Condition Basics

What are varicose veins?

Varicose veins are twisted, enlarged veins near the surface of the skin. They are most common in the legs and ankles. Varicose veins usually aren't serious. In rare cases, they may be a sign of a more serious problem that may need treatment, such as deep vein thrombosis.

What causes them?

Varicose veins are caused by weakened valves and veins in your legs. Normally, one-way valves in your veins keep blood flowing from your legs up toward your heart. When these valves don't work as they should, blood collects in your legs, and pressure builds up. The veins become weak, large, and twisted.

What are the symptoms?

Varicose veins look dark blue, swollen, and twisted under the skin. They may not cause any symptoms. Mild symptoms may include heaviness, burning, aching, tiredness, or pain in your legs. Symptoms may be worse after you stand or sit for long periods of time.

How are they diagnosed?

To diagnose varicose veins, your doctor will look at your legs and feet. The doctor will check your legs for tender areas, swelling, skin colour changes, sores, and other signs of skin breakdown. You might need tests if you plan to have treatment or if you have signs of a deep vein problem.

How are varicose veins treated?

Home treatment may be all you need to ease your symptoms and keep the varicose veins from getting worse. Wear compression stockings. Prop up (elevate) your legs. Avoid long periods of sitting or standing. And get plenty of exercise. There are procedures to treat varicose veins if home treatment doesn't help.

Cause

Varicose veins are caused by weakened valves and veins in your legs. Normally, one-way valves in your veins keep blood flowing from your legs up toward your heart. When these valves don't work as they should, blood collects in your legs, and pressure builds up. The veins become weak, large, and twisted.

Varicose veins often run in families. You may be born with defective valves or weak walls in your veins, or you may develop them later in life.

Varicose veins are more common in women than in men. And they happen more often as people get older.

Varicose veins often form during pregnancy. They might become less prominent after pregnancy and may disappear completely.

What Increases Your Risk

Factors that increase your risk of developing varicose veins include:

• Pregnancy (particularly repeated pregnancies).
• Being female.
• Advancing age.
• Being overweight (tends to be a stronger factor in women). Having low muscle mass and high body fat decreases the support for the veins.
• Family history of varicose veins.
• Prolonged sitting or standing.
• Conditions that increase pressure in the abdomen, such as liver disease, fluid in the abdomen, previous groin surgery, or heart failure.
• Injury to the veins.
• Blood clots.

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Prevention

Varicose veins may be prevented to some extent. Here are a few things you can try.

• Use compression stockings.

  They improve circulation and are a mainstay of treatment for varicose veins that are causing symptoms.

• Get regular exercise.

  Walk, bicycle, or swim to improve blood flow in your legs.

• Avoid long periods of standing or sitting.

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Symptoms

Varicose veins look dark blue, swollen, and twisted under the skin. They may not cause any symptoms. Mild symptoms may include:

• Heaviness, burning, aching, tiredness, or pain in your legs. These symptoms may be worse after you stand or sit for long periods of time.
• Mild swelling in your feet and ankles.
• Itching over the vein.

Symptoms may get worse a few days before and during a woman's menstrual period.

More serious symptoms include:

• Leg swelling.
• Swelling and calf pain after you sit or stand for long periods of time.
• Skin changes, such as:
  • Colour changes.
  • Dry, thinned skin.
  • Inflammation.
  • Scaling.
• Open sores.
• Bleeding after a minor injury.
• Superficial thrombophlebitis. This happens when a blood clot and inflammation form in a small vein near the surface of the skin.

What Happens

Varicose veins usually don't cause problems. There are things you can do at home to help with symptoms and keep varicose veins from getting worse. But if the way your veins look bothers you, there are procedures that may help.

Complications

Most varicose veins aren't a serious medical problem, but they sometimes can lead to complications.

