Varicose Veins

We’ve all seen varicose veins, but should we be worried? The bulging, twisted bluish veins can form on the legs. Many people over age 60 have them. You may not like how they look, but there usually is no cause for concern.

Veins are pipes that take the blood from different parts of our body back to the heart. At intervals in our veins, valves help move the blood in one direction: toward the heart. Sometimes, the valves in our leg veins may stop working. This condition is called chronic venous insufficiency (CVI). As a result, some of the blood stays in our feet and legs, especially when we are standing or sitting for a long time. The increased pressure inside the veins causes these veins to dilate over time and allows blood to leak out into the surrounding tissue.

These dilated veins underneath the skin are called varicose veins. Not everyone with chronic venous insufficiency will develop visible varicose veins. Many factors can cause varicose veins, such as family history, hormones, pregnancy, obesity and work that involves being on your feet.

In some cases, varicose veins can cause discomfort and may be a sign of deep vein thrombosis (DVT)—a blood clot in a vein deep in your leg. If you notice any unusual swelling in your leg, pain or changes in skin color, you should contact your health care professional. There are things you can do to get rid of varicose veins or keep them from getting worse. Use this condition center to learn more about CVI and varicose veins, create a list of questions to ask your health care professional and get practical tips.

Overview

Varicose veins are often thought of as a cosmetic problem, but for many people varicose veins and chronic venous insufficiency can cause problems.

Symptoms include:

• Legs feeling heavy or tired
• Aching legs
• Fatigue
• Swelling (rings formed by the sock)
• Restless legs
• Itching

The symptoms can get worse after standing a long time or at the end of the day. Discoloration—a dark or bronze skin color—extending from the mid-calf down to the ankles can occur.

Over time, the constant pressure on the vein walls from weakened valves, or venous insufficiency, can lead to more inflammation, persistent swelling, further discoloration and leathery skin. In the most severe or advanced cases, ulcers may form at or above the ankles.

Some people with this condition are able to find relief by raising their legs or with lifestyle changes (avoiding long periods of standing, losing weight and walking). Others get relief by wearing compression stockings or compression sleeves. More advanced stages and symptoms require treatments that identify the veins that aren’t working and “closing or removing them” using a variety of techniques.

What Increases Your Risk

Many people over the age of 60 have some form of varicose veins. The disease may start at a very early age. Varicose veins are more common in women, but many men have them, too. Quite a few factors can lead to chronic venous insufficiency. The biggest risk factor is family history, or an inherited weakness in vein walls.

Other risk factors include hormones (such as progesterone), pregnancy, smoking and obesity. Women who have had more than one pregnancy are at greater risk. Varicose veins can become worse during the late part of the menstrual cycle. They also may occur after a blood clot (deep vein thrombosis) in the leg.

Proper function of the venous system involves the muscles of the legs to assist in “pumping” the blood back up toward the heart. This places at much higher risk those with jobs that involve long hours standing or sitting, and individuals on bedrest who don’t move their legs.

When to Call a Doctor

You should call a doctor if your legs feel heavy or tired, or if you have symptoms. If you develop areas of redness or tenderness, pain when walking, a sudden increase in swelling, sores, or if your symptoms begin to affect your lifestyle, you should call a health care professional. These are all signs of advancing venous insufficiency or complications from the condition.

Inflammation or redness may be due to an inflammation of the vein (thrombophlebitis). Swelling and tenderness may be a sign of a blood clot (deep vein thrombosis). However, it is rare for varicose veins to cause a serious blood clot.

Exams and Tests

Your health care professional will take a complete medical history and examine you.

He or she likely will order a special leg ultrasound called a venous reflux study. This test takes about 45-60 minutes to perform. It is usually done with the patient lying down with head tilted up or with the patient standing. A detailed test will attempt to rule out blood clots (deep vein thrombosis) and assess valve function. A blood pressure cuff may be placed around the leg.

Sometimes, more detailed testing is required, in particular if there is a history of blood clot. A CT scan may be recommended to look for venous blood flow obstruction that slows the upward flow of blood.

Prevention

There is no clear way to prevent varicose veins from forming. Staying lean and remaining active are recommended. Avoid prolonged sitting or standing. If needed, use compression hose to minimize lower extremity congestion.

