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Varicose veins

Definition

Varicose veins are swollen, twisted, and sometimes painful veins that have filled with an abnormal collection of blood.

See also:

• Varicose vein stripping
• Varicose vein - noninvasive treatment
• Venous insufficiency

Alternative Names

Varicosity; Varicosis

Causes, incidence, and risk factors

In normal veins, valves in the vein keep blood moving forward toward the heart. With varicose veins, the valves do not function properly, allowing blood to remain in the vein. Pooling of blood in a vein causes it to enlarge.

This process usually occurs in the veins of the legs, although it may occur elsewhere. Varicose veins are common, affecting mostly women.

Causes include:

• Defective valves from birth (congenitally defective valves)
• Pregnancy
• Thrombophlebitis

Standing for a long time and having increased pressure in the abdomen may make you more likely to develop varicose veins, or may make the condition worse.

Primary varicose veins occur because of congenitally defective valves, or without a known cause. Secondary varicose veins occur because of another condition, such as when a pregnant woman develops varicose veins.

Symptoms

• Fullness, heaviness, aching, and sometimes pain in the legs
• Visible, enlarged veins
• Mild swelling of ankles
• Brown discoloration of the skin at the ankles
• Skin ulcers near the ankle (this is more often seen in severe cases)

Signs and tests

The diagnosis is mainly based on the appearance of the leg veins when you are standing or seated with the legs dangling.

At times a physician may order a duplex ultrasound exam of the extremity to see blood flow in the veins, and to rule out other disorders of the legs (such as a blood clot). Rarely, an angiogram of the legs may be performed to rule out other disorders.

Treatment

Treatment is usually conservative. You will be asked to avoid excessive standing, raise your legs when resting or sleeping, and wear elastic support hose.

You may need surgery or nonsurgical treatment for:

• Leg pain, often described as heavy or tired
• Skin ulcers or sores that are caused by poor blood flow through the veins
• Improving the appearance of the legs
• Lipodermatosclerosis - fatty tissue under that skin that hardens over time, caused by high blood pressure in a vein

Vein stripping is surgery to remove varicose veins in the legs. It is usually reserved for patients who are having a lot of pain or who have skin ulcers.

Noninvasive treatments for varicose veins do not involve surgery. Examples are:

• Sclerotherapy
• Laser ablation
• Radiofrequency ablation

Support Groups

Expectations (prognosis)

Varicose veins tend to get worse over time. You can ease discomfort and slow varicose vein progression with self care.

Complications

• Phlebitis (chronic inflammation of the vein)
• Formation of leg ulcers
• Rupture of a varicose vein

Calling your health care provider

Call for an appointment with your health care provider if:

• Varicose veins are painful
• They get worse or do not improve with self-treatment, such as keeping the legs elevated or avoiding excessive standing
• Complications occur, including a sudden increase in pain or swelling, fever, redness of the leg, or leg ulcers

Prevention

Avoid prolonged standing if personal or family history indicates you are at risk of developing varicose veins.

References

Freischlag JA, Heller JA. Venous disease. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 68.

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.

Bergen JJ, Shmidt-Shonbein GW, Smith PD, et al. Chronic venous disease. N Engl J Med. 2006;355:488-498.