Complications can include:

• Bleeding from a varicose vein, which may occur without an injury or after an injury to the thin skin over the varicose vein. Bleeding can be heavy, but it can be controlled by elevating the leg and applying pressure to the area that is bleeding.
• Blood clots or inflammation (superficial thrombophlebitis), when a blood clot and inflammation develop in a small vein near the surface of the skin. Unlike blood clots in deep veins, clots in superficial veins rarely travel to the heart or lungs, where they could cause serious blockages.
• Dry, stretched, swollen, itching, or scaling skin.
• Thin, fragile, easily injured skin at or above the ankle.
• Open sores (ulcers), usually near the ankles.
• Skin colour changes (stasis pigmentation) around the ankles and lower legs.
• Fungal and bacterial infections, which may arise from skin problems resulting from fluid buildup (edema) in the leg and increased risk of tissue infection (cellulitis).

Varicose veins most often are a result of problems in the superficial veins just under the skin. But they can happen along with problems or disease in the deep veins and perforating veins, which connect the deep and the superficial veins. Complications are much more common when varicose veins are caused by or linked with these deeper veins.

When to Call a Doctor

Call your doctor if you have varicose veins and:

• Your leg suddenly becomes swollen and painful. You might have a blood clot in a deep vein, which can be serious and may need prompt attention.
• Skin over a varicose vein begins to bleed on its own or when it is injured. The skin over varicose veins is often thin and can bleed heavily. If this happens, prop up your leg and apply pressure directly to the vein to stop the bleeding.
• Your leg has a tender lump. This could be a clot or inflammation in a vein just under the skin, which is usually not dangerous but may need treatment.
• You develop an open sore (ulcer).
• Your varicose vein symptoms don't improve with home treatment, or there are symptoms you are concerned about.

Watchful waiting

Varicose veins are common and generally aren't a serious health problem. With a doctor keeping an eye on the condition, most people can manage varicose veins with home treatment. This includes exercise, wearing compression stockings, and propping up the legs.

Examinations and Tests

Varicose veins are most often diagnosed based on how they look. No special tests are needed to confirm the diagnosis.

Your doctor will:

• Ask questions about any risk factors, such as vein problems, serious leg injuries, or leg ulcers you've had in the past.
• Do a physical examination. The doctor will examine your legs and feet (or any other affected areas). The doctor will check for tender areas, swelling, skin colour changes, ulcers, and other signs of skin breakdown.

You might need tests if you plan to have treatment or if you have signs of a deep vein problem. Duplex Doppler ultrasound is the most commonly used test. It can help your doctor study blood flow in your leg veins.

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Treatment Overview

The goals of treatment for varicose veins are to reduce symptoms and prevent complications. For some, the goal may be related to how the veins look. Home treatment is usually the first approach.

Home treatment

Home treatment may be all you need to ease your symptoms and keep the varicose veins from getting worse. You can:

• Wear compression stockings.
• Prop up (elevate) your legs.
• Avoid long periods of sitting or standing.
• Get plenty of exercise.

Procedures

If home treatment doesn't help, there are procedures that can treat varicose veins. These include:

Laser treatment.

Laser energy is used to scar and destroy varicose veins. This is called ablation.

• Simple laser therapy is done on small veins close to the skin, such as spider veins. The laser is used outside of your skin.
• Endovenous laser therapy uses a laser fibre inserted into the vein. Laser ablation inside the vein makes the vein close up.

Ligation and stripping.

This treatment is a type of surgery. Cuts (incisions) are made over the varicose vein, and the vein is tied off (ligated) and removed (stripped). This option may be used if other treatments haven't worked or aren't likely to work, and you don't like the way your veins look or your symptoms bother you.

Phlebectomy.

Several tiny cuts are made in the skin through which the varicose vein is removed. This is also called stab avulsion.

Radiofrequency treatment.

Radiofrequency energy is used inside a vein to scar it and close it off. It can be used to close off a large varicose vein in the leg.

Sclerotherapy.

