Varicose Veins

Varicose veins look like swollen and twisted blood vessels under the skin. They may not cause any symptoms. Mild symptoms may include:

• Heaviness, burning, aching, tiredness, or pain in your legs. These symptoms may be worse after you stand or sit for long periods of time.
• Mild swelling in your feet and ankles.
• Itching over the vein.

More serious symptoms include:

• Leg swelling.
• Swelling and calf pain after you sit or stand for long periods of time.
• Skin changes, such as:
  • Color changes.
  • Dry, thinned skin.
  • Inflammation.
  • Scaling.
• Open sores.
• Bleeding after a minor injury.
• Superficial thrombophlebitis. This happens when a blood clot and inflammation form in a small vein near the surface of the skin.

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 don't work as they should, blood collects in your legs, and pressure builds up. The veins become weak, large, and twisted.

Varicose veins often run in families. You may be born with defective valves or weak walls in your veins, or you may develop them later in life. Varicose veins happen more often as people get older.

Varicose veins often form during pregnancy. They might become less prominent after pregnancy and may disappear completely.

Varicose veins are most often diagnosed based on how they look. No special tests are needed to confirm the diagnosis.

Your doctor will:

• Ask questions about any risk factors, such as vein problems, serious leg injuries, or leg ulcers you've had in the past.
• Do a physical exam. The doctor will examine your legs and feet (or any other affected areas). The doctor will check for tender areas, swelling, skin color changes, ulcers, and other signs of skin breakdown.

You might need tests if you plan to have treatment or if you have signs of a deep vein problem. Duplex Doppler ultrasound is the most commonly used test. It can help your doctor study blood flow in your leg veins.

The goals of treatment for varicose veins are to reduce symptoms and prevent complications. For some, the goal may be related to how the veins look. Home treatment is usually the first approach.

Home treatment

Home treatment may be all you need to ease your symptoms and keep the varicose veins from getting worse. You can:

• Wear compression stockings.
• Stay at a healthy weight.
• Prop up (elevate) your legs.
• Avoid long periods of sitting or standing.
• Get regular exercise.

Procedures

If home treatment doesn't help, there are procedures that can treat varicose veins. These include:

Endovenous ablation.

Endovenous ablation is a procedure to close off varicose veins. Endovenous means that the procedure is done inside the vein. Ablation means a doctor uses something to damage and close off the vein. This may be heat, chemicals, or a small wire.

Ligation and stripping.

This treatment is a type of surgery. Cuts (incisions) are made over the varicose vein, and the vein is tied off (ligated) and removed (stripped).

Phlebectomy.

Several tiny cuts are made in the skin through which the varicose vein is removed. This is also called microphlebectomy, ambulatory phlebectomy, or stab avulsion.

Sclerotherapy.

A chemical is injected into a varicose vein to damage and scar the inside lining of the vein, causing the vein to close.

Simple laser treatment.

Laser energy is used to scar and destroy varicose veins. Simple laser therapy is done on small veins close to the skin, such as spider veins. The laser is used outside of your skin.

The size of your varicose veins affects your treatment options.

• Larger varicose veins are generally treated with endovenous ablation or ligation and stripping surgery.
• Smaller varicose veins and spider veins are usually treated with sclerotherapy or simple laser therapy on your skin.

Varicose veins just under the skin sometimes cause minor problems. Most can be treated at home.

Minimize bruising

If you bump your leg, prop up your leg and apply ice or cold packs right away. Apply the ice or cold pack for 10 to 20 minutes, 3 or more times a day. Put a thin cloth between the ice and your skin.

Control bleeding

• Prop up your leg. Apply pressure over the site of the bleeding.
• Apply pressure for a full 15 minutes.

Mild bleeding usually stops on its own or slows to an ooze or trickle after 15 minutes of pressure. It may ooze or trickle for up to 45 minutes. Call your doctor if the bleeding does not stop after 45 minutes.

Care for a small blood clot in a varicose vein

Follow your doctor's instructions. Care may include the following:

• Prop up your leg and apply a damp cloth that is warm or cool.
• Ask your doctor if you can take an over-the-counter pain medicine.

Talk to your doctor if you have questions.