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Varicose Veins

Topic Overview

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. They usually aren't serious, but they can sometimes lead to other problems.

What causes varicose veins?

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 do not 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. Aging also increases your risk.

Being overweight or pregnant or having a job where you must stand for long periods of time increases pressure on leg veins. This can lead to varicose veins.

What are the symptoms?

Varicose veins look dark blue, swollen, and twisted under the skin. Some people do not have 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.
  • Swelling in your feet and ankles.
  • Itching over the vein.

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, or you may bleed after a minor injury.

Varicose veins are common and usually aren't a sign of a serious problem. But in some cases, varicose veins can be a sign of a blockage in the deeper veins called deep vein thrombosis. If you have this problem, you may need treatment for it.

How are varicose veins diagnosed?

Your doctor will look at your legs and feet. Varicose veins are easy to see, especially when you stand up. Your doctor will check your legs for tender areas, swelling, skin colour changes, sores, and other signs of skin breakdown.

You might need further tests if you plan to have treatment or if you have signs of a deep vein problem.

How are they treated?

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.

If you need treatment or you are concerned about how the veins look, your options may include:

  • Sclerotherapy to close off the vein.
  • Laser treatment to close off the vein.
  • Radiofrequency treatment to close off the vein.
  • Phlebectomy, or stab avulsion, to remove the vein.
  • Ligation and stripping to tie off and remove the vein.

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Cause

Varicose veins are enlarged veins that usually occur just under the skin (superficial veins). Varicose veins are likely to be caused by one or more factors, including:

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 varicose veins happen more often as people get older.

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

Less commonly, varicose veins may be a sign of a more serious problem that may sometimes need treatment. These serious problems can include:

  • Blood clots or blockage in the deep veins or perforating veins.
  • Injury to the deep veins.
  • Abnormal blood vessels between arteries and veins (arteriovenous fistulas). A person may be born with these problems or develop them later in life.
  • Tumours (very rarely).

Symptoms

You may not have symptoms with varicose veins. Most people identify varicose veins by the appearance of twisted, swollen, bluish veins just beneath the skin.

If you have symptoms of varicose veins, they tend to be mild and may include:

  • A dull ache, burning, or heaviness in the legs. These symptoms may be more noticeable late in the day or after you have been sitting or standing for a long time.
  • Mild swelling, usually involving the feet and ankles only.
  • Itching skin over the varicose vein.

More severe symptoms or complications include:

  • A buildup of fluid and swelling in the leg.
  • Significant swelling and calf pain after sitting or standing for a long time.
  • Skin colour changes (stasis pigmentation) around the ankles and lower legs.
  • Dry, stretched, swollen, itching, or scaling skin.
  • Superficial thrombophlebitis (when a blood clot and inflammation develop in a small vein near the surface of the skin).
  • Open sores (ulcerations).
  • Bleeding and/or bruising after a minor injury.

Symptoms of varicose veins may become more severe a few days before and during a woman's menstrual period.

What Happens

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.

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.

When should you call your 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

The most important tools in diagnosing varicose veins are the physical examination and medical history. Varicose veins are typically diagnosed based on their appearance, and no other special tests are needed to confirm the diagnosis.

  • The medical history will include questions about any vein problems, serious leg injuries, or leg ulcers you have had in the past, as well as any other risk factors you might have, including whether your family has a history of varicose veins. Talk to your doctor about any symptoms you are having (such as swelling, fatigue, or cramps in your legs) and what you have been doing to treat your symptoms, if anything.
  • During the physical examination, the doctor will examine your legs and feet (or any other affected areas) for varicose veins. You will likely stand during this test. Varicose veins are usually easy to see. The doctor will also check your legs for tender areas, swelling, skin colour changes, ulcers, and other signs of skin breakdown. To study the blood flow in your legs, the doctor may ask you to move your legs around in different positions.

If a problem with the deep veins or complications are suspected based on your symptoms and examination, other tests may be done.