A chemical is injected into a varicose vein to damage and scar the inside lining of the vein, causing the vein to close. This usually works best for small veins.

All of these procedures can scar or discolour the skin.

The size of your varicose veins affects your treatment options.

• Larger varicose veins are generally treated with ligation and stripping, laser treatment, or radiofrequency treatment. In some cases, a combination of treatments may work best.
• Smaller varicose veins and spider veins are usually treated with sclerotherapy or laser therapy on your skin.

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Self-Care

Self-care, or home treatment, is recommended for most people with varicose veins. Home treatment can relieve symptoms and slow down the progress of varicose veins. For many people, home treatment is the only treatment they need.

Home treatment may include the following.

• Exercise.

  Exercise can help relieve symptoms and slow the progression of varicose veins by improving blood circulation in your legs.

  • Try to walk every day.
  • Bicycling and swimming are also recommended for varicose veins. Some doctors say swimming is ideal because, in addition to working your legs, it puts the legs at heart level and avoids the pooling of blood in the legs that comes with varicose veins.
  • Exercise your legs. When you are sitting down, rotate your feet at the ankles in both directions, making small circles. Extend your legs, and point and flex your feet. Bend your legs back and forth at the knees.

  High-impact exercises such as running may be uncomfortable for people with varicose veins.

• Stay at a healthy weight.

  Staying at a healthy weight, and losing weight if you need to, may help relieve symptoms caused by your varicose veins. Being overweight can increase the swelling and discomfort of varicose veins.

• Elevate your legs.

  When you elevate your legs, ideally at or above heart level, it helps keep the blood from pooling in your lower legs and improves blood flow to the rest of your body.

  There are simple ways to improve the blood flow in your legs and prevent or improve varicose veins:

  • Prop up your legs when you are sitting. Use a footrest at work and a footstool or ottoman at home to elevate your feet.
  • Lie down and prop your legs above heart level at the end of the day. Try lying on your back on a bed with your feet propped on the wall or on pillows to improve blood flow back to the heart.
  • Avoid crossing your legs at the knees when sitting. If you can't prop up your feet, set them flat on the floor or cross them at the ankles. Crossing legs at the knees squeezes veins and blocks blood flow.
  • Regularly tense the muscles in your legs and point and flex your feet when you are sitting for a long period of time, such as during airplane travel or a long car trip.
• Avoid long periods of sitting or standing.

  Sitting or standing still for long periods of time puts added stress on the veins in your legs.

  • If you stand when working, try to sit down for a few minutes regularly (with your feet up). Some people use a small stool to prop up first one foot, then the other when standing at work.
  • Move around after sitting for a long time. If you have a desk job, get up and walk around for a minute every hour to let your legs pump blood back to your heart.
  • Stop for a brief walk every 30 to 45 minutes during long car trips.
  • During a long plane trip, get up and walk up and down the aisle every 30 to 45 minutes.
• Wear compression stockings.

  Compression stockings are a main treatment for varicose veins that are causing symptoms. They improve circulation and help relieve symptoms.

Self-care for bruising or bleeding problems from a varicose vein

Superficial varicose veins just under the skin sometimes cause minor problems. Most can be treated at home.

Minimize bruising

If you bump your leg, prop up your leg and apply a cold pack for the next hour or two.

Control bleeding

• Prop up your leg. Apply pressure over the site of the bleeding.
• Apply pressure for a full 15 minutes.
• If the bleeding hasn't stopped after 15 minutes, apply pressure for another 15 minutes. Repeat up to 3 times (a total of 45 minutes).

Care for a small blood clot in a superficial varicose vein

Follow your doctor's instructions. Care may include the following:

• Prop up your leg and apply heat with a warm, damp cloth or a heating pad set on low. Put a cloth between your leg and the pad.
• Ask your doctor if you can take an over-the-counter pain medicine.

Talk to your doctor if you have questions.

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