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Medical reviewer:

Medically Reviewed On: July 11, 2006

Published on: July 11, 2006

Summary

Also known as varicosities, varicose veins are abnormally widened veins that are swollen, dark and frequently twisted or contorted instead of straight. They usually occur in the legs and may cause swelling (edema), inflammation and a dark color around the ankles.

For some people, the only problem caused by varicose veins is their appearance. For most people, however, varicose veins can cause pain, throbbing or itching. In extreme cases, varicose veins can lead to the development of a leg ulcer. A leg ulcer demands immediate medical attention to avoid serious medical consequences, such as amputation of the affected limb.

Varicose veins are more common in women than men. The condition appears in about half of all adults age 50 and over. The cause is uncertain, but the greatest risk factor is heredity (being born with weak vein valves), according to the U.S. National Institutes of Health (NIH).

Varicose veins can be treated with a variety of approaches, including surgical intervention, injection therapy and catheter-based therapies.

About varicose veins

Also known as varicosities, varicose veins are abnormally widened veins that are swollen, dark and frequently twisted or contorted instead of straight. They are more common in the superficial veins (just under the skin) than the deep veins (embedded deep in the muscles), although they can occur in either. Varicose veins are often noticeable at the back of the calf and thigh and may be surrounded by groups of flooded capillaries called spider veins (telangiectases).

Varicose veins may be caused by one of the following:

• Increased blood pressure in the veins.
  
  
• Damage, weakness or failure of the valves within the vein. The valves are responsible for keeping blood flowing in the right direction, which is particularly important when the veins are counteracting the effects of gravity to bring oxygen–poor blood from the legs to the heart. The valves close to prevent blood from flowing away from the heart in the veins (regurgitation). Leaky or damaged valves can cause blood to pool in the legs, resulting in swollen, varicose veins. Damage to the valves may be caused by a blood clot, a congential defect (a defect present since birth) or chronic venous insufficiency.

Risk factors include:

• Being born with weak leg valves
• Advanced age
• deep vein thrombosis
• Pregnancy, especially during the first and last trimesters
• Standing in one position for long periods of time
• Obesity
• A tumor in the abdomen

Varicose veins affect about half of people over the age of 50. The condition is more common in women, according to the U.S. National Institutes of Health (NIH). Although varicose veins usually occur in the legs, they can also occur around the anus (hemorrhoids), in the vulva of a pregnant woman and around a man’s scrotum (varicocele).

Signs and symptoms of varicose veins

Signs and symptoms of varicose veins in the legs may include:

• Dark blue, bulging veins just beneath the skin’s surface
  
  
• A group of thin, purple lines on the skin that looks somewhat like a spider web (“spider veins”)
  
  
• A heavy or achy feeling in the legs
  
  
• Burning, throbbing or itching around the bulging vein
  
  
• Swelling in the lower legs, especially around the ankles

If the affected leg is injured (e.g., due to a fall or other accident), people may also develop chronic venous insufficiency, which could lead to a complication called a leg ulcer (stasis ulcer). A leg ulcer is an open sore on the lower part of the leg that is usually small, close to the skin and very painful because of exposed nerve endings. A physician can often see or feel a varicose vein close to the open sore during a physical examination.

A leg ulcer is caused by poor circulation to the skin (stasis dermatitis), usually near the ankle. It demands immediate medical attention. If left untreated, it becomes virtually incurable. In the most extreme cases, leg ulcers can cause tissue death (necrosis), which can lead to amputation of the affected limb if infection (gangrene) sets in.

Diagnosis methods for varicose veins

The examination begins with the physician taking a medical history that includes the patient’s current symptoms and family history. The physician will perform a physical examination, which may include certain noninvasive tests that measure the circulation. Patients might be asked to lie with their legs elevated or walk during the examination.

Depending on what is revealed by these initial observations, the physician may order a Duplex ultrasound or a Doppler ultrasound. These noninvasive tests use high–frequency sound waves to take clear pictures of the veins. The test also gives information about the rate of blood flow and any leaking (regurgitation) of blood in the vein. The presence of venous clots will also be determined, especially when swelling (edema), darkening (pigmentation) of the skin and ulceration of the skin around the ankle are present.