Duplex Doppler ultrasound is the most commonly used non-invasive test that can help your doctor study blood flow in your leg veins.

An ultrasound might be done if you are considering having a procedure to treat varicose veins.

Treatment Overview

The goals of varicose vein treatment are to reduce symptoms and prevent complications. For some, the goal may be improved appearance. Home treatment—such as exercising and wearing compression stockings—is typically the first approach.

If home treatment does not help, there are procedures or a surgery 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. Incisions are made over the varicose veins, and the vein is tied off (ligated) and removed (stripped).
  • Phlebectomy. Several tiny cuts are made in the skin through which the varicose vein is removed.
  • Radiofrequency treatment. Radiofrequency energy (instead of laser energy) is used inside a vein to scar and close it off. It can be used to close off a large varicose vein in the leg.
  • Sclerotherapy. A chemical (sclerosant) 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.

Treatment may be needed to remove the damaged veins, treat complications, or correct an underlying problem that is causing the varicose veins. The size of your varicose veins affects your treatment options. Generally, larger varicose veins are 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.

Some people may want to improve how their legs look, even though their varicose veins are not causing other problems. In these cases, a procedure or surgery may be appropriate—as long as there are no other health problems that make these treatments risky.

What to think about

If you are thinking about having a vein treatment, you may want to know which treatment is best for you. No single approach is best for treating all varicose veins. Talk to your doctor about your choices.

If you are considering a surgery or procedure, consider some questions about treatment. For example, you may want to ask how much the examination and treatment cost.

All treatment methods—including all types of surgery, sclerotherapy, laser, and radiofrequency ablation—can scar or discolour the skin.

Treatment can be more difficult for deep veins that are damaged or for perforating veins, which connect the deep and superficial veins. These veins may be treated with surgery, radiofrequency ablation, or sclerotherapy, or a combination of these treatments.

Prevention

Varicose veins may be prevented to some extent by:

  • Using compression stockings. They improve circulation and are a mainstay of treatment for varicose veins that are causing symptoms.
  • Self-care. This includes exercising and avoiding long periods of standing or sitting.

Home Treatment

Home treatment is recommended for most people with varicose veins that aren't causing more serious problems. Home treatment can relieve symptoms, slow down the progress of varicose veins, and prevent complications such as sores or bleeding. For many people with varicose veins, home treatment is the only treatment they need.

These measures may help you avoid surgery or other medical treatment for your varicose veins. But you may still want surgery or a procedure if you are not satisfied with their appearance or your symptoms are not well controlled.

Home treatment includes the following:

After an injury

Superficial varicose veins can sometimes cause minor problems like bruising or bleeding if you scratch or cut the skin over a larger vein. Small blood clots may occasionally form in the surface veins (superficial phlebitis). Most of these problems can be safely treated at home.

  • If you bump your leg so hard that you know it is likely to bruise, elevate your leg and apply ice or a cold pack as soon as you can for the next hour or two. This may help reduce the amount of bleeding under the skin and minimize bruising.
  • If you cut or scratch the skin over a vein, it may bleed a lot. Elevate your leg and apply firm pressure with a clean bandage over the site of the bleeding. Continue to apply pressure for a full 15 minutes. Do not check to see if the bleeding has stopped sooner. If the bleeding hasn't stopped after 15 minutes, apply pressure again for another 15 minutes. You can repeat this up to three times for a total of 45 minutes.

Blood clot in a superficial vein (superficial phlebitis)

Signs of a small blood clot in a superficial varicose vein (superficial phlebitis) include tenderness and swelling over the vein. The vein may feel firm. If your doctor has told you how to care for superficial phlebitis, follow his or her instructions.

  • Often doctors will recommend that you elevate your leg and apply heat with a warm, damp cloth or a heating pad set on low (to prevent burns, put a towel or cloth between your leg and the heating pad).
  • Your doctor may also tell you to take a non-steroidal anti-inflammatory drug (for example, two aspirin or ibuprofen tablets taken 3 to 4 times a day at first and less often as your symptoms go away). Be safe with medicines. Read and follow all instructions on the label.
  • Talk to your doctor if you are not sure that your symptoms are caused by a superficial blood clot or if you are not sure how to treat your symptoms.

