Varicose Veins

Varicose veins are enlarged blue, red, or purple veins that are raised above the surface of the skin, often on the thighs, backs of the calves, or the inside of the leg. They may ache, throb, or feel itchy. During pregnancy, varicose veins can form around the vagina and buttocks.

Many factors increase a person's chances of developing varicose veins. These include increasing age, weak vein valves, hormonal changes, pregnancy, obesity, sitting or standing for extended periods of time, and prolonged sun exposure.

Varicose veins are treated with lifestyle changes and medical treatments.

Varicose veins can often be seen on the skin. Some other common symptoms of varicose veins in the legs include:

• Aching pain that may get worse after sitting or standing for a long time
• Throbbing or cramping
• Heaviness
• Swelling
• Rash that’s itchy or irritated
• Darkening of the skin (in severe cases)
• Restless legs

Many factors increase a person's chances of developing varicose or spider veins. These include:

• Increasing age. As you get older, the valves in your veins may weaken and not work as well.
• Medical history. Being born with weak vein valves increases your risk. Having family members with vein problems also increases your risk. About half of all people who have varicose veins have a family member who has them too.
• Hormonal changes. These occur during puberty, pregnancy, and menopause. Taking birth control pills and other medicines containing estrogen and progesterone also may contribute to the forming of varicose or spider veins.
• Pregnancy. During pregnancy, there is a huge increase in the amount of blood in the body. This can cause veins to enlarge. The growing uterus also puts pressure on the veins. Varicose veins usually improve within 3 months after delivery. More varicose veins and spider veins usually appear with each additional pregnancy.
• Obesity. Being overweight or obese can put extra pressure on your veins. This can lead to varicose veins.
• Lack of movement. Sitting or standing for a long time may force your veins to work harder to pump blood to your heart. This may be a bigger problem if you sit with your legs bent or crossed.
• Sun exposure. This can cause spider veins on the cheeks or nose of a fair-skinned person.

Most varicose veins appear in the legs due to the pressure of body weight, force of gravity, and task of carrying blood from the bottom of the body up to the heart.

Compared with other veins in the body, leg veins have the toughest job of carrying blood back to the heart. They endure the most pressure. This pressure can be stronger than the one-way valves in the veins.

Varicose veins may not cause any problems, or they may cause aching pain, throbbing, and discomfort. In some cases, varicose veins can lead to more serious health problems. These include:

• Sores or skin ulcers due to chronic (long-term) backing up of blood. These sores or ulcers are painful and hard to heal. Sometimes they cannot heal until the backward blood flow in the vein is repaired.
• Bleeding. The skin over the veins becomes thin and easily injured. When an injury occurs, there can be significant blood loss.
• Superficial thrombophlebitis, which is a blood clot that forms in a vein just below the skin. Symptoms include skin redness; a firm, tender, warm vein; and sometimes pain and swelling.
• Deep vein thrombosis, which is a blood clot in a deeper vein. It can cause a “pulling” feeling in the calf, pain, warmth, redness, and swelling. However, sometimes it causes no significant symptoms. If the blood clot travels to the lungs, it can be fatal.

You should see a doctor about varicose veins if:

• The vein has become swollen, red, or very tender or warm to the touch
• There are sores or a rash on the leg or near the ankle
• The skin on the ankle and calf becomes thick and changes color
• One of the varicose veins begins to bleed
• Your leg symptoms are interfering with daily activities
• The appearance of the veins is causing you distress

If you’re having pain, even if it’s just a dull ache, don’t hesitate to get help. Also, even if you don’t need to see a doctor about your varicose veins, you should take steps to keep them from getting worse

Your doctor may diagnose your varicose veins based on a physical exam. 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 symptoms, including any pain you’re having. Sometimes, you may have other tests to find out the extent of the problem and to rule out other disorders.

You might have an ultrasound, which is used to see the veins’ structure, check the blood flow in your veins, and look for blood clots. This test uses sound waves to create pictures of structures in your body.

Although less likely, you might have a venogram. This test can be used to get a more detailed look at blood flow through your veins.

