Varicose veins

Varicose veins are swollen, bulging, and twisted veins that are superficial or near the skin’s surface. Veins in the legs are most prone to varicosity because of the increased pressure in the veins from walking or standing.

Varicose and spider veins, a milder form of varicose veins, can be simply a cosmetic concern. However, some patients may experience discomfort, aching pain, or other severe varicose veins problems.

Treatment includes self-treatment and outpatient procedures to close or remove the veins.

Symptoms

Blue or dark purple veins
Twisted and swollen cord-like veins

In painful varicose vein cases, you may experience:

Skin color changes around a varicose vein
Itchiness around a varicose vein
Achy pain in the legs
Muscle cramping, burning, throbbing, or swelling in the lower legs
Increasing pain after prolonged sitting or standing

Spider veins are smaller, twisted, and swollen veins in red or blue color near the skin surface. They can appear on the legs or face and look like a spider’s web.

When to see a doctor
See your doctor when self-care does not improve your symptoms, or you are worried about how the veins look

Causes
Blood from the heart is carried through arteries to the rest of the body and returned through veins. Blood in the leg veins flows against gravity in returning to the heart. Within the veins, there are small valves that maintain unidirectional blood flow. If these valves do not function properly, blood can backflow raising the pressure in the veins and causing the veins to twist and swell.

Risk factors

Age: The valves controlling blood flow can deteriorate due to aging, causing the backflow and pooling of blood.
Female: Female hormones are likely to relax vein walls. Hormonal changes due to menstruation, pregnancy, and menopause or hormone treatments, including birth control pills, may increase the risk of varicose veins.
Pregnancy: The increased blood volume in the body to support the growing baby can enlarge the veins in the legs.
Family history of varicose veins
Obesity: Veins are more pressured with excessive body weight.
Long sitting or standing: Move around to increase blood flow

Complications
Complications of varicose veins are rare, but they include:

Ulcers. A painful leg ulcer can develop in the skin near the ankles. Before an ulcer develops, you may notice a darkening change in skin color. Seek immediate medical care if you think you have a leg ulcer.
Blood clots. In some cases, deeper veins in the legs are dilated and enlarged, leading to painful and swollen legs. If the symptoms persist, seek medical attention, as this may signify a blood clot in the deep veins.
Bleeding. If a superficial vein burst, medical attention is required.

Prevention
To reduce the risk of varicose veins, you should improve blood flow and muscle tone. The self-care measures which can treat and prevent the risk of developing varicose veins include:

Exercise regularly
Eat high-fiber, low-sodium food
Maintain healthy weight
Elevate your legs when sitting or lying down
Refrain from wearing high heels and tight stockings.

Diagnosis
Your doctor will inquire about ache and pain in your legs and perform a physical exam to check for swelling.

Tests. A leg doppler ultrasound can check the direction of blood flow through the valves in the leg veins. The noninvasive imaging test can also help diagnose a blood clot. As the ultrasound transducer moves along the length of the vein, its image will show on a monitor.

Treatment

Self-care. To relieve the pain and prevent aggravation of the varicose veins, you should exercise, elevate your legs when sitting or lying down, or wear compression stockings.
Compression stockings. Compression stockings help to squeeze the legs and increase blood flow. Wearing them all day long is usually the first treatment option.
Surgeries or other procedures. If self-care and compression stockings do not improve your symptoms or the symptoms are worse off, consider surgery or other treatment modalities.
- Sclerotherapy. A solution or foam will be injected into your veins to scar and close the veins. Some veins may need more than one injection; eventually, the treated veins will fade in a couple of weeks. Sclerotherapy does not require anesthesia and is an outpatient procedure.
- Laser treatment. Intense bursts of light are directed onto the vein, making the veins gradually fade away.
- Catheter-based procedures delivering radiofrequency or laser energy. This procedure is for large varicose veins and involves inserting a thin tube into an enlarged vein. The tube tip will heat up with either radiofrequency or laser energy. The heat will scar and close the vein after the tube removal.
- High ligation and vein stripping. This procedure involves tying off and disconnecting the superficial varicose veins before they join the deep veins and removing them through multiple small incisions. Deeper veins in the leg are another conduit for returned blood to the heart; superficial veins removal does not block the returning blood flow.
- Ambulatory phlebectomy. It is an outpatient procedure with minimal scarring, removing small varicose veins via tiny skin punctures.

Lifestyle modification and home treatment

Exercise regularly. To Walk and get moving promote blood flow in the legs. Discuss with your doctor a suitable exercise activity.
Keep a healthy weight. Try to lose excess weight to take pressure off the veins.
Refrain from eating high-sodium food to prevent swelling from water retention.
Wear proper footwear. Stop wearing high-heeled shoes and opt for flat or low-heeled shoes, which help work the calf muscles and are better for your veins.
Avoid wearing tight clothes around the waist, legs, or groin because it reduces blood flow. Avoid tight clothing.
Lie down with your legs above your heart level to improve blood flow.
Do not sit or stand for a long time. Try to change your position often to increase blood flow.

Alternative medicine
Some alternative medicines make an unsubstantiated claim for treating chronic venous insufficiency and varicose veins.

Preparing for your appointment
Your doctor will examine your legs and feet and choose the most suitable treatment. You may need to see a phlebologist specializing in vein conditions, a vascular surgeon, or a dermatologist.

What you can do
You can take note of the following:

The symptom onset and symptoms you experience, which may be related or unrelated to varicose veins
Your medical condition and family history of varicose veins or spider veins
All medication and dietary supplements you are taking

Sample questions you may want to ask your doctor

What is the cause of my symptoms?
Do I need to undergo any tests?
What kind of treatments are available?
I have a medical condition. How should I treat both varicose veins and preexisting health problems?
Are there any restrictions I should follow?
Where can I find more information about varicose veins?

Sample questions your doctor may ask