What Are Varicose Veins?

A Very Common Cosmetic Problem

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Varicose veins are fairly common, and while they can produce an unwanted cosmetic appearance, they rarely cause health issues. They typically look bluish underneath the skin, and they may bulge out a bit.

Typically developing on the lower legs, varicose veins form when the valves inside the veins weaken, a process that often occurs with normal aging. You may need to have diagnostic tests if you develop a complication of your varicose veins, like an infection.

There are a number of interventional therapies used to treat varicose veins—for cosmetic and therapeutic purposes—with a range of success levels. 

elderly woman shows varicose
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Varicose Veins Symptoms

Generally, varicose veins appear prominent on the lower legs, below the knee. They can also develop on the thighs or arms, although these locations are not common. Varicose veins may enlarge or increase in quantity over time, but they often remain stable.

Sometimes you may notice that your varicose veins seem larger or look more obvious after you have been sitting or standing for hours at a time. Varicose veins should feel soft if you press on them, and they normally don’t hurt or change in size or appearance when you press on them. Touching them is not dangerous or harmful.

Common symptoms of varicose veins include:

  • Bluish, purplish, or pinkish appearance of one or more veins 
  • A twisted or bulging vein (or veins) underneath the skin
  • Spider veins (a nearby cluster of tiny veins appearing directly below the skin’s surface)
  • Itching or a rash near the affected vein
  • Aching legs
  • Small areas of superficial bruising near the veins (these should heal within a few days)
  • Tenderness or discomfort near the veins

You can have one or several varicose veins and they might not all be the same exact size or appearance. If you have any pain associated with your varicose veins, it’s likely that you would only experience pain in one of them rather than all of them.

Pain is not necessarily correlated with the size of a varicose vein.

Spider veins are similar to varicose veins in that they are visible, but they usually don’t bulge out. They are generally smaller than varicose veins and they look like a web of tiny red or purplish vessels directly under the skin. Like varicose veins, spider veins are not dangerous.

Complications

It is very uncommon for health issues to develop as a result of varicose veins. However, complications require medical or surgical intervention and can result in serious problems if left untreated. It is important that you get medical attention if you develop signs of medical issues associated with your varicose veins. 

Medical complications you should look out for include:

  • Hematoma: A large area of bruising or bleeding underneath the skin 
  • Ulceration: A non-healing open wound 
  • Phlebitis: Infection of the vein 
  • Thrombophlebitis: Infection and blood clots in the vein 

Symptoms of these complications can include fevers, a patch of redness, swelling, pain, severe tenderness, or warmth near a varicose vein. You can also develop sensory changes such as numbness, tingling, or burning sensations. 

You can experience symptoms that seem to be associated with your varicose vein but are not typical of varicose veins. This could signal another medical issue, like a deep vein thrombosis (DVT, a blood clot in a deep vein) or peripheral neuropathy (nerve disease)

Causes

Varicose veins develop when the blood in the vein travels a little more slowly than usual. This happens when the valves inside the veins become somewhat lax. A number of risk factors increase the likelihood of having uncomplicated varicose veins.

Risk factors include:

  • Older age 
  • Female sex 
  • Pregnancy 
  • Obesity 
  • Family history of varicose veins 
  • Chronically standing for hours at a time 
  • Chronic constipation 
  • A history of a DVT

These risk factors are all quite common, and you might consider prevention with lifestyle approaches if you are very concerned that you could develop varicose veins.

Weakening Valves

One of the reasons that varicose veins develop is due to weakening of the valves inside the veins. Veins throughout the body bring blood to the heart so it can go back to the lungs to be replenished with oxygen.

Veins have valves inside them. The valves are composed of connective tissue, and they are shaped somewhat like gates. The valves open to allow blood to flow towards the heart and they close to prevent blood in the veins from flowing backward. 

With age, the connective tissue of the valves weakens, allowing blood to pool down towards gravity. Other factors, like obesity, can also contribute to weakening of the valves. Normal veins often appear bluish under the skin, and they can become more visible when they are slightly enlarged due to the weakness of the valves.

Risk of Complications

If you have varicose veins, you may have a higher risk of complications if you have chronic illnesses like diabetes, a blood clotting disorder, peripheral vascular disease, immune deficiency, or an inflammatory condition. These issues can raise the risk of an infection, bleeding, or blood clots in your varicose veins.

Diagnosis

Generally, varicose veins are diagnosed based on their appearance. If you have symptoms such as pain or discomfort, your doctor will evaluate you to determine whether your varicose veins are the cause of your symptoms.

Since varicose veins don’t usually result in symptoms, your doctor might also examine you to rule out other medical issues that could be causing your complaints. 

Physical Examination

Your diagnosis will include a physical examination. Your doctor will inspect your visible or enlarged veins and the area around them for evidence of swelling, warmth, or redness—which can all occur with an infection or a blood clot.

Your doctor will also check your pulse near the varicose veins to identify a blood flow problem. And your doctor may feel your varicose veins to identify any irregularities, and will ask you if physical pressure is contributing to the pain.

If you have a skin wound, this may be an ulceration related to your varicose vein or another health issue. A large area of swelling or a blue or red patch under the skin can be a sign of a hematoma.

Diagnostic Tests

Sometimes tests can also be helpful in your diagnostic evaluation. An ultrasound can be used to evaluate blood flow, and it can identify areas of blockage or severely altered blood flow.

If there is a concern that you could have a fracture or another injury, you might need an X-ray or a computerized tomography (CT) scan to help your doctors examine the area of concern. 

You might have a complete blood count (CBC), which is a sample of blood taken from a vein (but not from a varicose vein itself). This test may show elevated white blood cells, which is a sign of an infection.

