Varicose Veins

Varicose (VAR-i-kos) veins are swollen, twisted veins that you can see just under the surface of the skin. These veins usually occur in the legs, but they also can form in other parts of the body.

Varicose veins are a common condition. They usually cause few signs and symptoms. Sometimes varicose veins cause mild to moderate pain, blood clots, skin ulcers (sores), or other problems.

Overview

Veins are blood vessels that carry blood from your body's tissues to your heart. Your heart pumps the blood to your lungs to pick up oxygen. The oxygen-rich blood then is pumped to your body through blood vessels called arteries.

From your arteries, the blood flows through tiny blood vessels called capillaries, where it gives up its oxygen to the body's tissues. Your blood then returns to your heart through your veins to pick up more oxygen. For more information about blood flow, go to the Health Topics How the Heart Works article.

Veins 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.

Many factors can raise your risk for varicose veins. Examples of these factors include family history, older age, gender, pregnancy, overweight or obesity, lack of movement, and leg trauma.

Varicose veins are treated with lifestyle changes and medical procedures. The goals of treatment are to relieve symptoms, prevent complications, and improve appearance.

Outlook

Varicose veins usually don't cause medical problems. If they do, your doctor may simply suggest making lifestyle changes.

Sometimes varicose veins cause pain, blood clots, skin ulcers, or other problems. If this happens, your doctor may recommend one or more medical procedures. Some people choose to have these procedures to improve the way their veins look or to relieve pain.

Many treatments for varicose veins are quick and easy and don't require a long recovery.

Many vein problems are related to varicose veins, such as telangiectasias (tel-AN-juh-ek-TA-ze-uhs), spider veins, varicoceles (VAR-i-ko-seals), and other vein problems.

Telangiectasias

Telangiectasias are small clusters of blood vessels. They're usually found on the upper body, including the face.

These blood vessels appear red. They may form during pregnancy, and often they develop in people who have certain genetic disorders, viral infections, or other conditions, such as liver disease.

Because telangiectasias can be a sign of a more serious condition, see your doctor if you think you have them.

Spider Veins

Spider veins are a smaller version of varicose veins and a less serious type of telangiectasias. Spider veins involve the capillaries, the smallest blood vessels in the body.

Spider veins often appear on the legs and face. They're red or blue and usually look like a spider web or tree branch. These veins usually aren't a medical concern.

Varicoceles

Varicoceles are varicose veins in the scrotum (the skin over the testicles). Varicoceles may be linked to male infertility. If you think you have varicoceles, see your doctor.

Other Related Vein Problems

Other types of varicose veins include venous lakes, reticular veins, and hemorrhoids. Venous lakes are varicose veins that appear on the face and neck. Reticular veins are flat blue veins often seen behind the knees. Hemorrhoids are varicose veins in and around the anus.

Weak or damaged valves in the veins can cause varicose veins. After your arteries and capillaries deliver oxygen-rich blood to your body, your veins return the blood to your heart. The veins in your legs must work against gravity to do this.

One-way valves inside the veins open to let blood flow through, and then they shut to keep blood from flowing backward. If the valves are weak or damaged, blood can back up and pool in your veins. This causes the veins to swell.

Weak vein walls may cause weak valves. Normally, the walls of the veins are elastic (stretchy). If these walls become weak, they lose their normal elasticity. They become like an overstretched rubber band. This makes the walls of the veins longer and wider, and it causes the flaps of the valves to separate.

When the valve flaps separate, blood can flow backward through the valves. The backflow of blood fills the veins and stretches the walls even more. As a result, the veins get bigger, swell, and often twist as they try to squeeze into their normal space. These are varicose veins.

Normal Vein and Varicose Vein

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.

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.

Older age or a family history of varicose veins may raise your risk for weak vein walls. You also may be at higher risk if you have increased pressure in your veins due to overweight or obesity or pregnancy.

Many factors may raise your risk for varicose veins, including family history, older age, gender, pregnancy, overweight or obesity, lack of movement, and leg trauma.

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, and menopause (or with 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 3 to 
12 months of delivery.

Overweight or Obesity

Being overweight or obese can put extra pressure on your veins. This can lead to varicose veins. For more information about overweight and obesity, go to the Health Topics Overweight and Obesity article.

Lack of Movement

Standing or sitting for a long time, especially with your legs bent or crossed, may raise your risk for varicose veins. This is because staying in one position for a long time may force your veins to work harder to pump blood to your heart.

Leg Trauma

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.

You can't prevent varicose veins from forming. However, you can prevent the ones you have from getting worse. You also can take steps to delay other varicose veins from forming.

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 and improve muscle tone. This helps blood move through your veins.

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.

Wear compression stockings if your doctor recommends them. These stockings create gentle pressure up the leg. This pressure keeps blood from pooling in the veins and decreases swelling in the legs.

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. Sometimes this symptom is incorrectly diagnosed as dry skin.
• Discolored skin in the area around the varicose vein.

Signs of telangiectasias are clusters of red veins that you can see just under the surface of your skin. These clusters usually are found on the upper body, including the face. Signs of spider veins are red or blue veins in a web or tree branch pattern. Often, these veins appear on the legs and face.

See your doctor if you have these signs and symptoms. They also may be signs of other, more serious conditions.

Complications of Varicose Veins

Varicose veins can lead to dermatitis (der-ma-TI-tis), an itchy rash. If you have varicose veins in your legs, dermatitis may affect your lower leg or ankle. Dermatitis can cause bleeding or skin ulcers (sores) if the skin is scratched or irritated.

Varicose veins also can lead to a condition called superficial thrombophlebitis (THROM-bo-fleh-BI-tis). Thrombophlebitis is a blood clot in a vein. Superficial thrombophlebitis means that the blood clot occurs in a vein close to the surface of the skin. This type of blood clot may cause pain and other problems in the affected area.

