What Are Varicose Veins?
Varicose (VAR-i-kos) veins are swollen, twisted
veins that you can see just under the surface of the skin. These veins usually
occur in the legs. However, they also can form in other parts of your body.
Varicose veins are a common condition. They usually
cause few signs or symptoms. In some cases, varicose veins may cause
complications, such as mild to moderate pain, blood clots, or skin ulcers.
Overview
Veins are blood vessels that carry blood from your
bodys tissues to your heart. The heart pumps the blood to your lungs to
pick up oxygen. The oxygen-rich blood is then pumped out to your body through
your arteries.
From your arteries, the blood flows through tiny
blood vessels called capillaries, where it gives up its oxygen to the
bodys tissues. Your blood then returns to your heart through your veins
to pick up more oxygen.
Veins have one-way valves that help keep blood
flowing toward your heart. If your valves are weak or damaged, blood can back
up and pool in your veins. This causes the veins to swell and can lead to
varicose veins.
A number of factors may increase your risk for
varicose veins. These include family history, age, gender, pregnancy,
overweight
or obesity, and lack of movement.
Varicose veins are treated with lifestyle changes
and medical procedures. The goals of treatment are to relieve symptoms, prevent
complications, and improve appearance.
Outlook
Varicose veins usually dont cause medical
problems. If your varicose veins cause few signs and symptoms, your doctor may
suggest simply making lifestyle changes.
In some cases, varicose veins can cause
complications, such as pain, blood clots, or skin ulcers. If your condition is
more severe, your doctor may recommend one or more medical procedures. Some
people choose to have these procedures to improve the appearance of their
varicose veins or to relieve pain.
A number of treatments are available for varicose
veins that are quick and easy and dont require a long recovery
time.
Vein Problems Related to Varicose Veins
A number of vein problems are related to varicose
veins, such as telangiectasias (tel-AN-juh-ek-TA-ze-uhs), spider veins,
varicoceles (VAR-i-ko-seals), and other vein problems.
Telangiectasias
Telangiectasias are small clusters of blood vessels.
Theyre usually found on the upper body, including the face.
These blood vessels appear red. They may form during
pregnancy and often are found in people who have certain genetic disorders,
viral infections, or other medical conditions, such as liver disease.
Because telangiectasias can be a sign of a more
serious condition, see your doctor if you think you have them.
Spider Veins
Spider veins are a smaller version of varicose veins
and a less serious type of telangiectasias. Spider veins involve the
capillaries, the smallest blood vessels in the body.
Spider veins often show up on the legs and face.
They usually look like a spider web or tree branch and can be red or blue. They
usually arent a medical concern.
Varicoceles
Varicoceles are varicose veins in the scrotum (the
skin over the testicles). Varicoceles may be linked to male infertility. If you
think you have varicoceles, see your doctor.
Other Related Vein Problems
Other types of varicose veins include venous lakes,
reticular veins, and hemorrhoids. Venous lakes are varicose veins that appear
on the face and neck.
Reticular veins are flat blue veins often seen
behind the knees. Hemorrhoids are varicose veins in and around the
anus.
What Causes Varicose Veins?
Weak or damaged valves in the veins can cause
varicose veins. After your arteries deliver oxygen-rich blood to your body,
your veins return the blood to your heart. The veins in your legs must work
against gravity to do this.
One-way valves inside the veins open to let blood
flow through and then shut to keep blood from flowing backward. If the valves
are weak or damaged, blood can back up and pool in your veins. This causes the
veins to swell.
Weak valves may be due to weak vein walls. When the
walls of the veins are weak, they lose their normal elasticity. They become
like an overstretched rubber band. This makes the walls of the veins longer and
wider and causes the flaps of the valves to separate.
When the valve flaps separate, blood can flow
backward through the valves. The backflow of blood fills the veins and
stretches the walls even more. As a result, the veins get bigger, swell, and
often get twisted as they try to squeeze into their normal space. These are
varicose veins.
Normal Vein and Varicose
Vein
The illustration shows how a
varicose vein forms in a leg. Figure A shows a normal vein with a working valve
and normal blood flow. Figure B shows a varicose vein with a deformed valve,
abnormal blood flow, and thin, stretched walls. The middle image shows where
varicose veins might appear in a leg.
