Varicose veins

Alternative Names

Varicosity; Varicosis

Causes, incidence, and risk factors

In normal veins, valves in the vein keep blood moving forward toward the heart. With varicose veins, the valves do not function properly, allowing blood to stay in the vein. Blood that pools causes the vein to swell.

This process usually occurs in the veins of the legs, although it may occur in other parts of the body. Varicose veins are common, but they usually affect women.

Causes include:

• Defective valves from birth (congenitally defective valves)
• Pregnancy
• Thrombophlebitis

Standing for a long time and having increased pressure in the abdomen may lead to varicose veins, or may make the condition worse.

Symptoms

• Fullness, heaviness, aching, and sometimes pain in the legs
• Visible, swollen veins
• Mild swelling of ankles
• Brown color of the skin at the ankles (in more severe cases)
• Skin ulcers near the ankle (in more severe cases)

Signs and tests

The diagnosis is made based on the appearance of the leg veins when you are standing or sitting with your legs dangling.

The health care provider may order a duplex ultrasound exam of the extremity :

• To see blood flow in the veins
• To rule out other problems with the legs (such as a blood clot)

Treatment

You will be asked to:

• Avoid standing for too long
• Raise your legs when resting or sleeping
• Wear elastic support hose

You may need surgery or other treatment for:

• Leg pain, which may feel heavy or tired
• Skin sores that are caused by poor blood flow through the veins
• Improving the appearance of the legs
• Thickening and hardening of the skin in the legs and ankles

Vein stripping is surgery to remove varicose veins in the legs. It is usually only done in patients who are having a lot of pain or who have skin sores.

Less invasive treatments for varicose veins are:

• Laser ablation
• Radiofrequency ablation
• Sclerotherapy (which is often done to improve appearance)

Expectations (prognosis)

Varicose veins tend to get worse over time. You can ease discomfort and slow varicose veins from getting worse by taking care of them.

Veins may become swollen or inflamed. This is called thrombophlebitis .

Calling your health care provider

Call for an appointment with your health care provider if:

• Varicose veins are painful
• They get worse or do not improve with self-treatment, such as by keeping the legs raised or avoiding standing for too long
• You have a sudden increase in pain or swelling, fever, redness of the leg, or leg sores

References

Freischlag JA, Heller JA. Venous disease. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 65.

Nijsten T, van den Bos RR, Goldman MP, et al. Minimally invasive techniques in the treatment of saphenous varicose veins. J Am Acad Dermatol. 2009;60:110-119.