Varicose Veins

Overview

Varicose veins are twisted, enlarged veins. Any vein that is close to the skin's surface (superficial) can become varicosed. Varicose veins most commonly affect the veins in the legs. That's because standing and walking increase the pressure in the veins of the lower body.

For many people, varicose veins and spider veins — a common, mild variation of varicose veins — are simply a cosmetic concern. For other people, varicose veins can cause aching pain and discomfort. Sometimes varicose veins lead to more-serious problems.

Treatment might involve self-care measures or procedures done by a health care provider to close or remove veins.

Symptoms

Varicose veins might not cause pain. Signs of varicose veins include:

• Veins that are dark purple or blue
• Veins that appear twisted and bulging, often appearing like cords on the legs

When painful signs and symptoms of varicose veins occur, they might include:

• An achy or heavy feeling in the legs
• Burning, throbbing, muscle cramping and swelling in the lower legs
• Worsened pain after sitting or standing for a long time
• Itching around one or more of the veins
• Changes in skin color around a varicose vein

Spider veins are similar to varicose veins, but they're smaller. Spider veins are found closer to the skin's surface and are often red or blue.

Spider veins occur on the legs but can also be found on the face. They vary in size and often look like a spider's web.

When to see a doctor

If you're concerned about how your veins look and feel and self-care measures haven't helped, see your health care provider.

Causes

Weak or damaged valves can lead to varicose veins. Arteries carry blood from the heart to the rest of the body. Veins return blood from the rest of the body to the heart. To return blood to the heart, the veins in the legs must work against gravity.

Muscle contractions in the lower legs act as pumps, and elastic vein walls help blood return to the heart. Tiny valves in the veins open as blood flows toward the heart, then close to stop blood from flowing backward. If these valves are weak or damaged, blood can flow backward and pool in the veins, causing the veins to stretch or twist.

Risk factors

The following can increase the risk of developing varicose veins:

• Age. Aging causes wear and tear on the valves in the veins that help control blood flow. Eventually, that wear causes the valves to allow some blood to flow back into the veins, where it collects.
• Sex. Women are more likely to develop the condition. Hormonal changes before a menstrual period or during pregnancy or menopause might be a factor because female hormones tend to relax vein walls. Hormone treatments, such as birth control pills, might increase the risk of varicose veins.
• Pregnancy. During pregnancy, the blood volume in the body increases. This change supports the growing baby but can also enlarge the veins in the legs.
• Family history. If other family members had varicose veins, there's a greater chance you will too.
• Obesity. Being overweight puts added pressure on veins.
• Standing or sitting for long periods of time. Movement helps blood flow.

Complications

Complications of varicose veins, although rare, can include:

• Ulcers. Painful ulcers can form on the skin near varicose veins, particularly near the ankles. A discolored spot on the skin usually begins before an ulcer forms. See your health care provider immediately if you think you've developed a leg ulcer.
• Blood clots. Occasionally, veins deep within the legs become enlarged and might cause leg pain and swelling. Seek medical attention for persistent leg pain or swelling because it can be a sign of a blood clot.
• Bleeding. Occasionally, veins close to the skin burst. Although this usually causes only minor bleeding, it requires medical attention.

Prevention

Improving blood flow and muscle tone might reduce the risk of developing varicose veins. The same measures that treat the discomfort from varicose veins can help prevent them. Try the following:

• Avoiding high heels and tight hosiery
• Changing your sitting or standing position regularly
• Eating a high-fiber, low-salt diet
• Exercising
• Raising your legs when sitting or lying down
• Watching your weight

Diagnosis

Your health care provider will do a physical exam, including looking at your legs while you're standing to check for swelling. Your provider might also ask you to describe pain and aching in your legs.

Tests

To diagnose varicose veins, a health care provider might recommend a test called a venous Doppler ultrasound of the leg. A Doppler ultrasound is a noninvasive test that uses sound waves to look at blood flow through the valves in the veins. A leg ultrasound can help detect a blood clot.

In this test, a health care provider moves a small hand-held device (transducer), which is about the size of a bar of soap, against the skin over the body area being examined. The transducer transmits images of the veins in the legs to a monitor, which displays the results.

Treatment

Treatment for varicose veins may include self-care measures, compression stockings, and surgeries or procedures. Procedures to treat varicose veins are often done as an outpatient procedure, which means you usually go home on the same day.

Ask your insurer if varicose vein treatment is a covered expense. If varicose vein treatment is done only to improve the appearance of the legs (cosmetic reason), the cost might not be covered by insurance.

