Varicose Veins

Condition Basics

What are varicose veins?

Varicose veins are twisted, enlarged veins near the surface of the skin. They are most common in the legs and ankles. Varicose veins usually aren't serious.

What causes them?

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 don't work as they should, blood collects in your legs, and pressure builds up. The veins become weak, large, and twisted.

What are the symptoms?

Varicose veins look like swollen and twisted blood vessels under the skin. They may not cause any symptoms. Mild symptoms may include heaviness, burning, aching, tiredness, or pain in your legs. Symptoms may be worse after you stand or sit for long periods of time.

How are they diagnosed?

To diagnose varicose veins, your doctor will look at your legs and feet. The doctor will check your legs for tender areas, swelling, skin colour changes, sores, and other signs of skin breakdown. You might need tests if you plan to have treatment or if you have signs of a deep vein problem.

How are varicose veins treated?

Home treatment may be all you need to ease your symptoms and keep the varicose veins from getting worse. Wear compression stockings. Stay at a healthy weight. Prop up (elevate) your legs. Avoid long periods of sitting or standing. And get regular exercise. Procedures to close or remove varicose veins may also be done.

Cause

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 don't work as they should, blood collects in your legs, and pressure builds up. The veins become weak, large, and twisted.

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 life. Varicose veins happen more often as people get older.

Varicose veins often form during pregnancy. They might become less prominent after pregnancy and may disappear completely.

What Increases Your Risk

Factors that increase your risk of developing varicose veins include:

• Pregnancy.
• Advancing age.
• Being overweight.
• Family history of varicose veins.
• Prolonged sitting or standing.
• Smoking.
• Injury to the veins.
• Blood clots.

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Prevention

Varicose veins may be prevented to some extent. Here are a few things you can try.

• Stay at a healthy weight.

  Lose weight if you need to.

• Get regular exercise.

  Exercise may help improve blood flow in your legs.

• Avoid long periods of standing or sitting.
• Avoid crossing your legs at the knee while sitting.
• Do not smoke.

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Symptoms

Varicose veins look like swollen and twisted blood vessels under the skin. They may not cause any symptoms. Mild symptoms may include:

• Heaviness, burning, aching, tiredness, or pain in your legs. These symptoms may be worse after you stand or sit for long periods of time.
• Mild swelling in your feet and ankles.
• Itching over the vein.

More serious symptoms include:

• Leg swelling.
• Swelling and calf pain after you sit or stand for long periods of time.
• Skin changes, such as:
  • Colour changes.
  • Dry, thinned skin.
  • Inflammation.
  • Scaling.
• Open sores.
• Bleeding after a minor injury.
• Superficial thrombophlebitis. This happens when a blood clot and inflammation form in a small vein near the surface of the skin.

What Happens

Varicose veins usually don't cause problems. There are things you can do at home to help with symptoms and keep varicose veins from getting worse. But if you have symptoms or the way your veins look bothers you, there are procedures that may help.

Complications

Most varicose veins aren't a serious medical problem, but they sometimes can lead to complications.

Complications can include:

• Bleeding from a varicose vein, which may occur without an injury or after an injury to the thin skin over the varicose vein. Bleeding can be heavy, but it can be controlled by elevating the leg and applying pressure to the area that is bleeding.
• Blood clots or inflammation (superficial thrombophlebitis), when a blood clot and inflammation develop in a small vein near the surface of the skin.
• Dry, stretched, swollen, itching, or scaling skin.
• Thin, fragile, easily injured skin at or above the ankle.
• Open sores (ulcers), usually near the ankles.
• Skin colour changes (stasis pigmentation) around the ankles and lower legs.
• Fungal and bacterial infections, which may arise from skin problems resulting from fluid buildup (edema) in the leg and increased risk of tissue infection (cellulitis).

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.

When to Call a Doctor

Call your doctor if you have varicose veins and:

• You have signs of a blood clot in your leg. These signs include pain in the calf, back of the knee, thigh, or groin. Signs also include swelling in your leg or groin. Another sign is a colour change on the arm, leg or groin. The skin may be reddish or purplish, depending on your usual skin colour. A blood clot in a deep vein can be serious and may need prompt attention.
• Skin over a varicose vein begins to bleed and you cannot stop it. The skin over varicose veins is often thin and can bleed heavily. If this happens, prop up your leg and apply pressure directly to the vein to stop the bleeding.
• Your leg has a tender lump. This could be a clot or inflammation in a vein just under the skin, which may need treatment.
• You develop an open sore (ulcer).
• Your varicose vein symptoms don't improve with home treatment, or there are symptoms you are concerned about.

Watchful waiting

Varicose veins are common and generally aren't a serious health problem. With a doctor keeping an eye on the condition, most people can manage varicose veins with home treatment. This includes exercise, wearing compression stockings, and propping up the legs.

Examinations and Tests

Varicose veins are most often diagnosed based on how they look. No special tests are needed to confirm the diagnosis.

Your doctor will:

• Ask questions about any risk factors, such as vein problems, serious leg injuries, or leg ulcers you've had in the past.
• Do a physical exam. The doctor will examine your legs and feet (or any other affected areas). The doctor will check for tender areas, swelling, skin colour changes, ulcers, and other signs of skin breakdown.

