Varicose Veins

How varicose veins form

Leg veins carry blood back to the heart against gravity, helped by calf muscle pumping and one-way valves. When valves in the superficial veins, mainly the great and small saphenous veins, become weak or damaged, blood leaks backward (reflux) and pressure rises. Veins stretch, lengthen and twist. Over time, high pressure damages the skin and tissues around the ankle.

Varicose veins vs spider veins

Risk factors

• age
• female sex and hormonal changes (pregnancy, birth control, menopause hormone therapy)
• pregnancy, especially multiple pregnancies
• family history
• standing or sitting for long periods
• obesity
• previous deep vein thrombosis
• tall height

Symptoms

• visible, bulging, twisted veins, often on the calves and inner legs
• aching, throbbing, or a heavy feeling in the legs, worse at the end of the day or after standing
• swelling of the ankles
• itching over the veins
• night cramps and restless legs
• symptoms that improve with walking and leg elevation

Signs of advanced venous disease

• brown discoloration around the ankles
• itchy, scaly skin (stasis dermatitis)
• hardened, tight skin (lipodermatosclerosis)
• white scar-like patches (atrophie blanche)
• venous ulcers, usually above the inner ankle

Complications

• superficial thrombophlebitis: a painful clot in a surface vein, which occasionally extends into deep veins
• deep vein thrombosis: more likely in people with varicose veins
• bleeding: thin skin over a vein can rupture with minor injury and bleed heavily
• venous ulcers: slow-healing sores
• chronic venous insufficiency

Diagnosis

• examination standing up, looking at veins and skin
• duplex ultrasound: the key test, showing which valves leak and ruling out DVT; it guides treatment planning
• doctors grade severity using the CEAP classification, from spider veins (C1) to active ulcers (C6)

Treatment

Self-care

• move: walk regularly and do calf exercises to pump blood
• raise your legs above heart level for 15 to 30 minutes several times a day
• avoid long periods of standing or sitting; flex your ankles often
• manage weight
• compression stockings: graduated stockings (often 20 to 30 mm Hg) reduce aching and swelling; fitting is important, and people with poor arterial circulation should check with a doctor first

Minimally invasive procedures

Guidelines recommend these as first-line treatment for symptomatic varicose veins with reflux:

• endovenous thermal ablation: radiofrequency or laser energy seals the faulty vein from inside through a needle puncture, under local anesthetic
• non-thermal ablation: medical adhesive (cyanoacrylate glue) or mechanochemical ablation
• ultrasound-guided foam sclerotherapy: a foam medicine injected to close the vein
• ambulatory phlebectomy: removal of bulging surface veins through tiny incisions

Blood is rerouted through healthy veins. Most people walk the same day and return to normal activities within a few days.

Surgery

Traditional vein stripping and ligation is now used less often but remains an option.

Spider veins

Sclerotherapy or surface laser for cosmetic improvement.

Varicose veins in pregnancy

Rising hormones, increased blood volume and pressure from the uterus make varicose veins common in pregnancy, including in the vulva. They often improve within 3 to 12 months after birth. Compression stockings and leg elevation help. Treatment is usually delayed until after pregnancy.

Prevention

You cannot fully prevent varicose veins, but regular exercise, maintaining a healthy weight, avoiding long periods without moving and wearing compression stockings if you are at risk can slow their development.

Frequently asked questions

What causes varicose veins?

They are caused by weak or damaged valves in the leg veins, which let blood flow backward and pool, stretching the veins. Risk factors include age, female sex, pregnancy, family history, obesity and standing for long periods.

Are varicose veins dangerous?

Usually not, but they can cause discomfort and, over time, skin changes, ulcers, bleeding or superficial clots. People with varicose veins also have a somewhat higher risk of deep vein thrombosis. See a doctor for pain, swelling, skin changes or sores.

What is the best treatment for varicose veins?

For symptomatic varicose veins, minimally invasive endovenous ablation (radiofrequency or laser) is usually the first choice, often with phlebectomy or foam sclerotherapy for surface veins. Compression stockings and lifestyle measures help symptoms but do not remove the veins.

Do varicose veins come back after treatment?

Treated veins are closed permanently, but new varicose veins can develop over time because the underlying tendency remains. Recurrence rates after modern ablation are relatively low, and further treatment is possible if needed.

Does insurance cover varicose vein treatment?

Insurers often cover treatment when varicose veins cause symptoms such as pain, swelling or skin changes, and duplex ultrasound shows reflux, usually after a trial of compression stockings. Treatment for purely cosmetic spider veins is usually not covered.