Varicose Veins

Overview

Varicose veins are twisted, enlarged veins near the surface of the skin. They develop most often in the legs and ankles.

Some people may be more likely than others to get varicose veins because of aging or hormone changes or because a parent has them. Being overweight or pregnant can make varicose veins worse. Jobs that require standing for long periods of time also can make them worse.

Symptoms

Varicose veins

External view of legs with and without varicose veins, with details of healthy vein and twising 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 don't work as they should, blood collects in your legs, and pressure builds up. The veins become weak, large, and twisted.

Causes

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 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.

Prevention

Preventing varicose veins

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.

Diagnosis

How are varicose veins diagnosed?

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 exam. The doctor will examine your legs and feet (or any other affected areas). The doctor will check for tender areas, swelling, skin color 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.

Treatment

How are varicose veins treated?

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 fiber 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 discolor 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.

When to Call

Varicose veins: When to call

Call 911 anytime you think you may need emergency care. For example, call if:

  • You have sudden chest pain and shortness of breath, or you cough up blood.

Call your doctor now or seek immediate medical care if:

  • You have signs of a blood clot, such as:
    • Pain in your calf, back of the knee, thigh, or groin.
    • Redness and swelling in your leg or groin.
  • A varicose vein begins to bleed and you cannot stop it.
  • You have a tender lump in your leg.
  • You get an open sore.

Watch closely for changes in your health, and be sure to contact your doctor if:

  • Your varicose vein symptoms do not improve with home treatment.

Self-Care

How can you care for yourself when you have varicose veins?

  • Wear compression stockings during the day to help relieve symptoms. They improve blood flow and are the main treatment for varicose veins. Talk to your doctor about which ones to get and where to get them.
  • Prop up your legs at or above the level of your heart when possible. This helps keep the blood from pooling in your lower legs and improves blood flow to the rest of your body.
  • Avoid sitting and standing for long periods. This puts added stress on your veins.
  • Get regular exercise, and control your weight. Walk, bicycle, or swim to improve blood flow in your legs.
  • If you bump your leg so hard that you know it is likely to bruise, prop up your leg and put ice or a cold pack on the area for 10 to 20 minutes at a time. Try to do this every 1 to 2 hours for the next 3 days (when you are awake) or until the swelling goes down. Put a thin cloth between the ice and your skin.
  • If you cut or scratch the skin over a vein, it may bleed a lot. Prop up 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 sooner to see if the bleeding has stopped. If the bleeding has not stopped after 15 minutes, apply pressure again for another 15 minutes. You can repeat this up to 3 times for a total of 45 minutes.

If you have a blood clot in a varicose vein, you may have tenderness and swelling over the vein. The vein may feel firm. Be sure to call your doctor right away if you have these symptoms. If your doctor has told you how to care for the clot, follow his or her 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 towel or cloth between your leg and the heating pad to prevent burns).
  • Ask your doctor if you can take an over-the-counter pain medicine, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Be safe with medicines. Read and follow all instructions on the label.

Copyrighted material adapted with permission from Healthwise, Incorporated. This information does not replace the advice of a doctor.

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