Doctors often diagnose varicose veins based on a physical exam alone. Sometimes tests or procedures are used to find out the extent of the problem or to rule out other conditions.

Specialists Involved

If you have varicose veins, you may see a vascular medicine specialist or vascular surgeon. These doctors specialize in blood vessel conditions. You also may see a dermatologist. This type of doctor specializes in skin conditions.

Physical Exam

To check for varicose veins in your legs, your doctor will look at your legs while you're standing or sitting with your legs dangling. He or she may ask you about your signs and symptoms, including any pain you're having.

Diagnostic Tests and Procedures

Duplex Ultrasound

Your doctor may recommend duplex ultrasound to check blood flow in your veins and to look for blood clots. Duplex ultrasound combines traditional with Doppler ultrasound. Traditional ultrasound uses sound waves to create a picture of the structures in your body, in this case the blood vessels and anything that may be blocking the flow of blood. Doppler ultrasound uses sound waves to create pictures of the flow or movement of the blood through the veins. The two types of ultrasound together paint a picture that helps your doctor diagnose your condition.

During this test, a handheld device will be placed on your body and passed back and forth over the affected area. The device sends and receives sound waves. A computer will convert the sound waves into a picture of the blood flow in your arteries and veins.

Angiogram

Although it is not very common, your doctor may recommend an angiogram to get a more detailed look at the blood flow through your veins.

For this procedure, dye is injected into your veins. The dye outlines your veins on x-ray images.

An angiogram can help your doctor confirm whether you have varicose veins or another condition.

Varicose veins are treated with lifestyle changes and medical procedures. The goals of treatment are to relieve symptoms, prevent complications, and improve appearance.

If varicose veins cause few symptoms, your doctor may simply suggest making lifestyle changes. If your symptoms are more severe, your doctor may recommend one or more medical procedures. For example, you may need a medical procedure if you have a lot of pain, blood clots, or skin disorders caused by your varicose veins.

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 often are the first treatment for varicose veins. These changes can prevent varicose veins from getting worse, reduce pain, and delay other varicose veins from forming. Lifestyle changes include the following:

• 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 and improve muscle tone. This helps blood move through your veins.
• 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.

Your doctor may recommend compression stockings. These stockings create gentle pressure up the leg. This pressure keeps blood from pooling and decreases swelling in the legs.

There are three types of compression stockings. One type is support pantyhose. These offer the least amount of pressure. A second type is over-the-counter compression hose. These stockings give a little more pressure than support pantyhose. Over-the-counter compression hose are sold in medical supply stores and pharmacies.

Prescription-strength compression hose are the third type of compression stockings. These stockings offer the greatest amount of pressure. They also are sold in medical supply stores and pharmacies. However, you need to be fitted for them in the store by a specially trained person.

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.

You may be treated with one or more of the procedures described below. Common side effects right after most of these procedures include bruising, swelling, skin discoloration, and slight pain.

The side effects are most severe with vein stripping and ligation (li-GA-shun). Rarely, this procedure can cause severe pain, infections, blood clots, and scarring.

Sclerotherapy

Sclerotherapy (SKLER-o-ther-ah-pe) 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. The irritation and scarring cause the vein to close off, and it fades away.

This procedure often is used to treat smaller varicose veins and spider veins. It can be done in your doctor's office, while you stand. You may need several treatments to completely close off a vein.

Treatments typically are done every 4 to 6 weeks. Following treatments, your legs will be wrapped in elastic bandaging to help with healing and decrease swelling.

Microsclerotherapy

Microsclerotherapy (MI-kro-SKLER-o-ther-ah-pe) is used to treat spider veins and other very small varicose veins.

A small amount of liquid chemical is injected into a vein using a very fine needle. The chemical scars the inner lining of the vein, causing it to close off.

Laser Surgery

This procedure applies light energy from a laser onto a varicose vein. The laser light makes the vein fade away.

Laser surgery mostly is used to treat smaller varicose veins. No cutting or injection of chemicals is involved.

Endovenous Ablation Therapy

Endovenous ablation (ab-LA-shun) therapy uses lasers or radiowaves to create heat to close off a varicose vein.

Your doctor makes a tiny cut in your skin near the varicose vein. He or she then 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.

You'll be awake during this procedure, but your doctor will numb the area around the vein. You usually can go home the same day as the procedure.

Endoscopic Vein Surgery

For endoscopic (en-do-SKOP-ik) vein surgery, your doctor will make a small cut in your skin near a varicose vein. He or she then 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). After the procedure, you usually can return to your normal activities within a few weeks.

Ambulatory Phlebectomy

For ambulatory phlebectomy (fle-BEK-to-me), your doctor will make small cuts in your skin to remove small varicose veins. This procedure usually is done to remove the varicose veins closest to the surface of your skin.

You'll be awake during the procedure, but your doctor will numb the area around the vein. Usually, you can go home the same day that the procedure is done.

Vein Stripping and Ligation

Vein stripping and ligation typically is done only for severe cases of varicose veins. The procedure involves tying shut and removing the veins through small cuts in your skin.

You'll be given medicine to temporarily put you to sleep so you don't feel any pain during the procedure.

Vein stripping and ligation usually is done as an outpatient procedure. The recovery time from the procedure is about 1 to 4 weeks.

Varicose veins are a common condition. They often cause few signs and symptoms. If your signs and symptoms are minor, your doctor may simply suggest making lifestyle changes.

If your condition is more severe—for example, if you have pain, blood clots, or skin ulcers (sores)—your doctor may recommend one or more medical procedures. Many treatments for varicose veins are quick and easy and don't require a long recovery.

For more information about lifestyle changes and medical procedures, go to "How Are Varicose Veins Treated?"