Varicose veins are large bulging veins seen immediately under the skin. These veins result from malfunctioning valves that create high pressure and pooling of blood. The great saphenous vein is the most common culprit. This vein runs from the foot to the groin along the inner part of the thigh.

The great saphenous vein is usually not visible. However, high pressure and flow reversal in this vein can damage normally small tributary veins and cause them to bulge. This causes the characteristic appearance and symptoms of varicose veins. Left untreated, varicose veins can lead to disfigurement, pain, and disability.

What Causes Varicose Veins?

The circulatory system is made up of two major conduits. Arteries deliver blood from the heart to the bodily tissues under high pressure. Veins then return blood from the tissues to the heart. Normally, the pressure in the veins is low compared to the arteries.

The veins in the arms and legs have valves that keep blood flowing in the proper direction and prevent gravity from causing high pressure, particularly in the veins of the legs. Normally, the valves open to allow blood to flow toward the heart and close to prevent back flow.

If the valves malfunction, high pressure can develop and cause pooling of blood in the leg veins. This may cause varicose veins and leg swelling. In more advanced cases, damage to tissues may occur which can result in discoloration, inflammation, and ulceration.

Varicose Vein Symptoms

Symptoms of varicose veins include:

  • Fullness, heaviness, aching, and sometimes pain in the legs
  • Visible, swollen veins
  • Smaller veins that you can see on the surface of the skin, called spider veins.
  • Thigh or calf cramps (often at night)
  • Mild swelling of feet or ankles
  • Itching

If flow of blood through the veins becomes worse, symptoms may include:

  • Leg swelling
  • Leg or calf pain after sitting or standing for long periods
  • Skin color changes of the legs or ankles
  • Dry, irritated, scaly skin that can crack easily
  • Skin sores (ulcers) that do not heal easily
  • Thickening and hardening of the skin in the legs and ankles (this can happen over time)

Varicose Vein Risk Factors

The following are risk factors for developing varicose veins:

  • Age - Varicose veins usually develop after the age of 30 and become progressively worse with time. Occasionally, significant varicose veins can develop even in teenagers.
  • Gender - Women are much more likely than men to develop varicose veins. This is related to hormonal differences. The risk of developing varicose veins is especially increased due to pregnancy. The use of hormone replacement and birth control pills will also increase the risk of developing varicose veins.
  • Genetics - Many people have a strong genetic predisposition to developing varicose veins. If you have family members with them, there is a greater chance that you will also develop them.
  • Obesity
  • Prolonged Standing - Occupations that require prolonged standing may increase the risk of developing varicose veins. This is particularly true if the individual has other predisposing factors.

Varicose Vein Treatment

Your provider may suggest that you take the following self-care steps to help manage varicose veins:

  • Wear compression stockings to decrease swelling. These stockings gently squeeze your legs to move blood up towards your heart.
  • DO NOT sit or stand for long periods. Even moving your legs slightly helps keep the blood flowing.
  • Raise your legs above your heart 3 or 4 times a day for 15 minutes at a time.
  • Care for wounds if you have any open sores or infections. Your provider can show you how.
  • Lose weight if you are overweight.
  • Get more exercise. This can help you keep off weight and help move blood up your legs. Walking or swimming are good options.
  • If you have dry or cracked skin on your legs, moisturizing may help. However, some skin care treatments can make the problem worse. Talk to your provider before using any lotions, creams, or antibiotic ointments. Your provider can recommend lotions that can help.

If only a small number of varicose veins are present, the following procedures may be used:

  • Sclerotherapy - Salt water or a chemical solution is injected into the vein. The vein hardens and disappears.
  • Phlebectomy - Small surgical cuts are made in the leg near the damaged vein. The vein is removed through one of the cuts. 

If the varicose veins are larger, longer, or more widespread on the leg, your provider will suggest one of the following:

  • Procedures that can be done in a provider's office or clinic, such as using a laser or radiofrequency
  • Varicose vein stripping, used to remove or tie off a large vein in the leg called the superficial saphenous vein.