What Are Varicose Veins?
Varicose veins are swollen and twisted veins that
are visible just under the surface of the skin. They appear most commonly in
the legs, but also can develop in other parts of the body.
Veins are blood vessels that carry blood from the
tissues of the body to the heart. In the heart, blood is pumped to the lungs to
pick up oxygen. The oxygen-rich blood is then pumped out to the body through
the arteries. From the arteries, blood flows through tiny blood vessels called
capillaries, where it gives up its oxygen to the bodys tissues. The blood
then returns back to the heart through the veins to pick up more oxygen.
Veins have one-way valves that help to keep the
blood flowing toward the heart. When the valves dont work well, blood
backs up and pools in the veins. This causes them to swell and become varicose
veins.
Varicose veins usually dont cause medical
problems. On occasion, they require treatment for pain, skin problems, blood
clots, or other complications. People may choose to have cosmetic treatment to
improve the appearance of varicose veins.
Related Vein Problems
A number of other types of vein problems are related
to varicose veins.
Spider Veins
Spider veins are a smaller version of varicose
veins. They occur in the capillaries, which are the smallest blood vessels in
the body. Spider veins are commonly found on the legs and face, and they
usually resemble a spider web or tree branch in shape. They can be red or blue.
Spider veins are usually not a medical concern.
Telangiectasias
Telangiectasias (tel-AN-juh-ek-TA-ze-uhs) are small
clusters of blood vessels that look similar to spider veins. They are red in
color and are commonly found on the upper body, including the face. They can
develop during pregnancy and in people who have certain genetic disorders,
viral infections, and other medical conditions (such as liver disease). Newly
developed telangiectasias are often a reason to see a doctor.
Venous Lakes
Venous lakes are another type of varicose veins in
which blood collects in the veins of the face and neck.
Reticular Veins
Reticular veins are flat blue veins commonly seen
behind the knees.
Hemorrhoids
Hemorrhoids are varicose veins in blood vessels in
and around the anus.
Varicoceles
Varicoceles (VAR-i-ko-seals) are varicose veins in
the scrotum (the skin over the testicles). Varicoceles may be linked to male
infertility and should be checked by a doctor.
Outlook
People with varicose veins often require only simple
self-care measures, such as performing certain leg exercises, wearing
compression stockings, and avoiding long periods of sitting or standing. For
those who are concerned about the appearance of varicose veins, several
cosmetic treatments are available. Although uncommon, in some cases,
complications such as pain, skin ulcers, and blood clots can develop. A variety
of medical and surgical procedures are used to treat varicose veins in these
more complicated cases.
What Causes Varicose Veins?
Veins, especially those in the legs, have to pump
the blood up hill to the heart, against gravity. Inside the veins
are one-way valves that help with pumping action and prevent blood from flowing
backward. These valves allow blood to flow in only one direction, toward the
heart. Varicose veins develop when the valves become weakened, damaged, or
dont work well.
Weakness in the valves may be due to weakness in the
walls of the veins. This weakness tends to be associated with certain factors,
including increasing age, a family history of varicose veins, or high pressure
inside veins due to overweight or pregnancy.
When the walls of the veins are weak, they lose
their normal elasticity, like an overstretched rubber band. This makes them
longer and wider and causes the flaps of the valves to separate. Blood is then
able to flow backward through the valves, filling the vein and stretching it
even more. The vein becomes enlarged, swollen, and often twisted trying to
squeeze into its normal space.
The illustration shows the location
of leg veins, which can become varicose veins. Figure A shows a normal vein
with working valves and normal blood flow. Figure B shows a varicose vein with
deformed valves, abnormal blood flow, and thin, dilated (stretched) walls.
Who Is At Risk for Varicose Veins?
Populations Affected
About 25 million Americans are affected by varicose
veins. They are most common in people aged 30 to 70.
Risk Factors
Risk factors for developing varicose veins
include:
- Genetics. Having a family member with varicose
veins may increase the risk for developing them. Approximately half of the
people who get varicose veins have a family history of them.
- Age. The normal wear and tear of aging may cause
valves to weaken and not work as well.
- Gender. Women are two to three times more likely
to develop varicose veins than men. Up to half of American women have varicose
veins. Changes in hormones due to puberty, pregnancy, menopause, or taking
birth control pills may increase a womans risk of developing varicose
veins.
- Pregnancy. During pregnancy, the growth of the
fetus increases the pressure on the veins in the legs. Varicose veins that
occur during pregnancy usually improve within 3 to 12 months following
delivery.
- Overweight and obesity. Having extra weight on
the body can put additional pressure on the veins.
- Prolonged standing or sitting, particularly with
legs bent or crossed. When standing or sitting with legs bent or crossed, the
veins have to work harder to pump the blood up to the heart.
What Are the Signs and Symptoms of Varicose
Veins?
Common signs and symptoms of varicose veins
include:
- Enlarged veins that are visible on your skin
- Mild swelling of your ankles and feet
- Painful, achy, or heavy legs
- Throbbing or cramping in your legs
- Itchy legs, especially in the lower leg and ankle
(sometimes incorrectly diagnosed as dry skin)
- Discoloration of your skin surrounding the
varicose veins
Complications
Only a small percentage of people have complications
from varicose veins. Complications may include dermatitis and
thrombophlebitis.
