Enlarged veins that typically appear as cords bulging through the skin. They are commonly seen on the backs of the calves or the insides of the thighs and may be dark purple or blue in color. Varicose veins are commonly accompanied by aching pain, heaviness, swelling, numbness, itching, or rash in the legs along with darkening of the skin.
Arteries carry oxygen-rich blood from the heart to the rest of the body, and veins carry oxygen-poor blood back to the heart. The veins of the legs must work against gravity to carry blood back to the heart; they are aided by the squeezing of leg muscles, which help pump the blood upward. Veins have one-way valves that prevent blood from flowing backward. When these valves become weak, a condition known as venous insufficiency, blood can leak back into the veins and collect there.
Varicose veins are very common, affecting roughly half of people age 50 and older. Risk factors include older age; a family history of vein problems; hormonal changes that occur with puberty, pregnancy, or menopause; obesity; and prolonged standing.
Varicose veins can gradually grow larger, causing health problems that require medical treatment. In cases of severe venous insufficiency, pooling of blood in the veins can significantly slow the return of blood to the heart, leading to blood clots and severe infection. Blood clots are dangerous because they can travel to the lungs and cut off circulation — a life-threatening condition called pulmonary embolism. Sores or skin ulcers can also form on the skin surrounding varicose veins. Be sure to see your doctor if you have a sore or rash on a leg with a varicose vein, or if you have a varicose vein that becomes swollen, red, or very tender or warm to the touch.
A number of treatments are available for varicose veins. Sclerotherapy involves injecting a solution into the vein that causes the blood vessel wall to swell, stick to itself, and seal the vein closed. This stops the flow of blood and turns the vein into scar tissue, which gradually fades. Sclerotherapy can be performed in a doctor’s office without anesthesia.
Endovenous (from the inside) techniques can also be used to treat varicose veins deep inside the legs and have replaced surgery for most people with even severe varicose veins. Standard treatment involves threading a catheter (a very thin tube) into the vein and emitting radio waves or laser energy from the catheter to seal the vein shut. Eventually, healthy veins around the sealed vein restore the normal flow of blood. This procedure can also be performed in a doctor’s office.
Very large varicose veins are sometimes treated with surgery. Surgical ligation and stripping involves tying the vein shut and removing it from the leg. Veins deeper in the leg then compensate for the removed vein by transporting more blood. Surgical ligation and stripping requires local or general anesthesia and is done in an operating room on an outpatient basis.
Another surgical procedure, called ambulatory phlebectomy, involves using a special light to locate the vein, making tiny incisions in the skin, and using surgical hooks to pull the vein out of the leg. With this treatment, carried out under local or regional anesthesia, it is possible to remove very large varicose veins while leaving only small scars.
In endoscopic vein surgery, a small video camera is used to view the inside of the veins. Varicose veins are then removed through small incisions. This type of surgery requires epidural, spinal, or general anesthesia, and patients return to normal activity within a few weeks.
There are a number of steps you can take to reduce your risk of developing varicose veins. Exercise, especially activities such as walking and bicycling that work the legs, can improve circulation and the resilience of veins. Controlling your weight can limit the strain on legs that may lead to valve malfunction. To encourage proper circulation, avoid crossing your legs while sitting, and elevate your legs when resting. Try to avoid standing or sitting for long periods of time. If you must sit for a prolonged period, stand up and take a short walk every half hour or so. Avoid tight clothing that constrains your waist or legs. If you believe you may be especially at risk, consider wearing low-grade compression (“support”) stockings. Talk to your doctor before wearing moderate- or high-compression stockings or if you already have varicose veins or another medical problem in your legs.