Discusses causes and symptoms of twisted, enlarged veins near the surface of the skin called varicose veins. Covers treatment with self-care, sclerotherapy, endovenous laser, and radiofrequency. Includes vein surgery called ligation and stripping.
What are varicose veins?
Varicose veins are
twisted, enlarged veins near the surface of the skin. They are most common in
the legs and ankles. They usually aren't serious, but they can sometimes lead
to other problems.
What causes varicose veins?
Varicose veins are
caused by weakened valves and veins in your legs. Normally, one-way valves in
your veins keep blood flowing from your legs up toward your heart. When these
valves do not work as they should, blood collects in your legs, and pressure
builds up. The veins become weak, large, and twisted.
veins often run in families. Aging also increases your risk.
overweight or pregnant or having a job where you must stand for long periods of
time increases pressure on leg veins. This can lead to varicose veins.
What are the symptoms?
Varicose veins look dark
blue, swollen, and twisted under the skin. Some people do not have any
symptoms. Mild symptoms may include:
Heaviness, burning, aching, tiredness, or
pain in your legs. Symptoms may be worse after you stand or sit for long
periods of time.
Swelling in your feet and
Itching over the vein.
More serious symptoms include:
Swelling and calf
pain after you sit or stand for long periods of time.
Open sores, or you may bleed after a minor
Varicose veins are common and usually aren't a sign of a
serious problem. But in some cases, varicose veins can be a sign of a blockage
in the deeper veins called
deep vein thrombosis. If you have this problem, you
may need treatment for it.
How are varicose veins diagnosed?
Your doctor will
look at your legs and feet. Varicose veins are easy to see, especially when you
stand up. Your doctor will check your legs for tender areas, swelling, skin
color changes, sores, and other signs of skin breakdown.
You might need further tests if you plan to have treatment or if you
have signs of a deep vein problem.
How are they treated?
Home treatment may be all
you need to ease your symptoms and keep the varicose veins from getting worse.
Wear compression stockings.
Prop up (elevate) your legs.
long periods of sitting or standing.
Get plenty of exercise.
If you need treatment or you are concerned about how the
veins look, your options may include:
to close off the vein.
Laser treatment to close off the
Radiofrequency treatment to close off the
Phlebectomy, or stab avulsion, to remove the vein.
Ligation and stripping to tie off and remove the vein.
stretched, swollen, itching, or scaling skin.
thrombophlebitis (when a blood clot and inflammation
develop in a small vein near the surface of the skin).
Bleeding and/or bruising after a minor
Symptoms of varicose veins may become more severe a few
days before and during a woman's menstrual period.
varicose veins aren't a serious medical problem, but
they sometimes can lead to complications.
Bleeding from a varicose vein, which may occur
without an injury or after an injury to the thin skin over the varicose vein.
Bleeding can be heavy, but it can be controlled by elevating the leg and
applying pressure to the area that is bleeding.
Blood clots or
thrombophlebitis), when a blood clot and inflammation
develop in a small vein near the surface of the skin. Unlike blood clots in
deep veins, clots in superficial veins rarely travel to the heart or lungs,
where they could cause serious blockages.
Dry, stretched, swollen,
itching, or scaling skin.
Thin, fragile, easily injured skin at or
above the ankle.
Open sores (ulcers), usually near the
Skin color changes (stasis pigmentation) around the ankles and lower legs.
bacterial infections, which may arise from skin problems resulting from fluid
buildup (edema) in the leg and increased risk of tissue
Varicose veins most often are a result of problems in the
superficial veins just under the skin. But they can happen along with problems
or disease in the
deep veins and
perforating veins, which connect the deep and the
superficial veins. Complications are much more common when varicose veins are caused by
or linked with these deeper veins.
What Increases Your Risk
Factors that increase your
risk of developing
varicose veins include:
Being overweight (tends to be a
stronger factor in women). Having low muscle mass and high body fat decreases
the support for the veins.
Family history of varicose
Prolonged sitting or standing.
increase pressure in the abdomen, such as liver disease, fluid in the abdomen,
previous groin surgery, or
Injury to the
When To Call a Doctor
Call your doctor if you have
varicose veins and:
Your leg suddenly becomes swollen and painful.
You might have a blood clot in a deep vein, which can be serious and may need
Skin over a varicose vein begins to bleed on its
own or when it is injured. The skin over varicose veins is often thin and can
bleed heavily. If this happens, elevate your leg and apply pressure directly to
the vein to stop the bleeding.
Your leg has a tender lump. This
could be a clot or inflammation in a vein just under the skin, which is usually
not dangerous but may need treatment.
You develop an open sore
Your varicose vein symptoms don't improve with home treatment, or
there are symptoms you are concerned about.
