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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.
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.
veins often run in families. Aging also increases your risk.
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.
Varicose veins look dark
blue, swollen, and twisted under the skin. Some people do not have any
symptoms. Mild symptoms may include:
More serious symptoms include:
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.
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.
You might need further tests if you plan to have treatment or if you
have signs of a deep vein problem.
Home treatment may be all
you need to ease your symptoms and keep the varicose veins from getting worse.
If you need treatment or you are concerned about how the
veins look, your options may include:
Learning about varicose veins:
Health Tools help you make wise health decisions or take action to improve your health.
are enlarged veins that usually occur just under the skin (superficial veins).
Varicose veins are likely to be caused by one or more factors,
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
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:
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
More severe symptoms or complications include:
Symptoms of varicose veins may become more severe a few
days before and during a woman's menstrual period.
varicose veins aren't a serious medical problem, but
they sometimes can lead to complications.
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.
Factors that increase your
risk of developing
varicose veins include:
Call your doctor if you have
varicose veins and:
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.
Primary care doctors (including
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:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
The most important tools in
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.
Duplex Doppler ultrasound is the most
commonly used noninvasive 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.
The goals of
varicose vein treatment are to reduce symptoms and
prevent complications. For some, the goal may be improved appearance. Home
exercising and wearing compression stockings—is the first and often best
If home treatment does not help, there are procedures or a surgery that can treat varicose veins. These include:
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.
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
If you are considering a surgery or procedure, consider some
questions about treatment. These questions might
include: How much experience does the doctor have with the particular
treatment? How much do the exam and treatment cost?
All treatment methods—including all types of surgery,
sclerotherapy, laser, and radiofrequency ablation—can scar or discolor the
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.
may be prevented to some extent by:
Home treatment is recommended for most
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
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.
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.
Medicines are not generally used to treat
Surgery for varicose veins includes tying off (ligation) and removing (stripping) larger
veins. Surgery may be used to treat
varicose veins if:
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
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 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.
There are several nonsurgical, minimally invasive
vein treatments for treating
Sclerotherapy is a nonsurgical
procedure in which a chemical is injected into the vein, causing the vein to
People who have laser or
radiofrequency treatment generally feel less pain and heal faster than people
who have ligation and stripping.
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 insurance.
varicose veins may require further treatment, especially if you have developed
severe varicose veins or
chronic venous insufficiency.
The American Society for Dermatologic Surgery was founded in 1970
to promote excellence in the subspecialty of dermatologic surgery and to foster
the highest standards of patient care. Information on the treatment of skin
conditions and referral lists are available online and by calling the ASDS.
The U.S. National Heart, Lung, and Blood Institute
(NHLBI) information center offers information and publications about preventing
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
Other Works Consulted
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,
Tisi P (2011). Varicose veins, search date January 2010. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
August 17, 2012
E. Gregory Thompson, MD - Internal Medicine & David A. Szalay, MD - Vascular Surgery
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