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Varicose veins and venous insufficiency

Varicose veins are swollen, twisted, and enlarged veins that you can see under the skin. They are often red or blue in color. They usually appear in the legs, but can occur in other parts of the body.

Causes

Normally, one-way valves in your leg veins keep blood moving up toward the heart. When the valves do not work properly, they allow blood to back up into the vein. The vein swells from the blood that collects there, which causes varicose veins. Smaller varicose veins that you can see on the surface of the skin are called spider veins.

Varicose veins are common, and affect more women than men. They don't cause problems for most people. However, in some people, they can lead to serious conditions, such as leg swelling and pain, blood clots, and skin changes.

Risk factors include:

  • Older age
  • Being female (hormonal changes from puberty, pregnancy, and menopause can lead to varicose veins, and taking birth control pills or hormone replacement can increase your risk)
  • Being born with defective valves
  • Obesity
  • Pregnancy
  • History of blood clots in your legs
  • Standing or sitting for long periods of time
  • Family history of varicose veins

Symptoms


Severe symptoms include:

  • Leg swelling
  • Leg or calf pain after sitting or standing for long periods
  • Skin color changes of the legs or ankles
  • Dry, irritated, scaly skin that can crack easily
  • Skin sores (ulcers) that don't heal easily
  • Thickening and hardening of the skin in the legs and ankles (this can happen over time)

Exams and Tests

Your doctor will examine your legs to look for swelling, changes in skin color, or sores. Your doctor also may:

  • Check blood flow in the veins
  • Rule out other problems with the legs (such as a blood clot)

Treatment

Your doctor may suggest that you take the following self-care steps to help manage varicose veins:

  • Wear compression stockings to decrease swelling. These stockings gently squeeze your legs to move blood up towards your heart.
  • Do not sit or stand for long periods. Even moving your legs slightly helps keep the blood flowing.
  • Raise your legs above your heart three or four times a day for 15 minutes at a time.
  • Care for wounds in you have any open sores or infections. Your health care provider can show you how.
  • Lose weight if you are overweight.
  • Get more exercise. This can help you keep off weight and help move blood up your legs. Walking or swimming are good options.
  • If you have dry or cracked skin on your legs, moisturizing may help. However, some skin care treatments can make the problem worse. Talk to your health care provider before using any lotions, creams, or antibiotic ointments. Your provider can recommend lotions that can help.

If your condition is severe, your doctor may recommend the following treatments:

  • Laser therapy. Strong bursts of light are projected on smaller varicose veins, making them disappear.
  • Sclerotherapy. Salt water or a chemical solution is injected into the vein. The vein hardens and disappears.
  • Ablation. Heat is used to close off and destroy the vein. The vein disappears over time.
  • Microphlebectomy. Small surgical cuts are made in the leg near the damaged vein. The vein is removed through one of the cuts.
  • Bypass. Surgery reroutes blood flow around the blocked vein. A tube or blood vessel taken from your body is used to make a detour around, or bypass the damaged vein.
  • Angioplasty and stenting. A procedure opens a narrowed or blocked vein. Angioplasty uses a tiny medical balloon to widen the blocked vein. The balloon presses against the inside wall of the vein to open it and improve blood flow. A tiny metal mesh tube called a stent is then placed inside the vein to prevent it from narrowing again.

Outlook (Prognosis)

Varicose veins tend to get worse over time. Taking self-care steps can help relieve achiness and pain, keep varicose veins from getting worse, and prevent more serious problems.

When to Contact a Medical Professional

Call your health care provider if:

  • Varicose veins are painful
  • They get worse or do not improve with self-care, such as by wearing compression stockings or avoiding standing or sitting for too long
  • You have a sudden increase in pain or swelling, fever, redness of the leg, or leg sores
  • You develop leg sores that don't heal

Alternative Names

Varicosity; Varicosis

References

Freischlag JA, Heller JA. Venous disease. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 65.

Goldman MP, Guex JJ, Weiss RA. Clinical methods for sclerotherapy of varicose veins. In: Sclerotherapy: Treatment of Varicose and Telangiectatic Leg Veins. 5th ed. Philadelphia, PA: Elsevier Saunders; 2011.

Nijsten T, van den Bos RR, Goldman MP, et al. Minimally invasive techniques in the treatment of saphenous varicose veins. J Am Acad Dermatol. 2009;60:110-119.

Update Date: 5/27/2014

Updated by: Deepak Sudheendra, MD, Assistant Professor of Interventional Radiology & Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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