If you seek help for your varicose veins, there are several types of doctors you can see, including:

• A phlebologist, which is a vein specialist
• A vascular medicine doctor, who focuses on the blood system
• A vascular surgeon, who can perform surgery and do other procedures
• An interventional radiologist, who specializes in using imaging tools to see inside the body and do treatments with little or no cutting
• A dermatologist, who specializes in skin conditions

Each of these specialists do some or all of the procedures for treating varicose veins. You might start out by asking your regular doctor which specialist he or she recommends. You also might check with your insurance plan to see if it would pay for a particular provider or procedure.

Not all varicose veins can be prevented. But, there are some steps you can take to reduce your chances of getting new varicose and spider veins. These same things can help ease discomfort from the ones you already have:

• Wear sunscreen to protect your skin from the sun and to limit spider veins on the face.
• Exercise regularly to improve your leg strength, circulation, and vein strength. Focus on exercises that work your legs, such as walking or running.
• Control your weight to avoid placing too much pressure on your legs.
• Don’t cross your legs for long times when sitting. It’s possible to injure your legs that way, and even a minor injury can increase the risk of varicose veins.
• Elevate your legs when resting as much as possible.
• Don’t stand or sit for long periods of time. If you must stand for a long time, shift your weight from one leg to the other every few minutes. If you must sit for long periods of time, stand up and move around or take a short walk every 30 minutes.
• Wear elastic support stockings and avoid tight clothing that constricts your waist, groin, or legs.
• Avoid wearing high heels for long periods of time. Lower-heeled shoes can help tone your calf muscles to help blood move through your veins.
• Eat a low-salt diet rich in high-fiber foods. Eating fiber reduces the chances of constipation, which can contribute to varicose veins. High-fiber foods include fresh fruits and vegetables and whole grains, like bran. Eating less salt can help with the swelling that comes with varicose veins.

Varicose veins are treated with lifestyle changes and medical treatments. These can:

• Relieve symptoms
• Prevent complications
• Improve appearance

Your doctor may recommend lifestyle changes if your varicose veins don’t cause many symptoms. If symptoms are more severe, your doctor may recommend medical treatments. Some treatment options include:

Compression stockings put helpful pressure on your veins. There are 3 kinds of compression stockings:

• Support pantyhose, which offer the least amount of pressure. These also often are not “gradient” or “graduated.” That means they provide pressure all over instead of where it is needed most.
• Over-the-counter gradient compression hose, which give a little more pressure. They are sold in medical supply and drugstores.
• Prescription-strength gradient compression hose, which offer the greatest amount of pressure. They are sold in medical supply and drugstores. You need to be fitted for them by someone who has been trained to do this.

Sclerotherapy is the most common treatment for both spider veins and varicose veins. The doctor uses a needle to inject a liquid chemical into the vein. The chemical causes the vein walls to swell, stick together, and seal shut. This stops the flow of blood, and the vein turns into scar tissue. In a few weeks, the vein should fade. This treatment does not require anesthesia and can be done in your doctor's office. You can return to normal activity right after treatment.

The same vein may need to be treated more than once. Treatments are usually done every 4 to 6 weeks. You may be asked to wear gradient compression stockings after sclerotherapy to help with healing and decrease swelling. This treatment is very effective when done correctly.

Possible side effects include:

• Stinging, red and raised patches of skin, or bruises where the injection was made. These usually go away shortly after treatment.
• Spots, brown lines, or groups of fine red blood vessels around the treated vein. These also usually go away shortly after treatment.
• Lumps of blood that get trapped in vein and cause inflammation. This is not dangerous. You can relieve swelling by applying heat and taking aspirin. Your doctor can drain the trapped blood with a small pinprick at a follow-up visit.

There is a type of sclerotherapy called ultrasound-guided sclerotherapy (or echo-sclerotherapy). This type of sclerotherapy uses ultrasound imaging to guide the needle. It can be useful in treating veins that cannot be seen on the skin’s surface. It may be used after surgery or endovenous techniques if the varicose veins return. This procedure can be done in a doctor’s office. Possible side effects include skin sores, swelling, injection into an artery by mistake, or deep vein thrombosis (a potentially dangerous blood clot).

