Varicose veins are enlarged, swollen veins that often appear twisted or bulging. These usually develop in superficial veins, which are located just beneath the skin, most commonly in the legs. This happens because walking and standing for long periods increase pressure in the lower body veins.
Although many individuals view varicose veins -and the less severe spider veins- as a cosmetic issue, they can also cause discomfort and pain. In some cases, they may lead to more serious complications.
Management typically includes physical activity, leg elevation, and compression stockings. When these measures are not sufficient, a vascular surgeon may recommend procedures to seal or remove the affected veins.
Symptoms
Varicose veins don’t always cause discomfort, but signs can include:
- Veins that are dark blue, purple, or similar in color to the skin (visibility varies by skin tone).
- Veins that appear twisted, swollen, and rope-like beneath the skin.
When symptoms are present, they may include:
- A sensation of heaviness or aching in the legs.
- Burning, swelling, cramping in the lower limbs.
- Worsening pain after extended standing or sitting.
- Itching near the varicose veins.
- Changes in the color of skin around the affected area.
Spider veins are smaller, more superficial, and often appear on the legs or face, resembling a spider web.
When to See a Vascular Surgeon
If the appearance or symptoms of your veins are a concern and lifestyle changes haven’t provided relief, it is recommended to consult a vascular surgeon for evaluation and treatment options.
Causes
Varicose veins result from weakened or malfunctioning valves in the veins. While arteries move blood away from the heart, veins carry blood back. In the legs, this return flow must fight against gravity. Muscle contractions act like pumps, and valves help keep blood moving upward. When valves fail, blood can pool, causing the veins to stretch and become twisted.
Risk Factors
Two major risk factors include:
- Family history of varicose veins.
- Obesity, which increases pressure on leg veins.
Other contributing factors:
- Aging, which naturally weakens vein valves.
- Female sex, due to hormonal influences.
- Pregnancy, which increases blood volume and vein pressure.
- Sedentary lifestyle, especially prolonged standing or sitting.
Complications
Though uncommon, complications may arise such as:
- Skin ulcers, particularly around the ankles.
- Deep vein thrombosis (DVT) or blood clots, which may cause swelling and pain.
- Bleeding, especially if superficial veins rupture.
- Chronic leg swelling due to prolonged vein dysfunction.
Seek consultation with a vascular surgeon if any of these issues occur.
Prevention
Improving circulation and leg muscle tone can help prevent varicose veins. Tips include:
- Avoiding tight clothing and high heels (except compression stockings if advised).
- Frequent changes in position.
- Consuming a high-fiber, low-sodium diet.
- Maintaining a healthy body weight.
- Elevating legs while resting.
- Regular exercise.
Diagnosis
A vascular surgeon will perform a physical examination, often while you’re standing, to assess for swelling and visible vein changes. You may be asked about discomfort or other symptoms.
Tests
A venous Doppler ultrasound may be performed to evaluate blood flow and check for any blood clots. This non-invasive test uses sound waves to assess how blood moves through the leg veins.
Treatment Options
If self-care measures are ineffective or the condition is severe, a vascular surgeon may recommend further treatment. These are typically outpatient procedures, meaning you can go home the same day.
Self-Care Measures
You may be advised to:
- Wear compression stockings.
- Keep your legs elevated during rest.
- Stay active to encourage circulation.
Compression Stockings
These apply gentle pressure to the legs, promoting blood flow. Available over the counter or by prescription, compression stockings are often the first step recommended by vascular surgeons.
Procedures by a Vascular Surgeon
When necessary, your vascular surgeon may suggest one of the following:
- Sclerotherapy: A solution or foam is injected into affected veins to close them off. Multiple sessions may be required.
- Laser treatment: Strong light energy is applied to the vein, causing it to gradually fade.
- Catheter-based procedures: A catheter delivers radiofrequency or laser energy inside the vein, collapsing and sealing it. This is commonly used for larger varicose veins.
- High ligation and vein stripping: The vein is tied off and removed through small incisions. This outpatient surgery does not affect circulation, as deeper veins handle the redirected blood flow.
- Ambulatory phlebectomy: Small varicose veins are removed via tiny skin punctures. Only the targeted area is numbed, and scarring is minimal.