Varicose Veins

Varicose veins are swollen, stretched, or twisted veins located just under the skin (superficial veins). Varicose veins usually develop in the legs and are often visible.

Varicose veins are very common. They affect more women than men. Varicose veins frequently develop after age 40 and worsen as people age. Sometimes they are a symptom of another disorder.

Varicose veins can cause bothersome symptoms and minor blood clots, and they can mar the appearance of the legs. However, they usually do not cause serious problems.

Individual varicose veins can be treated. However, unless the cause is a curable disorder, no treatment can cure all of a person's varicose veins.

Causes

Aging itself can contribute to varicose veins because veins become less elastic. Then, veins widen when blood flow increases but may not return to their original size when blood flow decreases. They may become permanently widened. As a result, the flaps of the vein's valves are too far apart and cannot close to keep blood from flowing backward. The backward flow of blood can widen the veins even more.

See the figure Valves in Varicose Veins.

Varicose veins often develop in people who are overweight, in women who have been pregnant several times, and in people who repeatedly stand for long periods of time. Varicose veins also tend to run in families.

Varicose veins can develop when veins deeper in the legs are blocked by clots or are damaged and cannot carry enough blood. As a result, blood from these veins backs up in the superficial leg veins and increases pressure in them.

Varicose veins sometimes develop when large veins in the abdomen are blocked and pressure in them increases. Blood then backs up in the veins of the legs, increasing pressure in them. Cirrhosis and some pelvic or abdominal tumors can cause varicose veins in this way.

Symptoms and Diagnosis

Varicose veins bulge visibly, particularly when a person is standing. They may be twisted, coiled, or blue. Usually, there are no other symptoms. Itching or a rash may develop. If the veins are very large, the affected leg may tire more easily. Occasionally, pain occurs in the affected leg. If cut, a varicose vein can bleed profusely.

Many people with varicose veins also have spider veins, which are, despite the name, enlarged capillaries, not veins. Capillaries are tiny blood vessels that connect the arteries and veins. Spider veins appear as purple or red branches, resembling a spider web.

If varicose veins result from problems with deep leg veins, the area just above the ankle may become chronically swollen, and brown areas may develop on the skin. Sometimes deep sores (venous ulcers) also develop.

Occasionally, a varicose vein becomes inflamed and painful because a clot forms in it. This disorder is called superficial thrombophlebitis.

Varicose veins are usually diagnosed based on symptoms and results of the physical examination.

Treatment and Outlook

Wearing elastic stockings to compress the legs is usually the only treatment recommended for older people. The stockings squeeze the legs and help prevent excess blood from accumulating, stretching the veins, and causing pain. Elevating the legs and avoiding standing for long periods of time may also help.

Treatments designed to remove or hide individual varicose veins can make the veins less obvious, but such treatments do not improve a person's health. One of these treatments, called sclerotherapy, involves injecting an irritating solution into the veins. The solution makes the veins scar and shrink. Varicose veins can also be removed surgically. This procedure is called vein stripping. Laser treatment is being tried, but whether it is effective and safe is unclear.

For most people, the most troubling aspect of varicose veins is their appearance. Serious problems are rare.