What Are Varicose Veins? Varicose veins are swollen and twisted veins that are visible just under the surface of the skin. They appear most commonly in the legs, but also can develop in other parts of the body. Veins are blood vessels that carry blood from the tissues of the body to the heart. In the heart, blood is pumped to the lungs to pick up oxygen. The oxygen-rich blood is then pumped out to the body through the arteries. From the arteries, blood flows through tiny blood vessels called capillaries, where it gives up its oxygen to the body’s tissues. The blood then returns back to the heart through the veins to pick up more oxygen. Veins have one-way valves that help to keep the blood flowing toward the heart. When the valves don’t work well, blood backs up and pools in the veins. This causes them to swell and become varicose veins. Varicose veins usually don’t cause medical problems. On occasion, they require treatment for pain, skin problems, blood clots, or other complications. People may choose to have cosmetic treatment to improve the appearance of varicose veins. Related Vein Problems
A number of other types of vein problems are related to varicose veins. Spider Veins
Spider veins are a smaller version of varicose veins. They occur in the capillaries, which are the smallest blood vessels in the body. Spider veins are commonly found on the legs and face, and they usually resemble a spider web or tree branch in shape. They can be red or blue. Spider veins are usually not a medical concern. Telangiectasias
Telangiectasias (tel-AN-juh-ek-TA-ze-uhs) are small clusters of blood vessels that look similar to spider veins. They are red in color and are commonly found on the upper body, including the face. They can develop during pregnancy and in people who have certain genetic disorders, viral infections, and other medical conditions (such as liver disease). Newly developed telangiectasias are often a reason to see a doctor. Venous Lakes
Venous lakes are another type of varicose veins in which blood collects in the veins of the face and neck. Reticular Veins
Reticular veins are flat blue veins commonly seen behind the knees. Hemorrhoids
Hemorrhoids are varicose veins in blood vessels in and around the anus. Varicoceles
Varicoceles (VAR-i-ko-seals) are varicose veins in the scrotum (the skin over the testicles). Varicoceles may be linked to male infertility and should be checked by a doctor. Outlook
People with varicose veins often require only simple self-care measures, such as performing certain leg exercises, wearing compression stockings, and avoiding long periods of sitting or standing. For those who are concerned about the appearance of varicose veins, several cosmetic treatments are available. Although uncommon, in some cases, complications such as pain, skin ulcers, and blood clots can develop. A variety of medical and surgical procedures are used to treat varicose veins in these more complicated cases. What Causes Varicose Veins?
Veins, especially those in the legs, have to pump the blood “up hill” to the heart, against gravity. Inside the veins are one-way valves that help with pumping action and prevent blood from flowing backward. These valves allow blood to flow in only one direction, toward the heart. Varicose veins develop when the valves become weakened, damaged, or don’t work well. Weakness in the valves may be due to weakness in the walls of the veins. This weakness tends to be associated with certain factors, including increasing age, a family history of varicose veins, or high pressure inside veins due to overweight or pregnancy. When the walls of the veins are weak, they lose their normal elasticity, like an overstretched rubber band. This makes them longer and wider and causes the flaps of the valves to separate. Blood is then able to flow backward through the valves, filling the vein and stretching it even more. The vein becomes enlarged, swollen, and often twisted trying to squeeze into its normal space. 
The illustration shows the location of leg veins, which can become varicose veins. Figure A shows a normal vein with working valves and normal blood flow. Figure B shows a varicose vein with deformed valves, abnormal blood flow, and thin, dilated (stretched) walls. Who Is At Risk for Varicose Veins? Populations Affected
About 25 million Americans are affected by varicose veins. They are most common in people aged 30 to 70. Risk Factors
Risk factors for developing varicose veins include: - Genetics. Having a family member with varicose veins may increase the risk for developing them. Approximately half of the people who get varicose veins have a family history of them.
- Age. The normal wear and tear of aging may cause valves to weaken and not work as well.
- Gender. Women are two to three times more likely to develop varicose veins than men. Up to half of American women have varicose veins. Changes in hormones due to puberty, pregnancy, menopause, or taking birth control pills may increase a woman's risk of developing varicose veins.
- Pregnancy. During pregnancy, the growth of the fetus increases the pressure on the veins in the legs. Varicose veins that occur during pregnancy usually improve within 3 to 12 months following delivery.
- Overweight and obesity. Having extra weight on the body can put additional pressure on the veins.
- Prolonged standing or sitting, particularly with legs bent or crossed. When standing or sitting with legs bent or crossed, the veins have to work harder to pump the blood up to the heart.
What Are the Signs and Symptoms of Varicose Veins? Common signs and symptoms of varicose veins include: - Enlarged veins that are visible on your skin
- Mild swelling of your ankles and feet
- Painful, achy, or "heavy" legs
- Throbbing or cramping in your legs
- Itchy legs, especially in the lower leg and ankle (sometimes incorrectly diagnosed as dry skin)
- Discoloration of your skin surrounding the varicose veins
Complications
Only a small percentage of people have complications from varicose veins. Complications may include dermatitis and thrombophlebitis. Dermatitis
Dermatitis is an itchy rash that can occur on the lower leg or ankle of a person with varicose veins in the legs. It can sometimes cause bleeding or a skin ulcer to develop if scratched or irritated. Thrombophlebitis
This is a blood clot (thrombus) that occurs in a vein. There are two types of thrombophlebitis: - Superficial thrombophlebitis is a blood clot that occurs in a superficial vein and usually causes only minor problems that are limited to the area of the affected vein. Clots in varicose veins are usually of this type. Infections, chemical irritation, or other conditions that cause irritation and inflammation of the veins also can lead to superficial thrombophlebitis.
- Deep vein thrombosis is a blood clot that develops in veins deeper in the body. It can be life threatening if the clot breaks off and travels to the lungs, which is called pulmonary embolism. This type of thrombophlebitis does not occur in varicose veins
How Are Varicose Veins Diagnosed? Varicose veins are often diagnosed based simply on the appearance of the veins. For varicose veins in the legs, your doctor will examine your legs while you are standing or seated with your legs dangling. Your doctor may also ask you to describe pain or any other symptoms. Some diagnostic tests may be done to rule out other disorders or conditions. Specialists Involved
The following specialists may be involved in your medical care if you have varicose veins: - A vascular medicine specialist or vascular surgeon (blood vessel system specialist)
- A dermatologist (skin specialist)
Diagnostic Tests and Procedures
Your doctor may order a Doppler ultrasound to evaluate the flow of blood in your veins and to look for blood clots. During a Doppler ultrasound, a handheld device is placed on your body and passed back and forth over the affected area. A computer converts sound waves into a picture of the blood flow in the arteries and veins. Rarely, your doctor may order an angiogram to look at blood flow through your blood vessels. The procedure involves injecting a dye into your veins that can be seen using x ray. An angiogram can help to rule out other diagnoses besides varicose veins. Source:
National Heart, Lung and Blood Institute |