You might need tests if you plan to have treatment or if you have signs of a deep vein problem. Duplex Doppler ultrasound is the most commonly used test. It can help your doctor study blood flow in your leg veins.

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Treatment Overview

The goals of treatment for varicose veins are to reduce symptoms and prevent complications. For some, the goal may be related to how the veins look. Home treatment is usually the first approach.

Home treatment

Home treatment may be all you need to ease your symptoms and keep the varicose veins from getting worse. You can:

• Wear compression stockings.
• Stay at a healthy weight.
• Prop up (elevate) your legs.
• Avoid long periods of sitting or standing.
• Get regular exercise.

Procedures

If home treatment doesn't help, there are procedures that can treat varicose veins. These include:

Endovenous ablation.

Endovenous ablation is a procedure to close off varicose veins. Endovenous means that the procedure is done inside the vein. Ablation means a doctor uses something to damage and close off the vein. This may be heat, chemicals, or a small wire.

Ligation and stripping.

This treatment is a type of surgery. Cuts (incisions) are made over the varicose vein, and the vein is tied off (ligated) and removed (stripped).

Phlebectomy.

Several tiny cuts are made in the skin through which the varicose vein is removed. This is also called microphlebectomy, ambulatory phlebectomy, or stab avulsion.

Sclerotherapy.

A chemical is injected into a varicose vein to damage and scar the inside lining of the vein, causing the vein to close.

Simple laser treatment.

Laser energy is used to scar and destroy varicose veins. Simple laser therapy is done on small veins close to the skin, such as spider veins. The laser is used outside of your skin.

The size of your varicose veins affects your treatment options.

• Larger varicose veins are generally treated with endovenous ablation or ligation and stripping surgery.
• Smaller varicose veins and spider veins are usually treated with sclerotherapy or simple laser therapy on your skin.

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Self-Care

Self-care, or home treatment, is recommended for most people with varicose veins. Home treatment may relieve symptoms and slow down the progress of varicose veins. For many people, home treatment is the only treatment they need.

Your doctor can help you create a home treatment plan that is right for you. Here are some examples of things you can do at home.

• Exercise.

  Exercise can help relieve symptoms and slow the progression of varicose veins by improving blood circulation in your legs.

  • Try to take several short walks every day.
  • Try to do moderate to vigorous exercise for at least 2½ hours a week. And it's fine to be active in shorter periods of time throughout the day and week that add up to the recommended goals.
  • Do calf muscle exercises every day. When you are sitting down, rotate your feet at the ankles in both directions, making small circles. Extend your legs, and point and flex your feet.
• Stay at a healthy weight.

  Staying at a healthy weight, and losing weight if you need to, may help relieve symptoms caused by your varicose veins. Being overweight can increase the swelling and discomfort of varicose veins.

• Elevate your legs.

  When you elevate your legs, ideally at or above heart level, it helps keep the blood from pooling in your lower legs and improves blood flow to the rest of your body.

  • Prop up your legs when you are sitting. Use a footrest at work and a footstool or ottoman at home to elevate your feet.
  • Lie down and prop your legs above heart level. Try to do this for about 30 minutes at a time, about 3 times a day. You can lie in a recliner, bed, or couch with your feet propped on pillows to improve blood flow back to the heart.
• Avoid crossing your legs at the knees when sitting.

  Keep your feet flat on the floor or cross them at the ankles. Crossing legs at the knees squeezes veins and blocks blood flow.

• Avoid long periods of sitting or standing.

  Sitting or standing still for long periods of time puts added stress on the veins in your legs.

  • If you stand when working, try to sit down for a few minutes regularly (with your feet up). Some people use a small stool to prop up first one foot, then the other when standing at work.
  • If you are sitting, get up and move around every hour or so.
• Wear compression stockings.

  Compression stockings are a main treatment for varicose veins that are causing symptoms. They improve circulation and help relieve symptoms.

• Take good care of your skin.

  Your skin may be more fragile and even minor injuries can lead to skin ulcers.

  • Treat cuts and scrapes on your legs right away.
  • Keep your legs clean and moisturized to prevent drying and cracking.
  • Prevent sunburns.
• Do not smoke.

  Smoking can make varicose veins worse. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.

Self-care for bruising or bleeding problems from a varicose vein

Varicose veins just under the skin sometimes cause minor problems. Most can be treated at home.

Minimize bruising

If you bump your leg, prop up your leg and apply ice or cold packs right away. Apply the ice or cold pack for 10 to 20 minutes, 3 or more times a day. Put a thin cloth between the ice and your skin.

Control bleeding

• Prop up your leg. Apply pressure over the site of the bleeding.
• Apply pressure for a full 15 minutes.

Mild bleeding usually stops on its own or slows to an ooze or trickle after 15 minutes of pressure. It may ooze or trickle for up to 45 minutes. Call your doctor if the bleeding does not stop after 45 minutes.

Care for a small blood clot in a varicose vein

Follow your doctor's instructions. Care may include the following:

• Prop up your leg and apply a damp cloth that is warm or cool.
• Ask your doctor if you can take an over-the-counter pain medicine.

Talk to your doctor if you have questions.

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