Whereas arteries bring blood to the extremities and organs, veins are vessels that return the blood to the heart. The human body has surface (superficial) veins that are connected to deep veins by bridging (perforator) veins. Unlike arteries, which have thick muscular walls designed to withstand higher pressures, veins have thin, less muscular walls and are prone to dilate in response to persistently increased pressures. The calf muscles act as pumps to keep blood flowing through the legs back to the heart. Veins have delicate valves that keep blood flowing toward the heart and prevent backflow of blood into the legs.
What Are Varicose Veins?
Varicose veins are superficial veins that have become abnormally enlarged and cause symptoms or are cosmetically distressing. Types of varicose veins include spider veins, which are reddish-bluish and thread-like; reticular veins, which are bluish and string-like; and true varicose veins, which are large rope- or worm-like veins that feel spongy to the touch and bulge out from the skin surface (Figure).
Symptoms of varicose veins vary according to their size and extent and include aching or throbbing discomfort, burning, itching, and dry irritated skin. Leg heaviness and fatigue, cramping, brownish discoloration around the ankles, swelling, hardening of the skin, and skin breakdown (ulceration) are more advanced symptoms that suggest leakiness of the venous valves (called chronic venous insufficiency).
What Causes Varicose Veins?
Risk factors for varicose veins can be grouped as hormonal, lifestyle-related, acquired, and inherited (Table 1). The majority of patients with varicose veins have multiple risk factors. High pressures in the veins, leakiness of venous valves, weakness of the vein wall, and inflammation are the key mechanisms that lead to varicose veins. High pressures in the veins are caused by leakiness of the venous valves, obstruction of the veins, and failure of the calf muscle pump. Leakiness of venous valves is caused by tearing, thinning, or deformation of the valve leaflets and can develop in the deep, perforator, or superficial veins.
How Do Varicose Veins Impact My Health?
Varicose veins can be cosmetically distressing and can cause symptoms that decrease quality of life and impair the ability to carry out activities of daily life. If contributing factors are not corrected and treatment is not provided, varicose veins can progress in severity. More advanced forms of chronic venous insufficiency, such as ulceration, may further decrease quality of life and result in disability. Varicose veins can develop blood clots or may rupture and bleed. Varicose veins may increase the risk of more serious blood clots in the deep veins (called deep vein thrombosis).
How Are Varicose Veins Diagnosed?
Varicose veins are detected on physical examination. Health care providers should evaluate patients with varicose veins for more advanced signs of chronic venous insufficiency, such as swelling and ulceration. If the cause of the varicose veins is not clear from the physical examination, an ultrasound study of the veins is often done to assess for leakiness of venous valves and blood clots. Additional testing may be required if blockage of the large veins in the abdomen or groin is suspected.
How Are Varicose Veins Treated?
Treatment of varicose veins depends on the severity of symptoms, location, and cause. Treatment options include lifestyle changes, compression stockings, nonsurgical office-based procedures, and surgery (Table 2). Most patients will require a combination of treatments to achieve the best results. Regardless of whether a nonsurgical procedure or surgery is necessary for varicose vein treatment, lifestyle changes are crucial to ensure as complete and durable a response to treatment as possible. Most insurance companies will not cover the costs of nonsurgical procedures or surgery for cosmetic reasons.
Compression stockings are frequently prescribed as the first step in varicose vein treatment and are effective for treating discomfort and swelling. Consistent compression stocking use decreases the leakiness of venous valves and the pressure in the veins. To be effective, compression stockings should be placed on in the morning with the legs elevated at least to waist height and worn until bedtime. A variety of strengths and lengths are prescribed, depending on the severity and extent of varicose veins. To ensure comfort, compression stockings should be sized according to the patient’s legs. Devices are available to help patients apply compression stockings.
Nonsurgical procedures for varicose veins include local vein therapies and vein ablation. Local vein therapies, such as injection (sclerotherapy) or laser therapy, are used to treat spider veins and reticular veins. Sclerotherapy involves injection of a chemical that causes the small veins to seal shut. Most patients will require multiple treatments for the best results.
Vein ablation (also called endovenous ablation) uses either radiofrequency energy or laser to close large veins with leaky valves. Vein ablation is usually performed in an office-based procedure room with local anesthesia. Popularity of vein ablation has increased because it is less invasive than surgery, has a faster recovery time, and can be performed by a variety of physicians.
Surgery for varicose veins includes vein removal through small incisions (called microincision phlebectomy) and large varicose vein stripping. Microincision phlebectomy is performed under local anesthesia and is most useful for small varicose veins. Large varicose vein surgical stripping has been largely replaced by less invasive vein ablation procedures.
What Can I Do to Prevent Varicose Veins?
Because varicose veins are associated with obesity, weight loss is an important step in prevention and treatment (Table 3). Regular physical activity such as walking may help to improve calf muscle function. Avoiding prolonged standing and sitting encourages venous flow from the legs. Smoking cessation is also an important preventive measure.
For additional information, please consult the following resources:
American Venous Forum (www.veinforum.org/patients/vein-handbook/chapter-3-clotting-disorders)
National Heart, Lung, and Blood Institute (www.nhlbi.nih.gov/health/health-topics/topics/ebc/)
Rethink Varicose Veins (www.rethinkvaricoseveins.com)
The information contained in this Circulation Cardiology Patient Page is not a substitute for medical advice, and the American Heart Association recommends consultation with your doctor or healthcare professional.
- © 2014 American Heart Association, Inc.