Varicose Veins

What causes varicose veins?

Varicose veins are caused by increased blood pressure in the veins. They can occur in the veins near the surface of the skin.

The blood moves toward the heart by one-way valves in the veins. When the valves become weakened or damaged, blood can collect (pool) in the veins and even flow backward. This causes the veins to become enlarged. Sitting or standing for a long time can cause blood to pool in the leg veins. This increases the pressure in the veins. The veins can stretch from the increased pressure. This may weaken the walls of the veins and damage the valves.

Who is at risk for varicose veins?

You are at risk for varicose veins if you:  

• Are overweight or obese
• Are older
• Have a family history of the condition
• Are a person assigned female at birth
• Are not physically active
• Have had a leg injury
• Are pregnant

What are the symptoms of varicose veins?

The most common symptoms of varicose veins are:

• Color changes in the skin
• Bulging bluish-colored veins
• Sores on the legs (leg ulcers)
• Rash
• Sensations in the legs, such as a heavy feeling, burning, or aching

Over time, severe varicose veins may lead to long-term mild swelling. That can result in more serious skin and tissue problems. These include ulcers and nonhealing sores.

The symptoms of varicose veins may look like other health problems. Always talk with your healthcare provider for a diagnosis.

How are varicose veins diagnosed?

Your healthcare provider will ask about your health history and do a physical exam. You may also need a duplex ultrasound. This test is a type of ultrasound that checks blood flow and the structure of the leg veins. Duplex means 2 kinds of ultrasound are used.

How are varicose veins treated? 

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

If you don’t have symptoms, you may not need treatment. But varicose veins may sometimes get worse without treatment. If you need treatment, it may include:

• Leg elevation. You may be instructed to raise (elevate) your feet above your heart 3 or 4 times a day for about 15 minutes at a time. If you need to sit or stand for a long time, bending (flexing) your legs now and then can help keep blood circulating. If you have mild to moderate varicose veins, elevating your legs can help reduce leg swelling and ease other symptoms.
• Compression stockings. These elastic stockings squeeze the veins and prevent blood from traveling down and pooling in the legs. They can be effective if they are worn every day.
• Sclerotherapy. This is the most common treatment. A chemical is injected into the affected veins. The chemical causes scarring in the veins so that they can no longer carry blood. Blood then returns to the heart through other veins. The body absorbs the scarred veins.
• Endovenous laser ablation or radiofrequency ablation (RFA). This is a minimally invasive procedure. A tube (catheter) puts heat right into the affected vein. This closes the vein. Once the vein is closed, less blood pools in the leg. Overall blood flow is improved.
• Vein stripping. In more severe cases, the surgeon may tie off and remove veins by making small cuts in the skin. This procedure may be done when other treatments have not worked.
• Microphlebectomy. Special tools inserted through small cuts (incisions) are used to remove varicose veins. Microphlebectomy may be done in your healthcare provider’s office. It may be done alone or with vein stripping.

What are possible complications of varicose veins?

Varicose veins are often not serious. But complications may happen. They include:

• Inflammation or swelling of veins (phlebitis)
• Blood clots
• Pulmonary embolism (when a piece of a blood clot breaks off and travels to the lungs)

What can I do to prevent varicose veins?

You may help prevent varicose veins by:

• Keeping a healthy weight
• Exercising regularly
• Putting your feet up while sitting
• Not wearing tight clothing

Key points about varicose veins

• Varicose veins are enlarged, twisted veins. They are not often a serious health problem.
• Varicose veins can happen anywhere in the body. But they are more common in the legs.
• Varicose veins are caused by increased blood pressure in the veins from weakened or damaged valves.
• Many factors may raise the risk for varicose veins, such as being overweight and being physically inactive.
• Raising (elevating) the legs and wearing compression stockings can help treat varicose veins. More serious cases may require other treatments or surgery.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.