Surface laser treatments

In some cases, laser treatments can effectively treat smaller varicose veins. This technique sends very strong bursts of light through the skin onto the vein. This makes the vein slowly fade and disappear. Not all skin types and colors can be safely treated with lasers.

No needles or incisions are used, but the heat from the laser can be quite painful. Cooling helps reduce the pain. Laser treatments last for 15 to 20 minutes. Generally, 2 to 5 treatments are needed to remove spider veins in the legs. Laser therapy usually isn’t effective for varicose veins larger than 3 mm (about a tenth of an inch). You can return to normal activity right after treatment.

Possible side effects of lasers include:

• Redness or swelling of the skin right after the treatment that disappears within a few days
• Discolored skin that will disappear within 1 to 2 months
• Burns and scars from poorly performed laser surgery, though this is rare

Endovenous techniques (radiofrequency and laser)

These methods for treating the deeper veins of the legs, called the saphenous veins, have replaced surgery for most patients with severe varicose veins. These techniques can be done in a doctor’s office.

The doctor puts a very small tube, called a catheter, into the vein. A small probe is placed through the tube. A device at the tip of the probe heats up the inside of the vein and closes it off. The device can use radiofrequency or laser energy to seal the vein. The procedure can be done using just local anesthesia. You might have slight bruising after treatment.

Healthy veins around the closed vein take over the normal flow of blood. The symptoms from the varicose vein improve. Usually, veins on the surface of the skin that are connected to the treated varicose vein will also shrink after treatment. If they don’t, these connected veins can be treated with sclerotherapy or other techniques.

Surgery is used mostly to treat very large varicose veins. Types of surgery for varicose veins include:

• Surgical ligation and stripping. With this treatment, problem veins are tied shut and completely removed from the leg through small cuts in the skin. Removing the veins does not affect the circulation of blood in the leg. Veins deeper in the leg take care of the larger volumes of blood. This surgery requires general anesthesia and must be done in an operating room. It takes between 1 and 4 weeks to recover from the surgery. This surgery is generally safe. Pain in the leg is the most common side effect. Other possible problems include:

  • A risk of heart and breathing problems from anesthesia
  • Bleeding and congestion of blood. But, the collected blood usually settles on its own and does not require any further treatment.
  • Wound infection, inflammation, swelling, and redness
  • Permanent scars
  • Damage of nerve tissue around the treated vein. It's hard to avoid harming small nerve branches when veins are removed. This damage can cause numbness, burning, or a change in feeling around the scar.
  • A deep vein blood clot. These clots can travel to the lungs and heart. The medicine heparin may be used to reduce the chance of these dangerous blood clots. But, heparin also can increase the normal amount of bleeding and bruising after surgery.

• PIN stripping. In this treatment, an instrument called a PIN stripper is inserted into a vein. The tip of the PIN stripper is sewn to the end of the vein, and when it is removed, the vein is pulled out. This procedure can be done in an operating room or an outpatient center. General or local anesthesia can be used.

• Ambulatory phlebectomy. With ambulatory phlebectomy, tiny cuts are made in the skin, and hooks are used to pull the vein out of the leg. Only the parts of your leg that are being pricked will be numbed with anesthesia. The vein is usually removed in 1 treatment. Very large varicose veins can be removed with this treatment while leaving only very small scars. Patients can return to normal activity the day after treatment. Possible side effects of the treatment include slight bruising and temporary numbness.

Current treatments for varicose veins have very high success rates compared to traditional surgical treatments. Over a period of years, however, more abnormal veins can develop because there is no cure for weak vein valves. Ultrasound can be used to keep track of how badly the valves are leaking (venous insufficiency). Ongoing treatment can help keep this problem under control.

The single most important thing you can do to slow down the development of new varicose veins is to wear gradient compression support stockings as much as possible during the day.