Dermatitis
Dermatitis is an itchy rash that can occur on the
lower leg or ankle of a person with varicose veins in the legs. It can
sometimes cause bleeding or a skin ulcer to develop if scratched or
irritated.
Thrombophlebitis
This is a blood clot (thrombus) that occurs in a
vein. There are two types of thrombophlebitis:
- Superficial thrombophlebitis is a blood clot that
occurs in a superficial vein and usually causes only minor problems that are
limited to the area of the affected vein. Clots in varicose veins are usually
of this type. Infections, chemical irritation, or other conditions that cause
irritation and inflammation of the veins also can lead to superficial
thrombophlebitis.
- Deep
vein thrombosis is a blood clot that develops in veins deeper in the body.
It can be life threatening if the clot breaks off and travels to the lungs,
which is called
pulmonary
embolism. This type of thrombophlebitis does not occur in varicose
veins.
How Are Varicose Veins Diagnosed?
Varicose veins are often diagnosed based simply on
the appearance of the veins. For varicose veins in the legs, your doctor will
examine your legs while you are standing or seated with your legs dangling.
Your doctor may also ask you to describe pain or any other symptoms. Some
diagnostic tests may be done to rule out other disorders or conditions.
Specialists Involved
The following specialists may be involved in your
medical care if you have varicose veins:
- A vascular medicine specialist or vascular
surgeon (blood vessel system specialist)
- A dermatologist (skin specialist)
Diagnostic Tests and Procedures
Your doctor may order a
Doppler ultrasound to evaluate the flow of blood in your veins
and to look for blood clots. During a Doppler ultrasound, a handheld device is
placed on your body and passed back and forth over the affected area. A
computer converts sound waves into a picture of the blood flow in the arteries
and veins.
Rarely, your doctor may order an
angiogram to look at blood flow through your blood vessels.
The procedure involves injecting a dye into your veins that can be seen using
x ray. An angiogram can help to rule out other diagnoses
besides varicose veins.
How Are Varicose Veins Treated?
Goals of Treatment
The goals of treating varicose veins may include
easing symptoms, avoiding complications, and improving cosmetic appearance.
Although treatment can target existing varicose veins, it can't keep new
varicose veins from forming.
Who Needs Treatment
Varicose veins that cause few signs and symptoms
usually dont need to be treated. Instead, your doctor may recommend
simple self-care measures. Varicose veins causing more severe signs and
symptoms may need medical or surgical treatment. Treatment may be recommended
when the varicose veins are causing skin ulcers, serious skin conditions, blood
clots, significant pain, or disruption of daily life activities. Some people
with varicose veins may choose to have medical or surgical treatments to
improve the cosmetic appearance of varicose veins.
Types of Treatment
Self-Care Measures
Self-care measures are a common option for treating
varicose veins. If self-care measures are called for, your doctor may ask you
to:
- Avoid excess amounts of standing when possible.
Take frequent breaks during prolonged periods of standing.
- Elevate your legs when sitting, resting, or
sleeping. Elevating your legs above the level of your heart is very
important.
- Wear compression stockings. These are typically
worn all day long. Doctors may prescribe special-strength stockings or
over-the-counter support stockings, which may be available at pharmacies and
medical supply stores.
- Exercise. Exercise gets the legs moving and
improves muscle tone, which helps the circulation of blood through your
veins.
- Lose weight. Taking off extra pounds may help
with blood circulation and pressure on your veins.
- Avoid wearing tight clothes. Tight clothes,
especially those that are tight around your waist, groin (upper thighs), and
legs, can make varicose veins worse.
Medical and Surgical Treatments
Medical and surgical treatments are used to either
remove varicose veins or close them. Removing or closing varicose veins usually
doesnt create circulation problems because the blood reroutes itself
through other veins. These therapies range from approaches that dont
involve incisions or injections to those that are surgical procedures. It may
be necessary to combine therapies, depending on your condition and
lifestyle.
Sclerotherapy. This procedure uses
a liquid chemical to close off the vein. The solution is injected into the vein
to cause irritation and scarring inside the vein, which causes the vein to
close off and fade away. Its usually used to treat smaller varicose veins
and spider veins. Sclerotherapy is usually done in the doctors office,
while you stand. You may need several sclerotherapy treatments to close off a
vein completely. In this case, treatments are typically given every 4 to 6
weeks. Following treatments, your legs are wrapped in elastic bandaging to help
healing and decrease swelling.
Microsclerotherapy. This procedure
is used to treat spider veins and other very small varicose veins. It involves
injection of small amounts of a liquid chemical using a very fine needle. The
chemical causes scarring in the inner lining of the veins, causing them to
close off.
Laser surgery. This procedure uses
no incisions or injections. Light energy from a laser is used to make the vein
fade away. Laser surgery is typically used to treat smaller varicose veins.
With new technology, lasers are more effective than they used to be.
