What Is It?
Varicose veins occur when veins just below the skin's surface are damaged, become swollen and fill with too much blood.
Veins are the blood vessels that return blood to the heart. Arteries carry blood away from the heart to the rest of the body,
Varicose veins most commonly occur in the legs. In about 50% of cases, the condition runs in families, and probably is related to an inherited weakness in the veins' walls or the valves inside veins that keep blood from backing up. In other cases, changes in blood pressure related to pregnancy or obesity may make it harder for blood to flow back to the heart, increasing the tendency for blood to pool in the veins. Also, occupations that require uninterrupted standing (waitresses and waiters, nurses, mothers with young children) may force leg veins and valves to work against gravity for hours, increasing the risk of pressure-related vein and valve damage. Garters and knee-high socks also can increase the risk of varicose veins if their tight elastics slow blood flow in the legs.
About 15% of adults in the United States have varicose veins, and the condition is 2 to 3 times more common in women than men. Although varicose veins most often are seen in the legs, they also can occur in the vagina during pregnancy or around the anus as hemorrhoids.
Varicose veins can be associated with prior blood clots and damage to the deeper veins in one or both legs, a situation that sometimes can lead to chronic venous insufficiency. When this happens, the veins lose their ability to effectively move blood back to the heart. This can cause significant leg swelling and skin sores or ulcers.
In the legs, varicose veins commonly are found along the inside of the leg, at the ankles and at the back of the calf. The affected veins look blue, swollen or stretched out, kinked or twisted.
In some people, varicose veins do not cause any symptoms. However, other people may experience one or more of the following:
In more severe cases of chronic venous insufficiency, a slowing of blood flow through the vein can lead to localized skin changes, including dryness, a rash or brownish discoloration and open sores (ulcers). Slow blood flow also can cause a clot to form inside the affected vein. This condition is called thrombosis.
In general, symptoms of varicose veins are worse at the end of the day, especially after periods of prolonged standing. Some women also find that their symptoms are more intense during the days before their menstrual periods, and during pregnancy.
Your doctor will ask you about your symptoms and about your family history of varicose veins. He or she also will ask about your lifestyle, especially the number of hours that you spend on your feet. In women, your doctor will ask about your pregnancy history and about the tightness of elastics on the socks or stockings you wear.
Your doctor can diagnose varicose veins with a simple physical examination. In most cases, no special tests are necessary.
Varicose veins are a long-term problem, but symptoms can come and go. If you are pregnant and experiencing severe problems with varicose veins, your symptoms will improve after delivery. However, your varicose veins probably will not disappear totally, and you can expect symptoms to return during future pregnancies.
You can help to prevent varicose veins by maintaining a normal weight and by avoiding situations where you must stand for prolonged periods. Even with these preventive measures, however, you still may develop varicose veins if this condition tends to run in your family.
If you already have varicose veins, you can prevent symptom flare-ups by periodically lying down or sitting down with your legs elevated above the level of your chest. Some physicians also recommend that you wear support stockings or more specialized compression stockings when you walk or stand for long periods of time. The stockings prevent blood from pooling in the veins, and prevent strain on the valves and leg swelling.
Treatment for most people with mild symptoms of varicose veins includes:
Elevating and supporting the legs periodically throughout the day
Wearing compression stockings
Sclerotherapy, in which an irritating solution is injected into the affected vein, causing the vein to scar and shut down.
For people with severe venous insufficiency, however, especially those with repeated episodes of thrombosis or skin ulcers, a procedure called vein stripping and ligation may be necessary. In this surgical procedure, the abnormal veins are tied off and pulled out of the body through series of small cuts in the skin. Another surgical procedure, called ambulatory phlebectomy, also removes veins through small skin incisions, but it is less invasive than classic stripping and ligation.
Newer therapies include endovenous thermal ablation, which uses laser or high-frequency radio waves to heat the abnormal veins, and transilluminated power phlebotomy, which is a modification of ambulatory phlebotomy. These newer procedures appear to cause less scarring, but more data is needed to determine if they are better techniques. External laser therapy is reserved primarily for cosmetic removal of small, superficial, spider-like veins.
When To Call A Professional
Call your doctor whenever you have pain, swelling, skin ulcers or an unexplained area of bruising on your legs. New leg swelling, especially in just one leg, can be caused by a blood clot, which requires immediate treatment.
If you have varicose veins, call your doctor immediately if you develop an ulcer or a painful, black and blue area near a varicose vein or if you cut the skin over a varicose vein and you have trouble controlling the bleeding.
Varicose veins are a long-term problem, but their symptoms often can be controlled with leg elevation and therapeutic stockings.
For people who want more than conservative therapy, sclerotherapy may be effective at first, but the results are not always permanent. Surgical procedures remove varicose veins permanently, but they leave scars, and they cannot prevent new varicose veins from forming.
National Heart, Lung, and Blood Institute (NHLBI)
P.O. Box 30105
Bethesda, MD 20824-0105
Phone: (301) 592-8573
TTY: (240) 629-3255
Fax: (301) 592-8563
American College of Surgeons (ACS)
633 North Saint Clair St.
Chicago, IL 60611-3211
Phone: (312) 202-5000
Toll-Free: (800) 621-4111
Fax: (312) 202-5001