Differential Diagnosis

Several medical problems can mimic symptomatic varicose veins. Depending on your risk factors and medical history, you might need an evaluation to determine whether you could have any of these conditions. Common conditions that can mimic varicose veins include:

Deep Venous Thrombosis

A blood clot in a vein can form in the same areas of the body where varicose veins tend to develop—the lower leg, upper leg, or arm. A DVT may cause painless swelling, but it can be a health danger because the blood clot can travel to the lungs, causing a life-threatening pulmonary embolism (PE).

A DVT would be diagnosed with vascular ultrasound. It usually requires treatment, often with blood thinners.

Peripheral Neuropathy

Nerve damage can affect the peripheral nerves in the toes, legs, or fingers. This may cause pain or burning sensations or a loss of sensation in the affected areas.

Peripheral neuropathy may also result in infections and wounds that don’t heal. These issues can be initially confused with an infected or painful varicose vein. If you have both conditions, it may be difficult to determine which of them is causing your symptoms.

Peripheral neuropathy and painful varicose veins can be distinguished from each other based on a physical exam. Peripheral neuropathy manifests with diminished sensation and varicose veins don't cause a change in sensation.

If needed, tests like a vascular ultrasound or diagnostic nerve examinations like electromyography (EMG) or nerve conduction studies (NCV) can identify the severity of each condition.

Vascular Insufficiency

The muscles throughout your veins can weaken, resulting in slow and diminished blood return to the heart. This is not usually a dangerous condition, but it can cause swelling of the extremities.

Vascular insufficiency may seem similar to varicose veins, but there are subtle differences:

  • Vascular insufficiency should involve all or most of the veins in your legs, while you should only have a few varicose veins.
  • Your veins are not expected to become prominent or visible if you have vascular insufficiency.

A physical examination and a vascular ultrasound of the affected area may distinguish these conditions.

Congestive Heart Failure

Congestive heart failure (CHF) often results in leg or arm swelling that improves with elevation of the extremity. Your veins may become prominent, and the swelling can be confused with swelling of varicose veins.

With CHF, you can also have fatigue and shortness of breath, which are not characteristic of varicose veins. Heart tests like an electrocardiogram (EKG) and echocardiogram can identify heart failure.

If you already have varicose veins, they can become more noticeable and uncomfortable if you develop other health problems that cause swelling of the extremities or that affect your veins.

Treatment

If you have been diagnosed with varicose veins, there is a big chance that you won’t need any treatment. Since the condition isn’t harmful for your health unless you develop complications, there is rarely any health benefit of treatment. 

Most of the time, varicose veins are treated for cosmetic reasons or if complications develop. If you are unhappy with how your veins look, you can talk with your doctor about different treatments and assess your likelihood of satisfaction after treatment. 

If you don’t like the appearance of your varicose veins but don’t want to have medical or surgical treatment, you can consider lifestyle approaches or strategies for covering them up, like wearing opaque stockings or applying makeup to make them less noticeable. 

Lifestyle Approaches 

Sometimes lifestyle approaches can help make varicose veins less prominent. These approaches are more likely to be successful for prevention than for treatment. And lifestyle strategies may help make very large varicose veins appear smaller.

Exercise strengthens the muscles surrounding the varicose veins, which naturally helps squeeze the veins to push blood back towards the heart. If you are overweight, weight loss can help prevent excess physical pressure from weakening the valves.

Sometimes doctors recommend compression stockings, especially if prolonged standing is causing lower leg swelling and/or pain.

Medical and Surgical Treatment

There are several different treatment approaches that your doctor will discuss with you if you are interested in having treatment to reduce the visibility of your varicose veins.

The right approach for you may depend on the size and location of your varicose veins. All of the interventional procedures can leave a surgical scar on the skin, and the success rate is variable.

Surgery: Surgical treatment for varicose veins, often described as ligation or vein stripping, involves an operation in which the varicose veins are surgically tied off. You can have an open procedure or a minimally invasive endoscopic procedure, depending on the accessibility of your varicose veins.

After surgery, the vein should atrophy (shrink) so it will not be apparent anymore. Blood flow from the surgical limb (the lower leg, for example) can still return to the heart through other veins. Some people may experience swelling in the surgical limb, which can resolve after a few months or can be permanent. 

Laser therapy: This approach uses a small incision, and a catheter (thin tube) with ultrasound guidance to direct light energy to the varicose vein or veins. The light will shrink the enlarged vein so it will atrophy.

Radiotherapy: With a catheter, heat is applied to make the varicose vein or veins close, without the use of a large surgical incision. Your doctor would use ultrasound guidance during this procedure.

Sclerotherapy: This approach uses an injected foam solution to seal off the varicose vein.

Medication: Vasculera (diosmiplex) is a prescription medication used for the treatment of chronic venous insufficiency, varicose veins, and spider veins. It works by altering metabolic pathways in the body to reduce inflammation that may contribute to the formation of these vein changes.

Treatment for Complications of Varicose Veins 

Aching pain associated with varicose veins may improve with over the counter or prescription pain medication. 

If you develop serious complications, you will need urgent evaluation and treatment. An infection may need to be treated with antibiotic medication and/or surgery. Blood clots may be treated with blood thinner medication and/or surgery.

A Word From Verywell

Varicose veins are common, especially with advancing age. They can become noticeable after age 40, and they can progress over time, becoming larger and increasing in quantity.

If you have varicose veins, you shouldn’t worry about a risk to your health, even if they are becoming more visibly noticeable. However, if the appearance is bothering you, there are many options you can consider for cosmetic treatment of your varicose veins.

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