Varicose veins are common and are generally not
a serious health problem. With a doctor keeping an eye on the condition, most
people can manage varicose veins with home treatment, such as exercising,
wearing compression stockings, and elevating the legs.
The most important tools in
varicose veins are the
physical examination and medical history. Varicose
veins are typically diagnosed based on their appearance, and no other special
tests are needed to confirm the diagnosis.
The medical history will include questions about
any vein problems, serious leg injuries, or leg ulcers you have had in the
past, as well as any other risk factors you might have, including whether your
family has a history of varicose veins. Talk to your doctor about any symptoms
you are having (such as swelling, fatigue, or cramps in your legs) and what you
have been doing to treat your symptoms, if anything.
physical exam, the doctor will examine your legs and feet (or any other
affected areas) for varicose veins. You will likely stand during this test. Varicose veins are usually easy to see. The doctor
will also check your legs for tender areas, swelling, skin color changes,
ulcers, and other signs of skin breakdown. To study the blood flow in your
legs, the doctor may ask you to move your legs around in different
If a problem with the
deep veins or complications are suspected based on your symptoms and exam,
other tests may be done.
Duplex Doppler ultrasound is the most
commonly used noninvasive test that can help your doctor study blood flow in
your leg veins.
An ultrasound might be done if you are considering having a procedure to treat varicose veins.
The goals of
varicose vein treatment are to reduce symptoms and
prevent complications. For some, the goal may be improved appearance. Home
exercising and wearing compression stockings—is the first and often best
If home treatment does not help, there are procedures or a surgery that can treat varicose veins. These include:
Sclerotherapy. A chemical (sclerosant)
is injected into a varicose vein to damage and scar the inside lining of the
vein, causing the vein to close. This usually works best for small
Laser treatment. Laser energy is used to scar and
destroy varicose veins. This is called ablation.
Simple laser therapy is done on small veins close to the skin, such as spider veins. The laser is used outside of your skin.
Endovenous laser therapy uses a laser fiber inserted into the vein. Laser
ablation inside the vein makes the vein close up.
Radiofrequency treatment. Radiofrequency energy
(instead of laser energy) is used inside a vein to scar and close it off. It
can be used to close off a large varicose vein in the leg.
Phlebectomy. Several tiny
cuts are made in the skin through which the varicose vein is removed.
Ligation and stripping. Incisions are made over the
varicose veins, and the vein is tied off (ligated) and removed
Treatment may be needed to remove the damaged veins,
treat complications, or correct an underlying problem that is causing the
varicose veins. The size of your varicose veins affects your treatment options.
Generally, larger varicose veins are treated with ligation and
stripping, laser treatment, or radiofrequency treatment. In some cases, a
combination of treatments may work best. Smaller varicose veins and
spider veins are usually treated with sclerotherapy or
laser therapy on your skin.
Some people may want to improve how
their legs look, even though their varicose veins are not causing other
problems. In these cases, a procedure or surgery may be appropriate—as long as there are no other health problems that
make these treatments risky.
If you are thinking about having a vein
treatment, you may want to know which treatment is best for you. No single
approach is best for treating all varicose veins. Talk to your doctor about your
If you are considering a surgery or procedure, consider some
questions about treatment. These questions might
include: How much experience does the doctor have with the particular
treatment? How much do the exam and treatment cost?
All treatment methods—including all types of surgery,
sclerotherapy, laser, and radiofrequency ablation—can scar or discolor the
Treatment can be more difficult for deep veins that are damaged or for perforating veins, which connect the deep and
superficial veins. These veins may be treated with surgery, radiofrequency ablation, or sclerotherapy, or a combination of these treatments.
may be prevented to some extent by:
Self-care. This includes exercising and avoiding long periods of standing or sitting.
Home treatment is recommended for most
varicose veins that aren't causing more serious
problems. Home treatment can relieve symptoms, slow down the progress of
varicose veins, and prevent complications such as sores or
bleeding. For many people with varicose veins, home treatment is the only
treatment they need.
These measures may help you avoid surgery or other medical
treatment for your varicose veins. But you may still want surgery or a procedure if you are
not satisfied with their appearance or your symptoms are not well
If you have varicose veins, you can help
control the problem and keep it from getting worse if you:
Superficial varicose veins can sometimes cause minor
problems like bruising or bleeding if you scratch or cut the skin over a larger
vein. Small blood clots may occasionally form in the surface veins (superficial
phlebitis). Most of these problems can be safely treated at home.
If you bump your leg so hard that you know it
is likely to bruise, elevate your leg and apply ice or a cold pack as soon as
you can for the next hour or two. This may help reduce the amount of bleeding
under the skin and minimize bruising.
If you cut or scratch the
skin over a vein, it may bleed a lot. Elevate your leg and apply firm pressure
with a clean bandage over the site of the bleeding. Continue to apply pressure
for a full 15 minutes. Do not check to see if the bleeding has stopped sooner.
