As many as 1 in 4 adults have varicose veins: large, dark blue, swollen or gnarled blood vessels visible through the skin. Besides pain, varicose veins can cause itching, fullness, swelling, inflammation, leg ulcers or restless legs – all of which can be more severe at the end of the day.
So what causes them?
"Think of your veins and arteries as expressways or rivers. When there is a traffic jam or road construction, or when a dam breaks, trouble ensues," says Jenny Cho, MD, vascular surgeon at The University of Kansas Health System. "The valves that move blood to the heart don't close properly and start to leak. That causes blood to pool in the legs and the veins to bulge."
Spider veins, another common vascular problem, are small, thin clusters of red, blue or purple veins that lie close to the skin's surface. They are found in thighs, calves and ankles, but also can be on the face from sun exposure and often appear as:
- A spider shape with a group of veins radiating from a dark central point
- Tiny branch-like shapes
- Thin separate lines
Pain can range from dull and throbbing to burning sensations. But whether varicose veins or spider veins, discomfort may not be related to the size of the blood vessel.
"Small spider veins can be just as painful or more so," she says. "The same rule applies to varicose veins."
The heart pumps blood filled with oxygen and nutrients to the whole body. Arteries carry blood from the heart toward the body parts. Veins carry oxygen-poor blood from the body back to the heart. The squeezing of leg muscles pumps blood back to the heart from the lower body. Veins have valves that act as one-way flaps. These valves prevent the blood from flowing backward as it moves up the legs. If the one-way valves become weak, blood can leak back into the vein and collect there. This problem is called venous insufficiency. Pooled blood enlarges the vein and it becomes varicose.
Varicose veins are enlarged veins that have become distended or swollen and the valves which move blood to the heart cannot close properly and start to leak. Blood that should be pushed back to the heart leaks downward, pooling in the lower extremities of the body and causing the veins to bulge. People who sit or stand in one position for long periods of time, sit with their legs crossed, or who do not exercise are prone to varicose veins.
Varicose veins are dark blue, swollen and twisted veins visible through the skin. People with varicose veins describe having legs that feel heavy, tired, achy and painful. Symptoms may worsen after standing or sitting for long periods of time. If you have varicose veins, you may also notice skin color changes, dry, thin skin, irritated skin, open sores or bleeding.
Sometimes a blood clot or injury develops at the surface of the skin near a vein. This is called thrombophlebitis.
Although varicose veins are not considered serious, in some cases, varicose veins can signal a blockage in the deeper veins. This condition, called deep vein thrombosis, requires evaluation and possible treatment.
With over 80 million Americans suffering from venous conditions, the treatment of varicose veins is an important procedure, both for pain relief, prevention of more serious conditions and aesthetic improvement.
Signs of venous problems include:
- Appearance of blue or purple spider vein configurations under the skin
- Raised outline of overly curved veins visible under the skin
- Dramatic skin color changes
- Tired legs
- Heavy legs
- Itching or burning
- Nighttime cramping
- Increased age
- Family history
- Hormonal changes, such as puberty, pregnancy or birth control pills
- Leg injury
- Prolonged standing/sitting
- Heavy lifting
“We still don’t completely know the cause of spider veins,” Dr. Cho says. “They may be caused by certain medications. Other factors that increase the likelihood of varicose veins are leg injury, heavy lifting and lack of exercise.”
The good news is vascular conditions are highly treatable and vascular treatments have gotten better. Several minimally invasive outpatient procedures have replaced complex surgical therapy known as ligation and stripping.
Learn about the treatment options available for varicose veins:
Who should have varicose vein procedures?
Patients who are experiencing any of the above symptoms should schedule a consultation to determine whether they are suffering from varicose veins or venous ulcerations. The first treatment step is often compression therapy, in which a pressure of 35-40 mmHg is applied to prevent capillary secretion. This may take up to 5 months, but if there has not been a noticeable improvement in 3 months, you may be a candidate for various varicose vein procedures.
With a wide range of procedures available, your physician may perform an ultrasound to help determine which procedure will maximize effectiveness while limiting expense and recovery time for your condition.
What happens during the procedure?
Oral pain medication and local anesthetic may be given for some patients prior to the procedure. Varicose veins will be clearly marked while the patient is in a standing position to ensure no veins are missed. For minimally invasive, ultrasound-guided laser treatment of varicose veins, a small incision is made near the bottom of the affected vein. A fiber-optic laser is inserted into the vein and passed through as far as possible. Laser energy is activated, causing the vein to collapse as the laser is withdrawn slowly, leaving just harmless fibrous tissue, which will soon be absorbed.
Other methods of varicose vein treatment include the surgical removal of the veins. For this procedure, commonly used on smaller lower leg veins, a hook is inserted through a small incision made over an affected vein. The vein is caught with the hook and withdrawn through the incision, though it may need to be segmented surgically prior to extraction. Another method of varicose vein removal is the injection of a foam within the veins, which causes them to contract until they are eventually absorbed by the body. Learn about sclerotherapy.
What should I expect after the procedure?
Once the procedure is complete, the leg will be wrapped to minimize swelling, and there will be a 20-30 minute recovery period. After the recovery period, you can return home and resume activities that are comfortable for you. After 48 hours, the recovery wrap should be removed and the leg placed within a compression stocking, which should remain around the leg for 3 weeks.
Depending on the specifics of the venous condition and the treatment performed, it may be necessary to return for additional treatments in 1 week. Additionally, there will be a follow-up visit and an ultrasound to ensure the site is healing normally, the veins are closed and symptoms are improved.
Complications that may occur during varicose vein treatment include brown discolorations, skin burns, infection, blood clots and changes in sensitivity.
- Wear compression stockings or support hose.
- Elevate legs above the heart for 15 to 20 minutes at the end of the day to improve blood flow.
- Take breaks when sitting or standing – or try flexing your feet up and down 10 times each hour.
- When standing, raise yourself up and down on your toes or rock back and forth on your heels.
- Take walking breaks.
- Lose weight or keep it at a normal level.
- Take blood thinning medications.
- Use sun protection to limit the number of unwanted vessels on the face.
- Cross your legs when you sit.
- Wear tight clothing, especially around the waist and legs.
- Wear high-heeled shoes, when practical.
Know the myths
Varicose and spider veins are commonly associated with women, but to say they are strictly a women’s issue is a myth, according to Dr. Cho.
“Men and teens get them, too,” she says. “They are not necessarily a sign of aging.”
Other common misconceptions include:
- They are strictly a cosmetic problem. Wrong, they could lead to dangerous blood clots.
- They can be caused by running. Actually, the reverse is true. Exercise is good for your veins.
- They are always visible. No, they also can occur deep in the body.
- Recovery from treatment is difficult. Not so. Innovative procedures have led to quicker, easier recovery times.