You may be at higher risk for weak vein walls due to
increasing age or a family history of varicose veins. You also may be at higher
risk if you have increased pressure in your veins due to
overweight
or obesity or pregnancy.
Who Is At Risk for Varicose Veins?
A number of factors may increase your risk for
varicose veins, including family history, age, gender, pregnancy,
overweight
or obesity, and lack of movement.
Family History
Having family members who have varicose veins may
raise your risk for the condition. About half of all people who have varicose
veins have a family history of them.
Age
Getting older may put you at higher risk for
varicose veins. The normal wear and tear of aging may cause the valves in your
veins to weaken and not work as well.
Gender
Women tend to get varicose veins more often than
men. Hormonal changes that occur during puberty, pregnancy, menopause, or with
the use of birth control pills may raise a womans chances of getting
varicose veins.
Pregnancy
During pregnancy, the growing fetus puts pressure on
the veins in the legs. Varicose veins that occur during pregnancy usually get
better within 3 to 12 months of delivery.
Overweight or Obesity
Being overweight or obese can put extra pressure on
your veins. This can lead to varicose veins.
Lack of Movement
Standing or sitting for a long time, especially with
your legs bent or crossed, may raise your risk for varicose veins. This is
because staying in one position for a long time may force your veins to work
harder to pump blood to your heart.
What Are the Signs and Symptoms of Varicose Veins?
The signs and symptoms of varicose veins
include:
- Large veins that you can see on your skin.
- Mild swelling of your ankles and feet.
- Painful, achy, or "heavy" legs.
- Throbbing or cramping in your legs.
- Itchy legs, especially on the lower leg and
ankle. This is sometimes incorrectly diagnosed as dry skin.
- Discolored skin in the area around the varicose
vein.
Signs of telangiectasias are red clusters of veins
that you can see on your skin. They're usually found on the upper body,
including the face. Signs of spider veins are red or blue veins in a web
pattern that often show up on the legs and face.
See your doctor if you have these signs and
symptoms. They also may be signs of other, sometimes more serious
conditions.
Complications
Sometimes varicose veins can lead to dermatitis
(der-ma-TI-tis), an itchy rash. If you have varicose veins in your legs,
dermatitis may affect your lower leg or ankle. Dermatitis can cause bleeding or
skin ulcers if the skin is scratched or irritated.
Varicose veins also may lead to a condition called
superficial thrombophlebitis (THROM-bo-fleh-BI-tis). Thrombophlebitis is a
blood clot in a vein. Superficial thrombophlebitis means that the blood clot
occurs in a vein close to the surface of the skin. This type of blood clot may
cause pain and other problems in the affected area.
How Are Varicose Veins Diagnosed?
Doctors often diagnose varicose veins based on a
physical exam alone. Sometimes tests or procedures are done to find out the
extent of the problem and to rule out other disorders.
Specialists Involved
If you have varicose veins, you may see a vascular
medicine specialist or vascular surgeon. These are doctors who specialize in
blood vessel conditions. You also may see a dermatologist. This is a doctor who
specializes in skin conditions.
Physical Exam
To check for varicose veins in your legs, your
doctor will look at your legs while youre standing or sitting with your
legs dangling. He or she may ask you about your signs and symptoms, including
any pain you're having.
Diagnostic Tests and Procedures
Doppler Ultrasound
Your doctor may recommend a Doppler ultrasound to
check blood flow in your veins and to look for blood clots. A Doppler
ultrasound uses sound waves to create pictures of structures in your body.
During this test, a handheld device will be placed
on your body and passed back and forth over the affected area. A computer will
convert the sound waves into a picture of the blood flow in your arteries and
veins.
Angiogram
Although rare, your doctor may order an angiogram to
get a more detailed look at the blood flow through your blood vessels. For this
procedure, dye is injected into your veins. The dye outlines your veins on
x-ray images.
An angiogram can help your doctor confirm whether
you have varicose veins or another problem.
How Are Varicose Veins Treated?
Varicose veins are treated with lifestyle changes
and medical procedures. The goals of treatment are to relieve symptoms, prevent
complications, and improve appearance.
If your varicose veins cause few symptoms, your
doctor may suggest simply making lifestyle changes. If your symptoms are more
severe, your doctor may recommend one or more medical procedures. For example,
you may need a medical procedure if you have significant pain, blood clots, or
skin disorders as a result of your varicose veins.