Endovenous ablation therapy. This
procedure uses an energy source (either laser or radiowave) to create heat to
close off the vein. A tiny incision is made in the skin, and a small catheter
(tube) is inserted into the vein. A device at the tip of the catheter heats up
the inside of the vein, which causes it to close off. Youre awake during
the procedure, but your doctor numbs the area of the vein. You can usually go
home on the same day. You may experience less pain and recover more quickly
with this procedure than with some of the others.
Endoscopic vein surgery. This
procedure uses a tiny camera at the end of a thin tube to move through the
varicose veins. A surgical instrument at the end of the camera is used to close
the veins. Endoscopic vein surgery is currently only used in severe cases in
which there are skin ulcers due to the varicose veins. Only small incisions are
required for this procedure.
Ambulatory phlebectomy. In this
procedure, small varicose veins are removed through small incisions in your
skin. Ambulatory phlebectomy is typically used to treat varicose veins close to
the surface of the skin. Youre awake during the procedure, but your
doctor numbs the area of the vein. You can usually go home the same day.
Vein stripping and ligation. In
this procedure, veins are tied shut (ligation) and removed (stripping) through
small incisions. The procedure is typically used in severe cases, in which the
varicose veins cause pain or skin ulcers. Youre given medicine to sleep
so that you dont feel any pain during the procedure.
What To Expect After Treatment
Recovery times vary based on the specific procedure
thats performed. Vein stripping and ligation requires more recovery than
most other procedures. Activity is not significantly limited following most
other procedures. In fact, walking is often recommended during recovery. Some
treatments may require that you wear compression stockings or bandages for a
period ranging from a couple days to a few weeks following the procedure.
Common side effects immediately following a
procedure may include bruising, swelling, skin discoloration, cramping, and
itching. Swelling and skin discoloration may last for several months. Less
common side effects include blood clots or nerve damage. An uncommon side
effect of sclerotherapy is liquid chemical leaking out of the vein, which could
cause tissue damage or ulcers.
How Can Varicose Veins Be Prevented?
Varicose veins cant be prevented from forming,
but there are ways to reduce the severity of existing varicose veins and the
risk of getting new varicose veins. To decrease the risk for and severity of
varicose veins, you can:
- Exercise. Moving your legs by walking or other
forms of exercise can help move blood through your body.
- Control your weight. If you are overweight or
obese, losing weight will reduce pressure on your veins.
- Avoid high heels and tight clothes. Flat or
low-heeled shoes give your calf muscles a better workout, which will help to
improve muscle strength and blood circulation. Avoiding tight clothing will
reduce unnecessary pressure on your veins.
- Avoid excessive standing or sitting with your
legs bent or crossed. This will help blood flow and avoid additional pressure
on your veins. During long periods of standing, try to take sitting breaks
often.
- Elevate your legs. Elevating your legs when
sitting, resting, or sleeping can help the flow of blood, especially if your
legs are raised above the level of your heart.
Living With Varicose Veins
Varicose veins can typically be treated with
self-care. If medical procedures are necessary, they are generally very
effective, and treated veins eventually fade or disappear. But the treatments
dont prevent new varicose veins or other vein problems. Its
possible for the same varicose veins to reappear after treatment, but this is
uncommon.
Ongoing Health Care Needs
Although its not possible to completely
prevent new varicose veins from forming, following the steps in the How
Can Varicose Veins Be Prevented? section can help keep developing or
worsening varicose veins under control. Watch for skin ulcers or other
complications that may develop, and consult a doctor if this happens.
Key Points
- Varicose veins are enlarged and twisted veins
close to the surface of the skin. They usually dont cause medical
problems, but occasionally require treatment for complications, including pain,
skin ulcers, and blood clots.
- Varicose veins are usually the result of damaged
or improperly working valves in the veins, which cause blood to back up and
make the vein swell.
- Varicose veins can affect any vein, but are most
common in the legs.
- Varicose veins are more common in women than in
men. Family history and increasing age also are risk factors for varicose
veins.
- Common signs and symptoms of varicose veins
include enlarged veins visible on the skin, swelling, and sometimes pain or
throbbing in the legs. More serious complications can occur, such as skin
ulcers and blood clots, but these are usually the result of problems with
deeper veins.
- Varicose veins are usually diagnosed simply on
the appearance of leg veins when youre standing or seated with your legs
dangling. Medical tests are usually not needed for the diagnosis.
- Most varicose veins dont require treatment.
Doctors may recommend simple self-care measures, including exercise, weight
loss (if youre overweight), and avoiding long periods of sitting or
standing.
- In cases where signs and symptoms are more severe
or there are complications such as skin ulcers, medical treatment may be
necessary. Treatments also are done for cosmetic reasons. Varicose vein
treatments are typically very effective.
- Goals of treatment include easing symptoms,
avoiding complications, and improving cosmetic appearance.
- Although theres no way to completely
prevent new varicose veins from forming, existing varicose veins can be kept
under control with simple self-care measures.
Links to Other Information About Varicose
Veins
Non-NHLBI Resources
Clinical Trials
|