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.
See a picture of
varicose veins.
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:
- Color 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
color changes, sores, and other signs of skin breakdown.
If you
have signs of a deep vein problem or you plan to have treatment for a varicose
vein, you may need more tests.
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:
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 destroy the
vein.
- Radiofrequency treatment to close off the
vein.
- Surgery to tie off or remove the vein.
Frequently Asked Questions
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Learning about varicose veins:
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Being diagnosed:
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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:
- Increased pressure in the leg
veins.
- Damage to the leg veins.
- Damage to the valves of
the leg veins.
- Venous insufficiency.
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.
Pregnancy is a common cause of varicose veins. During
pregnancy, hormones relax the veins and more blood travels through the veins.
Extra weight and a heavy uterus place pressure on leg veins, too.
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.
- Tumors (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 color 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 are not 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 color 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 they are caused by
or linked with these deeper veins.
You can limit the progress and
discomfort of varicose veins by doing the following things:
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 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, elevate 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 are generally not
a serious health problem. With a doctor keeping an eye on the condition, most
people can manage varicose veins with home treatment, such as exercising,
wearing compression stockings, and elevating the legs.
Who To See
Primary care doctors (including
internists,
family medicine doctors, and
general practitioners) can diagnose, treat, and
monitor varicose veins and most of the complications they may cause.
Minimally invasive procedures or surgery may be done by:
- A
surgeon who specializes in blood vessel problems
(vascular surgeon).
- A
dermatologist.
- A
plastic surgeon.
- Other doctors with
special training and experience in sclerotherapy or varicose vein
surgery.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams 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.
If a problem with the
deep veins or complications are suspected based on your symptoms and exam,
other tests may be done.
If you are considering varicose vein
surgery or
sclerotherapy, further testing can help pinpoint the
location of the vein problem so that treatment will have the best chance of
success.
- Duplex Doppler ultrasound is the most
commonly used noninvasive test that can help your doctor study blood flow in
your leg veins.
- Venogram may be done to assess
complications of varicose veins, such as those related to the deep veins. This
test is rarely helpful in the diagnosis or treatment of 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—especially
exercising,
wearing compression stockings, and
elevating the legs—is the first and often best
approach.
If home treatment does not help, there are a number of minimally invasive treatment
options. These include sclerotherapy, laser treatment, and radiofrequency ablation. Laser treatment and radiofrequency ablation may be used to treat larger varicose veins. Vein surgery, called ligation and stripping, is an option for severe varicose veins.
- 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.
- Laser treatment. Laser energy is used to scar and
destroy varicose veins. This is called ablation.
Endovenous laser therapy uses a laser fiber inserted into the vein. Laser
ablation inside the vein makes the vein close up.
- 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. This ablation
treatment is new and may not be available in your area.
- Ligation and stripping. Incisions are made over the
varicose veins, and the vein is tied off (ligated) and removed
(stripped).
Treatment may be necessary 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 surgery (ligation and
stripping), endovenous laser, 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, surgery, sclerotherapy, or laser or radiofrequency
treatment may be appropriate—as long as there are no other health problems that
make these treatments risky. For more information, see:
Varicose veins: Should I have a surgical procedure?
What To Think About
Doctors recommend home
treatment as a first step for varicose veins. This may be all you need to
relieve symptoms. But you may still want surgery or vein treatment if you are
not satisfied with their appearance or your symptoms are not well
controlled.
If you are thinking about having surgery or a vein
treatment, you may want to know which treatment is best for you. No single
approach is best for treating all varicose veins. Sclerotherapy, endovenous
laser, or radiofrequency treatment may be best for smaller veins. Surgery may
work better for larger veins, though laser or radiofrequency treatment may also
work well. Talk to your doctor about your
choices.
Many treatment methods—including all types of surgery,
sclerotherapy, laser, and radiofrequency ablation—can scar or discolor 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:
These suggestions can relieve your symptoms, slow the
progression of varicose veins, and prevent complications such as sores or
bleeding. They are especially important if you have a family history of
varicose veins. These measures may help you avoid surgery or other medical
treatment for your varicose veins.