Some people who have varicose veins choose to have
procedures to improve the appearance of their varicose veins.
Although treatment can help existing varicose veins,
it can't keep new varicose veins from forming.
Lifestyle Changes
Lifestyle changes often are the first treatment for
varicose veins. These changes can prevent varicose veins from getting worse,
reduce pain, and delay other varicose veins from forming. Lifestyle changes
include the following:
- Avoid standing or sitting for long periods
without taking a break. When sitting, avoid crossing your legs. Raise your legs
when sitting, resting, or sleeping. When you can, raise your legs above the
level of your heart.
- Do physical activities to get your legs moving
and improve muscle tone. This helps blood move through your veins.
- If you're
overweight
or obese, lose weight. This will improve blood flow and ease the pressure
on your veins.
- Avoid wearing tight clothes, especially those
that are tight around your waist, groin (upper thighs), and legs. Tight clothes
can make varicose veins worse.
- Avoid wearing high heels for long periods. Lower
heeled shoes can help tone your calf muscles. Toned muscles help blood move
through the veins.
Your doctor may recommend compression stockings.
These stockings create gentle pressure up the leg. This pressure keeps blood
from pooling and decreases swelling in the legs.
There are three types of compression stockings. One
type is support pantyhose. These offer the least amount of pressure. A second
type is over-the-counter compression hose. These stockings give a little more
pressure than support pantyhose. Over-the-counter compression hose are sold in
medical supply stores and pharmacies.
Prescription-strength compression hose are the third
type of compression stockings. These stockings offer the greatest amount of
pressure. They also are sold in medical supply stores and pharmacies. However,
you need to be fitted for them in the store by a specially trained person.
Medical Procedures
Medical procedures are done either to remove
varicose veins or to close them. Removing or closing varicose veins usually
doesnt cause problems with blood flow because the blood starts moving
through other veins.
You may be treated with one or more of the
procedures listed below. Common side effects right after most of these
procedures include bruising, swelling, skin discoloration, and slight pain.
The side effects are most severe with vein stripping
and ligation (li-GA-shun). Although rare, this procedure can cause severe pain,
infection, blood clots, and scarring.
Sclerotherapy
Sclerotherapy (SKLER-o-ther-a-pe) uses a liquid
chemical to close off a varicose vein. The chemical is injected into the vein
to cause irritation and scarring inside the vein. The irritation and scarring
cause the vein to close off, and it fades away.
This procedure often is used to treat smaller
varicose veins and spider veins. It can be done in your doctor's office, while
you stand. You may need several treatments to completely close off a vein.
Treatments are typically done every 4 to 6 weeks.
Following treatments, your legs will be wrapped in elastic bandaging to help
healing and decrease swelling.
Microsclerotherapy
Microsclerotherapy (MI-kro-SKLER-o-ther-a-pe) is
used to treat spider veins and other very small varicose veins.
A small amount of liquid chemical is injected into a
vein using a very fine needle. The chemical scars the inner lining of the vein,
causing it to close off.
Laser Surgery
This procedure applies light energy from a laser
onto a varicose vein. The laser light makes the vein fade away.
Laser surgery is mostly used to treat smaller
varicose veins. No cutting or injection of chemicals is involved.
Endovenous Ablation Therapy
Endovenous ablation (ab-LA-shun) therapy uses lasers
or radiowaves to create heat to close off a varicose vein.
Your doctor makes a tiny cut in your skin near the
varicose vein. He or she then inserts a small tube called a catheter into the
vein. A device at the tip of the tube heats up the inside of the vein and
closes it off.
You will be awake during this procedure, but your
doctor will numb the area around the vein. You usually can go home the same day
as the procedure.
Endoscopic Vein Surgery
For endoscopic (en-do-SKOP-ik) vein surgery, your
doctor will make a small cut in your skin near a varicose vein. He or she then
uses a tiny camera at the end of a thin tube to move through the vein. A
surgical device at the end of the camera is used to close the vein.
Endoscopic vein surgery usually is used only in
severe cases when varicose veins are causing skin ulcers. After the procedure,
you usually can return to your normal activities within a few weeks.
Ambulatory Phlebectomy
For ambulatory phlebectomy (fle-BEK-to-me), your
doctor will make small cuts in your skin to remove small varicose veins. This
procedure usually is done to remove the varicose veins closest to the surface
of your skin.