If the bleeding hasn't stopped after 15 minutes, apply pressure again for
another 15 minutes. You can repeat this up to three times for a total of 45
Blood clot in a superficial vein (superficial
Signs of a small blood clot in a superficial varicose vein
(superficial phlebitis) include tenderness and swelling over the vein. The vein
may feel firm. If your doctor has told you how to care for superficial
phlebitis, follow his or her instructions.
Often doctors will recommend that you elevate
your leg and apply heat with a warm, damp cloth or a heating pad set on low (to
prevent burns, put a towel or cloth between your leg and the heating
Your doctor may also tell you to take a
nonsteroidal anti-inflammatory drug (for example, two
aspirin or ibuprofen tablets taken 3 to 4 times a day at first and less often
as your symptoms go away).
Talk to your doctor if you are not sure
that your symptoms are caused by a superficial blood clot or if you are not
sure how to treat your symptoms.
Medicines are not generally used to treat
Surgery for varicose veins includes tying off (ligation) and removing (stripping) larger
veins. Surgery may be used to treat
varicose veins if:
The varicose veins have not responded to home
treatment and your symptoms are bothering you.
You are concerned
about the way varicose veins look, and laser treatment, radiofrequency
sclerotherapy is not likely to improve their
appearance to your satisfaction.
Some people may want to have surgery
to improve how their legs look, even though their varicose veins are not
causing other problems. Surgery may be appropriate in some cases as long as you
don't have other health problems that make the treatment risky.
Keep in mind that surgery for varicose veins done only for cosmetic reasons
(that is, not medically necessary) is usually not covered by insurance.
In some cases, a combination of surgery and
sclerotherapy may be used to treat varicose veins. Sclerotherapy is a
nonsurgical procedure in which a chemical is injected into the vein, causing
the vein to close off.
There are several nonsurgical, minimally invasive
vein treatments for treating
Sclerotherapy is a nonsurgical
procedure in which a chemical is injected into the vein, causing the vein to
People who have laser or
radiofrequency treatment generally feel less pain and heal faster than people
who have ligation and stripping.
Some people may
want to have vein treatment to improve how their legs look, even though their
varicose veins are not causing other problems. Vein treatments may be
appropriate in some cases as long as you don't have other health problems that
make the treatment risky.
Keep in mind that vein treatments done only for cosmetic
reasons are not likely to be covered by insurance.
varicose veins may require further treatment, especially if you have developed
severe varicose veins or
chronic venous insufficiency.
Other Places To Get Help
American Academy of Dermatology
American Society For Dermatologic Surgery
5550 Meadowbrook Drive
Rolling Meadows, IL 60008
The American Society for Dermatologic Surgery was founded in 1970
to promote excellence in the subspecialty of dermatologic surgery and to foster
the highest standards of patient care. Information on the treatment of skin
conditions and referral lists are available online and by calling the ASDS.
National Heart, Lung, and Blood Institute
P.O. Box 30105
Bethesda, MD 20824-0105
The U.S. National Heart, Lung, and Blood Institute
(NHLBI) information center offers information and publications about preventing
Diseases affecting the heart and circulation, such as heart
attacks, high cholesterol, high blood pressure, peripheral artery disease, and
heart problems present at birth (congenital heart diseases).
Diseases that affect the lungs, such as asthma, chronic
obstructive pulmonary disease (COPD), emphysema, sleep apnea, and
Diseases that affect the blood, such as anemia,
hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.
Society of Interventional Radiology
Society for Vascular Surgery
633 North Saint Clair Street, 24th Floor
Chicago, IL 60611
VascularWeb is a Web site provided by the Society for Vascular
Surgery. This Web site provides information about vascular conditions for
patients and families. VascularWeb can help you learn about how to prevent and
treat vascular diseases, learn about vascular screening, and find a vascular
Khilnani NM, et al. (2010). Multi-society consensus quality improvement guidelines for the treatment of lower extremity superficial venous insufficiency with endovenous thermal ablation from the Society of Interventional Radiology, Cardiovascular Interventional Radiological Society of Europe, American College of Phlebology, and Canadian Interventional Radiology Association. Journal of Vascular and Interventional Radiology, 21(1): 14–31.
Kundu S, et al. (2010). Multi-disciplinary quality improvement guidelines for the treatment of lower extremity superficial venous insufficiency with ambulatory phlebectomy from the Society of Interventional Radiology, Cardiovascular Interventional Radiological Society of Europe, American College of Phlebology, and Canadian Interventional Radiology Association. Journal of Vascular and Interventional Radiology, 21(1): 1–13.
Raju S, Neglen P (2009). Chronic venous insufficiency
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Tisi P (2011). Varicose veins, search date January 2010. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
How this information was developed to help you make better health decisions.