The ultrasound is now used much more commonly than the venogram – a catheter based procedure in which a special dye (contrast medium) is injected into the affected vein to take x–rays of blood flow through the vein and the vein’s anatomical structure.

Treatment options for varicose veins

The treatment of varicose veins depends on several factors, including the severity of symptoms, the amount of pressure in the veins and the presence of inflammation. In the early stages, patients are advised to keep the affected leg elevated as much as possible and to wear supportive elastic stockings to relieve the aching and swelling. However, these strategies do not cure the condition, and many people elect to have varicose veins repaired.

There are a number of strategies available for repairing varicose veins. The goal of each strategy is to destroy all or part of the varicose vein and to detour blood flow through healthier blood vessels. These strategies include:

• Compression stockings have been shown to improve blood flow in leg veins. Patients with mildly symptomatic varicose veins will often be treated with compression stockings before other, invasive procedures. Most physicians consider compression therapy a necessary adjunct to any surgical therapies, to be initiated before and maintained after any surgery.
  
  
• Injection therapy (sclerotherapy) is recommended for patients with small varicose veins. During this procedure, an irritant chemical such as salt solution or a sclerosing agent is injected into the offending veins, causing them to scar and seal off. Following the injections, compression bandages are applied to prevent blood from refilling the veins and to allow them to heal. Injection therapy carries risks such as residual brown spots at the injection sites, formation of blood clots in superficial veins, an allergic reaction to the injected irritant or the formation of new spider veins. It is not used to treat large varicose veins. Multiple treatments may be required.
  
  
• Using a laser, a physician can direct bursts of light onto the vein that cause it to slowly fade and disappear. This procedure was originally used on smaller varicose veins and spider veins, especially on the upper body and face, although it can now be used for varicose veins on the legs.
  
  
• Ambulatory phlebectomy can be used to remove smaller varicose veins through a series of tiny skin punctures under local anesthesia. Scarring is kept to a minimum.
  
  
• Vein stripping is a surgical treatment reserved for large varicose veins such as the greater saphenous vein of the leg. In this procedure, incompetent segments of large varicosed veins are tied off and surgically removed.
  
  
• Endoscopic vein surgery is typically reserved for advanced cases of vascular disease involving leg ulcers. Surgeons insert a small endoscope (a fiber optic device equipped with a tiny camera) into the veins to visualize vascular abnormalities from inside the vein and to continue providing these clear images as the abnormalities are surgically removed.
  
  
• Vein ablation, also called saphenous vein ablation, is a catheter-based procedure that uses laser or radiofrequency energy to close off varicose veins. During this procedure, the physician inserts a long, thin tube (catheter) into the varicose vein and heats the tip of the catheter. As the catheter is removed, the heat destroys the vein. Radiofrequencies can also be used to close the vein.

Both surgery and injection therapy tend to produce good results. However, patients with varicose veins are strongly encouraged to make lifestyle changes that reduce their risk of future recurrences.

Prevention methods for varicose veins

Lifestyle changes can help to alleviate the symptoms of varicose veins and prevent a possible recurrence. They include:

• Regular exercise, especially walking.
  
  
• Avoiding long periods of standing or sitting in one place.
  
  
• Periodically shifting weight from one foot to another and flexing each foot up and down. This muscular activity releases the backflow pressure on the veins.
  
  
• Elevating legs above the level of the heart whenever possible.
  
  
• Avoiding crossing the legs at the knees when sitting, which can create a strong back pressure on the veins of the leg.
  
  
• Controlling weight to lighten unnecessary pressure on the leg veins.
  
  
• Avoiding constrictive clothing such as tight girdles and knee–high or thigh–high stockings with strong elastic bindings.

Questions for your doctor about varicose veins

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about varicose veins:

1. Can my varicose veins be treated conservatively?
   
   
2. If more aggressive treatment is needed, which type is best?
   
   
3. Can varicose veins be prevented?
   
   
4. Do I need to make adjustments at work to reduce my risk?