Varicose Veins

Varicose veins are swollen, twisted veins that you can see just under the surface of the skin. They usually occur in the legs, but they also can form in other parts of the body. Varicose veins are common; they sometimes cause mild to moderate pain, skin ulcers or sores, blood clots or other problems.

Veins are blood vessels that carry blood from your body's tissues to your heart. They have one-way valves that help keep blood flowing toward your heart. If the valves are weak or damaged, blood can back up and pool in your veins. This causes the veins to swell, which can lead to varicose veins.

Figure A shows a normal vein with a working valve and normal blood flow. Figure B shows a varicose vein with a deformed valve, abnormal blood flow, and thin, stretched walls. The middle image shows where varicose veins might appear in a leg.

Risk Factors

Family History: Having family members who have varicose veins may raise your risk for the condition. About half of all people who have varicose veins have a family history of them.

Older Age: Getting older may raise your risk for varicose veins. The normal wear and tear of aging may cause the valves in your veins to weaken and not work well.

Gender: Women tend to get varicose veins more often than men. Hormonal changes that occur during puberty, pregnancy, menopause and/or the use of birth control pills may raise a woman's risk for varicose veins.

Pregnancy: During pregnancy, the growing fetus puts pressure on the veins in the mother's legs. Varicose veins that occur during pregnancy usually get better within a year of giving birth.

Overweight or Obesity: Being overweight or obese can put extra pressure on your veins, leading to varicose veins.

Lack of Movement: Standing or sitting for a long time, especially with your legs bent or crossed, may raise your risk for varicose veins. Staying in one position for a long time may force your veins to work harder to pump blood to your heart.

Signs and Symptoms

The signs and symptoms of varicose veins include:

Large veins that you can see just under the surface of your skin
Mild swelling of your ankles and feet
Painful, achy, or "heavy" legs
Throbbing or cramping in your legs
Itchy legs, especially on the lower leg and ankle.
Discolored skin in the area around the varicose vein.

Diagnosis

Doctors often diagnose varicose veins based on a physical exam alone. Sometimes Doppler ultrasound or an angiogram may be used to find out the extent of the problem or to rule out other conditions.

Treatment

Varicose veins are treated with lifestyle changes and medical procedures. The goals of treatment are to relieve symptoms, prevent complications, and improve appearance. If you have few symptoms, your doctor may simply suggest making lifestyle changes. If your symptoms are more severe, such as pain, blood clots or skin disorders, your doctor may recommend one or more medical procedures. Some people who have varicose veins choose to have procedures to improve how their veins look. Although treatment can help existing varicose veins, it can't keep new varicose veins from forming.

Lifestyle Changes

Lifestyle changes can prevent varicose veins from getting worse, reduce pain, and delay other varicose veins from forming. Lifestyle changes to help with varicose veins include:

Avoid standing or sitting for long periods without taking a break.
When sitting, avoid crossing your legs.
Keep your legs raised when sitting, resting, or sleeping.
When you can, raise your legs above the level of your heart.
Use physical activity to get your legs moving, help blood move through your veins and improve muscle tone.
If you're overweight or obese, try to lose weight. This will improve blood flow and ease the pressure on your veins.
Avoid wearing tight clothes, especially those that are tight around your waist, groin (upper thighs), and legs. Tight clothes can make varicose veins worse.
Avoid wearing high heels for long periods. Lower heeled shoes can help tone your calf muscles. Toned muscles help blood move through the veins.

If your doctor recommends them, wear compression stockings, which create gentle pressure up the leg, keeping blood from pooling and decreasing swelling in the legs.

Medical Procedures

Medical procedures are done either to remove varicose veins or to close them. Removing or closing varicose veins usually doesn't cause problems with blood flow because the blood starts moving through other veins.

Sclerotherapy: Sclerotherapy uses a liquid chemical to close off a varicose vein. The chemical is injected into the vein to cause irritation and scarring inside the vein, which make the vein close off, and it fades away.

Microsclerotherapy: Microsclerotherapy is sclerotherapy used to treat spider veins and other very small varicose veins with a very fine needle.

Laser Surgery: This procedure applies light energy from a laser onto a varicose vein, which makes the vein fade away.

Endovenous Ablation Therapy: Endovenous ablation therapy uses lasers or radiowaves to create heat to close off a varicose vein. Your doctor inserts a small tube called a catheter into the vein. A device at the tip of the tube heats up the inside of the vein and closes it off.

Endoscopic Vein Surgery: For endoscopic vein surgery, your doctor uses a tiny camera at the end of a thin tube to move through the vein. A surgical device at the end of the camera is used to close the vein. Endoscopic vein surgery usually is used only in severe cases when varicose veins are causing skin ulcers (sores).

Ambulatory Phlebectomy: For ambulatory phlebectomy, your doctor will make small cuts in your skin to remove small varicose veins close to the surface of your skin.

Vein Stripping and Ligation: This procedure is typically used only for severe cases of varicose veins; it involves tying shut and removing the veins through small cuts in your skin.

Prevention

You can't prevent varicose veins from forming; however, you can prevent new ones from forming and prevent the ones you have from getting worse.

Avoid standing or sitting for long periods without taking a break.
When sitting, avoid crossing your legs.
Keep your legs raised when sitting, resting, or sleeping. When you can, raise your legs above the level of your heart.
Do physical activities to get your legs moving, help blood move through your veins and improve muscle tone.
If you're overweight or obese, try to lose weight to improve blood flow and ease the pressure on your veins.
Avoid wearing tight clothes, especially those that are tight around your waist, groin (upper thighs) and legs. Tight clothes can make varicose veins worse.
Avoid wearing high heels for long periods. Lower heeled shoes can help tone your calf muscles. Toned muscles help blood move through the veins.
Wear compression stockings if your doctor recommends them. These stockings create gentle pressure up the leg, keep blood from pooling in the veins and decrease swelling in the legs.

To learn more about using interventional radiology to diminish or remove your varicose veins, please watch the varicose veins video in the media player above and/or call 304.526.2230.

Source: National Institutes of Health