Medications

Medicines are not generally used to treat varicose veins.

Surgery

Surgery for varicose veins includes tying off (ligation) and removing (stripping) larger veins. Surgery may be used to treat varicose veins if:

  • The varicose veins have not responded to home treatment and your symptoms are bothering you.
  • You are concerned about the way varicose veins look, and laser treatment, radiofrequency treatment, or sclerotherapy is not likely to improve their appearance to your satisfaction.

Less invasive procedures are another option to treat varicose veins. Less invasive procedures are more commonly done than surgery. These procedures can give good results with less risk than surgery. These procedures include laser treatment (including endovenous laser); phlebectomy, or stab avulsion; and radiofrequency treatment.

The size of your varicose veins affects your treatment options. Typically, larger varicose veins are treated with ligation and stripping, endovenous laser treatment, or radiofrequency treatment. For some people, a combination of treatments may work best. Smaller varicose veins and spider veins are usually treated with laser therapy on your skin or sclerotherapy.

What to think about

Some people may want to have surgery to improve how their legs look, even though their varicose veins are not causing other problems. Surgery may be appropriate in some cases as long as you don't have other health problems that make the treatment risky.

Keep in mind that surgery for varicose veins done only for cosmetic reasons (that is, not medically necessary) is usually not covered by provincial health plans, but it may be partially covered by private insurance.

In some cases, a combination of surgery and sclerotherapy may be used to treat varicose veins. Sclerotherapy is a non-surgical procedure in which a chemical is injected into the vein, causing the vein to close off.

Other Treatment

There are several non-surgical, minimally invasive vein treatments for treating varicose veins.

Sclerotherapy is a non-surgical procedure in which a chemical is injected into the vein, causing the vein to close off.

Minimally invasive procedures

What to think about

Some people may want to have vein treatment to improve how their legs look, even though their varicose veins are not causing other problems. Vein treatments may be appropriate in some cases as long as you don't have other health problems that make the treatment risky.

Keep in mind that vein treatments done only for cosmetic reasons are not likely to be covered by provincial health plans, but they may be partially covered by private insurance.

Complications of varicose veins may require further treatment, especially if you have developed severe varicose veins or chronic venous insufficiency.

References

Other Works Consulted

  • Gloviczki P, et al. (2011). The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. Journal of Vascular Surgery, 53(16S): 2S–48S. DOI:10.1016/j.jvs.2011.01.079. Accessed December 29, 2014.
  • Khilnani NM, et al. (2010). Multi-society consensus quality improvement guidelines for the treatment of lower extremity superficial venous insufficiency with endovenous thermal ablation from the Society of Interventional Radiology, Cardiovascular Interventional Radiological Society of Europe, American College of Phlebology, and Canadian Interventional Radiology Association. Journal of Vascular and Interventional Radiology, 21(1): 14–31.
  • Kundu S, et al. (2010). Multi-disciplinary quality improvement guidelines for the treatment of lower extremity superficial venous insufficiency with ambulatory phlebectomy from the Society of Interventional Radiology, Cardiovascular Interventional Radiological Society of Europe, American College of Phlebology, and Canadian Interventional Radiology Association. Journal of Vascular and Interventional Radiology, 21(1): 1–13.
  • Raju S, Neglen P (2009). Chronic venous insufficiency and varicose veins. New England Journal of Medicine, 360(22): 2319–2327.
  • Tisi P (2011). Varicose veins, search date January 2010. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.

Credits

Current as of:
July 6, 2021

Author: Healthwise Staff
Medical Review:
E. Gregory Thompson MD - Internal Medicine
Adam Husney MD - Family Medicine
David A. Szalay MD - Vascular Surgery
Martin J. Gabica MD - Family Medicine