Compression hose may be obtained over the counter, but for more severe disease, graduated compression hose with prescription strength compression may be recommended. Many sports stores are selling compression sleeves which may also provide similar benefit.

Treatment

Current treatment options for varicose veins include:

1. Compression stockings
   ProceduresCompression Stockings

   Compression stockings come in various types, strengths and lengths. They can provide relief from some of the symptoms but do not cure varicose veins. People with so-called venous ulcer disease should wear compression stockings. This form of treatment is typically the first line of therapy. They may be difficult to apply and often require direction for proper fitting.

   Other forms of compression include wraps that stay on for several days and also have a medication to help skin or ulcers heal.

   Pneumatic compression devices also may be recommended for excessive swelling and a progressive form of venous insufficiency. This therapy consists of pumps that are worn on the legs intermittently for hours a day.

   Procedures

   An effective way to treat varicose veins and chronic venous insufficiency is a procedure in which the failing veins are closed or removed. This can be done only for the superficial veins.

   A number of minimally invasive procedures with less discomfort and downtime are available to seal closed the “broken” (dysfunctional) veins and allow the blood to be rerouted through healthy veins. These methods include thermal ablation, mechanochemical ablation, sclerotherapy and glue. These procedures are typically performed in a medical office or clinic with local anesthetic and take less than an hour.

   Thermal ablation procedures are very common. With this technique, the tissue around the vein is anesthetized, or numbed, by injection of medication. Then a catheter is inserted into the leaking vein and the vein wall is sealed closed using the energy produced by heat (laser or radiofrequency).

   Other techniques available include mechanochemical ablation or glue, in which the vein is closed without needing to use heat. These procedures do not require as much local anesthetic and are usually less painful. Varicose vein clusters can be injected with a special medicine to chemically destroy them (sclerotherapy) or can be removed with tiny surgical hooks and local anesthetic (phlebectomy).

   When a varicose vein is treated, or shut down and sealed closed, the blood is rerouted via healthy veins with working valves. The same blood that used to collect in the lower leg causing swelling is now able to flow properly.

Living With Varicose Veins

Varicose veins are very common and do not bother most people. In those cases, there is no need for concern. Over time, symptoms can occur such as aching and swelling. If the symptoms become bothersome, then a specialist evaluation is recommended.

More Information

Tips for Using Compression Hose 

1. Apply compression hose first thing in the morning before you get out of bed or at a time of day when you have the least swelling.
2. Do not bunch the stocking up and try to pull it over your foot and heel (as you might do with a sock or nylon stockings). The material is meant to apply compression and will not stretch over the heel easily.
3. Invert stocking inside out and cup it over toes, front of your foot and sole. Then slide your heal over a skid proof surface (such as a cabinet liner, mouse pad or other grippy surface). The stocking will slide over your heel and be easier to pull up your leg.
4. You may use a small dab of silicone ointment or heel balm on your heel to assist if needed.
5. Rubber dish gloves can help you grip the stocking.
6. Make certain there are no wrinkles in the stocking while you are wearing it. This can cause discomfort and injure the skin.
7. Do not roll or fold down the stocking. A body adhesive can be used to keep it in place if needed. Also, be sure the silicone border is clean, and the material is pulled up and evenly spread over your entire leg. You may consider compression therapy using pantyhose stockings if compression stockings are difficult to keep fitting properly.
8. If you experience any pain or skin changes while wearing your hose, please call your health care professional.
9. Maintain good skin hygiene with moisturizer or anti-itch cream if you have no skin break down.
10. If you have any sores or ulcers, follow up with a wound care specialist.
11. Wear your hose for the majority of the day, especially when you are going to be on your feet. If you can tolerate them only for a few hours a day, try gradually increasing the number of hours you can wear them.
12. Hose should be taken off at night, and you should try to sleep with legs elevated on a pillow or foam wedge.
13. Wash and dry stockings as recommended on the product label.
14. Replace your hose every six months.
15. Hose purchased from a drugstore may have only 10-15 mmHg of compression. When treating venous insufficiency, a higher compression may be required, such as 20-30 mmHg. A prescription is required for hose with higher compression.