Home Treatment
Home treatment is recommended for most
people with
varicose veins that aren't causing more serious
problems. Home treatment can relieve symptoms and slow down the progress of
varicose veins. For many people with varicose veins, home treatment is the only
treatment they need.
If you have varicose veins, you can help
control the problem and keep it from getting worse if you:
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.
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
nonsteroidal 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).
- 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.
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.
For more information on making the decision about surgery,
see:
- Varicose veins: Should I have a surgical procedure?
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);
microphlebectomy, or stab avulsion; and
radiofrequency treatment.
Surgery Choices
- Vein ligation and stripping involves tying off (ligation) and removing (stripping) larger
varicose veins.
What To Think About
If you are considering surgery,
you will probably need to have tests (such as duplex ultrasound) to pinpoint
where damaged valves are in your veins. These tests can increase the chances of
having a successful surgery.
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
do not 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 insurance.
In some cases, a combination of surgery and
sclerotherapy may be used to treat varicose veins. Sclerotherapy is a
nonsurgical procedure in which a chemical is injected into the vein, causing
the vein to close off.
Other Treatment
There are several nonsurgical, minimally invasive
vein treatments for treating
varicose veins.
Other Treatment Choices
- Sclerotherapy is a nonsurgical
procedure in which a chemical is injected into the vein, causing the vein to
close off.
Minimally invasive procedures
What To Think About
People who have laser or
radiofrequency treatment generally feel less pain and heal faster than people
who have vein surgery.
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 do not have other health problems that
make the treatment risky. For more information on making this decision,
see:
- Varicose veins: Should I have a surgical procedure?
Keep in mind that vein treatments done only for cosmetic
reasons are not likely to be covered by insurance.
Complications of
varicose veins may require further treatment, especially if you have developed
severe varicose veins or
chronic venous insufficiency.
Other Places To Get Help
Organizations
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Society for Interventional Radiology
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| 3975 Fair Ridge Drive |
| Suite 400 North |
| Fairfax, VA 22033 |
| Phone: |
1-800-488-7284
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| Web Address: |
www.sirweb.org |
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The Society of Interventional Radiology is a national organization of physicians, scientists, and health professionals dedicated to improving public health through disease management and minimally invasive, image-guided therapies.
Intervention radiology includes using X-rays, MRI, and other imaging to move a thin tube in the body, usually in an artery, to treat a disease. An example is angioplasty for heart disease. The Web site includes a section on patient information. This section gives information on therapies for various diseases and conditions. The Web site can also help you find a doctor.
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| American Academy of Dermatology |
| P.O. Box 4014 |
| Schaumburg, IL 60168 |
| Phone: |
1-866-503-SKIN (1-866-503-7546) toll-free
(847) 240-1280 |
| Fax: |
(847) 240-1859 |
| Web Address: |
www.aad.org |
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The American Academy of Dermatology provides information
about the care of skin, hair, and nails. You can find a dermatologist in your
area by calling 1-888-462-DERM (1-888-462-3376).
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| VascularWeb |
| Society for Vascular Surgery |
| 633 North Saint Clair Street, 24th Floor |
| Chicago, IL 60611 |
| Phone: |
1-800-258-7188
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| Email: |
vascular@vascularsociety.org |
| Web Address: |
www.vascularweb.org |
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VascularWeb is a Web site provided by the Society for Vascular
Surgery. This Web site provides information about vascular conditions for
patients and families. VascularWeb can help you learn about how to prevent and
treat vascular diseases, learn about vascular screening, and find a vascular
surgeon.
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References
Other Works Consulted
- Raju S, Neglen P (2009). Chronic venous insufficiency
and varicose veins. New England Journal of Medicine,
360(22): 2319–2327.
- Tisi P (2007). Varicose veins, search date May 2007.
Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
Credits
| By |
Healthwise Staff |
| Primary Medical Reviewer |
Anne C. Poinier, MD - Internal Medicine |
| Specialist Medical Reviewer |
David A. Szalay, MD - Vascular Surgery |
| Last Revised |
February 5, 2010 |