You will be awake during the procedure, but your
doctor will numb the area around the vein. Usually, you can go home the same
day that the procedure is done.
Vein Stripping and Ligation
Vein stripping and ligation typically is done only
for severe cases of varicose veins. The procedure involves tying shut and
removing the veins through small cuts in your skin.
You will be given medicine to temporarily put you to
sleep so you dont feel any pain during the procedure.
Vein stripping and ligation usually is done as an
outpatient procedure. The recovery time from the procedure is about 1 to 4
weeks.
How Can Varicose Veins Be Prevented?
You can't prevent varicose veins from forming.
However, you can prevent the ones you have from getting worse. You also can
take steps to delay other varicose veins from forming.
Avoid standing or sitting for long periods without
taking a break. When sitting, avoid crossing your legs. Raise your legs when
sitting, resting, or sleeping. When you can, raise your legs above the level of
your heart.
Do physical activities to get your legs moving and
improve muscle tone. This helps blood move through your veins.
If you're
overweight
or obese, lose weight. This will improve blood flow and ease the pressure
on your veins.
Avoid wearing tight clothes, especially those that
are tight around your waist, groin (upper thighs), and legs. Tight clothes can
make varicose veins worse.
Avoid wearing high heels for long periods. Lower
heeled shoes can help tone your calf muscles. Toned muscles help blood move
through the veins.
Wear compression stockings if your doctor advises
you to. These stockings create gentle pressure up the leg. This pressure keeps
blood from pooling in the veins and decreases swelling in the legs.
Living With Varicose Veins
Varicose veins are a common condition. They often
cause few signs or symptoms. If your signs and symptoms are minor, your doctor
may suggest simply making lifestyle changes.
If your condition is more severefor example,
if you have significant pain, blood clots, or skin ulcersyour doctor may
recommend one or more medical procedures. A number of treatments are available
that are quick and easy and don't require a long recovery time.
For more information on lifestyle changes and
medical procedures, see "How Are Varicose Veins
Treated?"
Key Points
- Varicose veins are swollen, twisted veins that
you can see just under the surface of the skin. These veins usually occur in
the legs, although they also can form in other parts of the body.
- Varicose veins are a common condition. They
usually cause few signs or symptoms. In some cases, they may cause mild to
moderate pain, blood clots, or skin ulcers.
- A number of other types of vein problems are
related to varicose veins, including telangiectasias, spider veins,
varicoceles, venous lakes, reticular veins, and hemorrhoids.
- Weak or damaged valves in the veins can cause
varicose veins. One-way valves inside the veins open to let blood flow through
and then shut to keep blood from flowing backward. If the valves are weak or
damaged, blood can back up and pool in your veins. This causes the veins to
swell.
- A number of factors may increase your risk for
varicose veins. These include family history, age, gender, pregnancy,
overweight
or obesity, and lack of movement.
- The signs and symptoms of varicose veins include
large veins that you can see on your skin; mild swelling of your ankles and
feet; painful, achy, or "heavy" legs; throbbing or cramping in your legs; itchy
legs; and discolored skin in the area around the varicose vein.
- Sometimes varicose veins can lead to dermatitis,
an itchy skin rash. Varicose veins also can lead to superficial
thrombophlebitis. This refers to a blood clot that occurs in a vein thats
at the surface of the skin.
- Doctors often diagnose varicose veins based on a
physical exam alone. Sometimes tests or procedures are done to confirm a
diagnosis.
- Lifestyle changes often are the first treatment
for varicose veins. These changes can prevent varicose veins from getting
worse, reduce pain, and delay other varicose veins from forming.
- If your condition is more severe, your doctor may
recommend one or more medical procedures. A number of treatments are available
that are quick and easy and dont require a long recovery time.
- Some people choose to have a medical procedure to
improve the appearance of varicose veins or to relieve pain.
- You can't prevent varicose vein from forming.
However, you can prevent the ones you have from getting worse. You also can
take steps to delay other varicose veins from forming. Avoid sitting or
standing for long periods, stay active, lose weight (if you're overweight),
avoid tight clothes and high heels, and wear compression stockings if your
doctors advises you to.
Links to Other Information About Varicose
Veins
Non-NHLBI Resources
Clinical Trials
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