Varicose Veins Varicose Veins

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Varicose veins, or varicosities, are swollen, twisted veins  that lie just under the skin. They usually occur in the legs.

Sometimes varicose veins form in other parts of the body. Hemorrhoids, for example, are a type of varicose vein that develops in the rectum. Telangiectasias, or spider veins, are another type of vein problem that affects smaller blood vessels. Varicoceles are swollen veins in the scrotum. This health topic focuses on varicose veins in the legs.

Symptoms of varicose veins include:

• Bulging, bluish veins
• Itching or burning discomfort around the veins
• Skin color changes around the veins
• Swelling in the legs
• Aching pain in the legs
• A feeling of heaviness in the legs and feet
• Nighttime leg cramps

Sometimes varicose veins can limit your activities. Your symptoms may get worse when you sit or are on your feet for long periods, and they may get better when you lie down or put your feet up. Talk to a healthcare provider if you think you may have varicose veins. Getting treatment early can stop your varicose veins from getting worse and help you avoid complications, such as bleeding and ulcers. Ulcers are open sores that don’t heal well and can get infected or cause other problems. Call your provider right away if your varicose veins suddenly get worse or you notice bleeding or a sore.

To diagnose varicose veins, your healthcare provider will do a physical exam and ask about your symptoms, family history, activity levels, and lifestyle.

Your provider may also do an imaging test, such as a duplex ultrasound (DUS). This noninvasive method uses sound waves to assess blood flow through the vessels in your legs. It is common for providers to recommend DUS to diagnose varicose veins.

Varicose veins are a common condition caused by weak or damaged vein walls and valves. Veins have one-way valves inside them that open and close to keep blood flowing toward the heart. Weak or damaged valves or walls in the veins can cause blood to pool and even flow backward. This is called reflux. The veins may grow larger and become distorted, resulting in varicose veins. Learn more about how the heart works and how blood flows to and from the heart.

Varicose veins may form whenever blood pressure increases inside your veins. This can happen because of age, pregnancy, overweight and obesity, repeated sitting or standing for long periods, or an inactive lifestyle. Your risk may be higher if you have a family history of varicose veins.

Depending on how serious your symptoms are, your healthcare provider may recommend a combination of treatments and preventive measures. Keep in mind that new varicose veins may form even after treatment or that you may need to receive treatments more than once.

The goal of treatment is to relieve symptoms, keep varicose veins from worsening, improve appearance, and prevent serious complications, such as ulcers and bleeding. Some of the lifestyle changes that can help with your varicose veins may also lower your chance of having deep vein thrombosis and other medical problems.

If you are pregnant, your provider may recommend compression therapy and pain medicine to relieve symptoms of varicose veins such as pain or heaviness in the legs.

Lifestyle changes

Your healthcare provider may recommend adopting healthy lifestyle changes to relieve symptoms or prevent varicose veins from getting worse.

• Aim for a healthy weight. This will improve blood flow and ease the pressure on your veins.
• Stay physically active to help blood move through your veins. Walking and exercising makes the muscles in your lower legs contract, which can help blood return toward your heart and not pool in the veins in your legs. However, strenuous exercise, especially if it involves heavy lifting, might make varicose veins worse. Before starting any exercise program, ask your provider about the level of physical activity that is right for you.
• Avoid standing or sitting for long periods. When sitting, elevate your feet to help lower the pressure inside the veins in your legs. Lying down with your feet above the level of your heart for a few minutes several times per day can also lower the pressure in your veins and help blood return to your heart. If you have to spend a lot of time standing or sitting, try changing your position often to help your blood flow.
• Avoid high heels or shoes that limit your ankle movement. Some shoes may affect the blood flow in the veins of your legs. If some shoes make your varicose veins feel worse, try to wear those shoes less often.
• Quit smoking. Damage to your veins from smoking can make you more likely to develop varicose veins.

Procedures

Your healthcare provider may do a DUS or other exams to see how well your veins are working and may use ultrasound as guidance during the procedure. The goal of the treatments in the list below is to block or destroy the varicose vein that is causing blood to pool. This allows other veins to take over. Most procedures for varicose veins are minimally invasive and do not require a long recovery. Your provider may recommend that you avoid being in the sun or that you wear sunscreen with an SPF of 30 or higher after some procedures to help prevent scars and skin changes.

• Endovenous  ablation  to close off a varicose vein. Your provider uses laser or radiofrequency energy to heat the inside of the vein and close it off. This procedure usually happens in a doctor’s office, with ultrasound to guide the treatment. Your provider numbs the area around the vein so that you do not feel pain during the procedure. Bruising, pain, and changes in skin color are common after receiving the treatment. More serious complications, including numbness, venous thromboembolism, and skin burns, are rare.
• Sclerotherapy to seal off a varicose vein. Your provider injects liquid or foam chemicals into the vein to create a plug that seals it shut. The procedure can take place in a doctor’s office with ultrasound guidance. Liquid sclerotherapy is more often used for spider veins. Complications of foam sclerotherapy may include skin color changes and, rarely, venous thromboembolism, nerve damage, serious allergic reaction, or stroke. Some people may have temporary vision problems, headaches, or confused mental states after this procedure.
• Phlebectomy to remove small varicose veins. Your provider makes small cuts to remove smaller veins near the skin. This procedure can be added on during endovenous ablation or open surgery to enhance treatment effects.
• Surgery to remove severe varicose veins. For larger, deeper veins, your provider may tie off and remove varicose veins in a procedure called vein ligation or stripping. Surgery can often be done on an outpatient basis, which means that you do not need to spend the night at the hospital, but you may need medicine to sedate you so that you are not awake during the procedure. Surgery may be more painful and require more recovery time, so it is usually recommended only for people who cannot get a less invasive procedure to close off or seal the varicose vein. Surgery complications may include infection, nerve damage, bruising, pain, and changes in skin color. More serious complications are rare.

Compression therapy

Your healthcare provider may recommend compression therapy alone or, more likely, after a procedure to remove or close off varicose veins. Compression therapy involves special elastic stockings or compression bandages that put gentle pressure on the legs to help prevent swelling.

For some people, especially those who have to sit or stand for long periods, compression may help relieve symptoms such as pain, swelling, and heaviness in the legs. If you are pregnant, your provider may recommend compression hose. Compression therapy only relieves symptoms. Most providers now recommend procedures to correct the reflux problem that is causing your varicose veins.

After you have a procedure to remove or close off your varicose veins, your provider will probably recommend wearing compression stockings for at least a week. Compression stockings may also help heal leg ulcers or sores that are a complication of varicose veins. Because vein problems are long-term issues, your provider may suggest that you continue to wear compression stockings.

For some people, compression stockings can cause discomfort, itching, skin irritation, or swelling.