veins include:

  • Adverse effects of treatment
  • Chronic leg swelling
  • Cosmetic disfigurement
  • Phlebitis
  • Recurrence after treatment
  • Thrombosis
  • Ulcers of the leg
  • Venous rupturing and bleeding
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Jan 4
  1. Leg Varicose Veins. PubMed. U.S. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0023369/
  2. Varicose veins and spider veins. U.S. Office on Women's Health. https://www.womenshealth.gov/a-z-topics/varicose-veins-and-spider-veins
  3. Bergan JJ, et al. Chronic venous disease. N Engl J Med 2006; 355:488.
  4. Raju S, Neglen P. Clinical practice. Chronic venous insufficiency and varicose veins. N Engl J Med. 2009; 360:2319-27.
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