Self-care

Self-care — such as exercise, raising the legs when sitting or lying down, or wearing compression stockings — can help ease the pain of varicose veins and might prevent them from getting worse.

Compression stockings

Wearing compression stockings all day is often the first approach to try. The stockings squeeze the legs, helping veins and leg muscles move blood more efficiently. The amount of compression varies by type and brand.

Compression stockings are available at most pharmacies and medical supply stores. Prescription-strength stockings also are available and may be covered by insurance if varicose veins are causing symptoms.

Surgeries or other procedures

If self-care steps and compression stockings don't work, or varicose veins are more severe, a health care provider might recommend surgery or other procedures:

• Sclerotherapy. A health care provider injects the varicose veins with a solution or foam that scars and closes those veins. In a few weeks, treated varicose veins should fade.

  The same vein might need to be injected more than once. Sclerotherapy doesn't require anesthesia and can be done in a health care provider's office.

• Laser treatment. Laser treatment sends strong bursts of light onto the vein, which makes the vein slowly fade and disappear. No cuts or needles are used.
• Catheter-based procedures using radiofrequency or laser energy. This procedure is the preferred treatment for larger varicose veins. A health care provider inserts a thin tube (catheter) into an enlarged vein and heats the tip of the catheter using either radiofrequency or laser energy. As the catheter is removed, the heat destroys the vein by causing it to collapse and seal shut.
• High ligation and vein stripping. This procedure involves tying off a vein before it joins a deep vein and removing the vein through small cuts. This is an outpatient procedure for most people. Removing the vein won't keep blood from flowing in the leg because veins deeper in the leg take care of the larger volumes of blood.
• Ambulatory phlebectomy (fluh-BEK-tuh-me). A health care provider removes smaller varicose veins through a series of tiny skin punctures. Only the parts of the leg that are being pricked are numbed in this outpatient procedure. Scarring is generally minimal.

Lifestyle and home remedies

Lifestyle and home remedies for varicose veins include:

• Exercise. Get moving. Walking is a great way to encourage blood flow in the legs. Your health care provider can recommend an appropriate activity level for you.
• Manage weight. Shedding excess pounds takes unnecessary pressure off the veins.
• Avoid salt. Follow a low-salt diet to prevent swelling caused from water retention.
• Choose proper footwear. Avoid high heels. Low-heeled shoes work calf muscles more, which is better for your veins.
• Avoid tight clothing. Don't wear tight clothes around your waist, legs or groin because these garments can reduce blood flow.
• Raise the legs. To improve the blood flow in the legs, take several short breaks daily to raise the legs above the level of the heart. For example, lie down with the legs resting on three or four pillows.
• Avoid long periods of sitting or standing. Change your position frequently to encourage blood flow.

Alternative medicine

Though they haven't been well studied, a number of alternative therapies claim to be helpful treatments for chronic venous insufficiency. This is a condition associated with varicose veins in which leg veins have problems returning blood to the heart. Alternative therapies for varicose veins may include:

• Horse chestnut
• Butcher's broom
• Grape (leaves, sap, seed and fruit)
• Sweet clover

Talk with your health care provider before trying any herb or dietary supplement to make sure the product is safe and won't interfere with medications you take.

Preparing for your appointment

Your health care provider will need to look at your bare legs and feet to diagnose varicose veins and figure out what treatment might be best for your condition.

Your primary care doctor might recommend that you see a doctor who specializes in vein conditions (phlebologist), a vascular surgeon or a doctor who treats skin conditions (dermatologist or dermatology surgeon). In the meantime, there are some steps you can take to prepare for your appointment.

What you can do

Make a list of:

• Your symptoms, including any that may seem unrelated to varicose veins, and when they began
• Key personal information, including a family history of varicose veins or spider veins
• All medications, vitamins or supplements you take, including doses
• Questions to ask your doctor

Some basic questions to ask your doctor include:

• What's the most likely cause of my symptoms?
• Are there other possible causes for my varicose veins?
• What tests will I need?
• What treatment do you recommend for me?
• How can I best manage varicose veins along with other health conditions I have?
• Do I need to restrict any activities?
• Are there any brochures or other printed materials I can have? What websites do you recommend?

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

• When did you notice the varicose veins?
• Do you have pain? If so, how severe is it?
• What, if anything, seems to improve your symptoms?
• Does anything appear to worsen your symptoms?

What you can do in the meantime

Even before your appointment, you can begin self-care.

• Try not to stand or sit in one position for a long time.
• Raise your legs when you're seated.
• Avoid uncomfortable footwear and tight socks or hosiery.