Introduction

Photo of a woman harvesting apples (PantherMedia / Dieter Möbus) Varicose veins are mostly a cosmetic issue for a lot of people. They do not like the look of purple bumpy veins on their legs. It is estimated that about one out of every five adults have varicose veins. Although they are generally not a problem, they can cause symptoms such as heavy-feeling legs or muscle cramps in your lower legs. They only rarely lead to more serious medical conditions.

Varicose veins are superficial (just underneath the skin) veins that are lumpy. They may appear purple or blue through the skin, are swollen and sometimes bulge outward quite a lot. They are most commonly found on the backs of the calves or on the inner leg.

A milder form of varicose veins may also affect the face or other areas of the body. These are known as spider veins because they look a bit like a spider’s web underneath the skin. Spider veins are common but don't cause any health problems.

Symptoms

Varicose veins can make your legs feel heavy and your skin tight or itchy. The symptoms usually get worse towards the end of the day, especially after sitting or standing for longer periods of time. Varicose veins sometimes cause pain or cramps in the calf muscles at night too. Warm weather usually makes the symptoms worse. There is not necessarily a connection between how bad varicose veins look and how much of a problem they are. For example, varicose veins that don't look bad might actually cause a lot of discomfort, while ones that are very large and bumpy may cause no discomfort whatsoever.

Varicose veins can affect your wellbeing too. Some people feel self-conscious and don't want others to see their legs. They might stop wearing shorts or skirts and avoid activities such as swimming. Even if varicose veins aren't causing any other problems, if someone is very troubled by the appearance of their legs, treatment might be worth considering.

Causes

Our legs have superficial veins and veins that run deeper under the surface. The deeper leg veins carry oxygen-poor blood back to the heart. The muscles of the legs help to do this: They squeeze the deep leg veins when you walk, which pushes the blood upwards against the force of gravity. There are valves inside the veins that prevent blood from flowing back down.

 

Illustration: Blood flowing back in varicose veinsBlood flowing back in varicose veins

 

The superficial veins in the legs transport blood from the skin, fat tissue and muscles to the deep veins. If the valves in the superficial veins stop working properly, blood builds up in the veins. There are several reasons why this might happen. Some people simply have weaker vein walls and valves than others. There may also not be enough pressure on the veins - for instance, because the muscles aren't used enough if you spend too much time standing in one place or sitting still.

Risk factors

Some people are more likely to develop varicose veins because it runs in their family. Women often first get varicose veins during pregnancy. This is probably due to a combination of two factors – hormone-related changes in their body's tissue and weight gain – which makes it harder for the blood in their leg veins to flow back to the heart properly. Being very overweight also increases pressure in the legs and veins, which can increase the risk of varicose veins, especially in women.

Prevalence

It is estimated that about 20% of all adults will get varicose veins at some point in their lives. Although they are more common in older people, young people sometimes have them too. Varicose veins are more common in women than in men.

Effects

Only rarely do varicose veins lead to more serious health problems. But you should see a doctor if you notice any signs of complications. These include the following:

  • Skin ulcers or open sores near the ankle that are not the result of an injury or that do not appear to be healing even after several weeks
  • Major swelling in the leg
  • Reddened veins that feel warm and are painful
  • Bleeding from or near varicose veins

Venous leg ulcers could arise from varicose veins, but can also be caused by other, more serious medical conditions such as diabetes or narrowing of the arteries.

A skin rash near to varicose veins might be an early sign of a leg ulcer. A condition called lipodermatosclerosis is also sometimes a sign that a leg ulcer is forming. Lipodermatosclerosis is quite a rare condition in which the skin covering the inside of the ankle becomes brown, tight, thinner and more sensitive to pain.

Varicose veins that have been around for a long time can make the leg swell up a lot. But major swelling in a leg can also be caused by other conditions, such as heart failure.

Red, warm veins that are sometimes associated with a burning pain can be a sign of phlebitis (vein inflammation). Phlebitis might occur at the same time as a blood clot (thrombophlebitis).

Bleeding of varicose veins is rare but can be dangerous, so immediate medical attention is needed. First-aid treatment involves raising the leg and applying pressure to the site of bleeding.

The risk of developing deep vein thrombosis (DVT) on a flight is very low, even if you have varicose veins.

Diagnosis

Most people with varicose veins don't need to have any special medical examinations. If it is thought that there is a problem in the deep veins of a leg, an ultrasound examination can be done. A special kind of ultrasound called duplex ultrasound is used to gain information about the condition of the deep leg veins and blood flow in the veins. Ultrasound scans are carried out before surgery too, in order to assess the veins. People may also have an x-ray examination after being injected with a contrast medium (phlebography or venography).

Treatment

The most common treatment is wearing compression stockings. These special stockings are thought to help the muscles transport blood back to the heart by applying pressure to the veins.

Varicose veins can also be surgically removed or closed off. There are different ways to surgically remove varicose veins. The most common types of surgery are:

  • Vein stripping: Two incisions (cuts) are made on the leg and the entire vein is pulled out through an incision near the groin.
  • Phlebectomy: Several very small incisions (just a few millimeters wide) are made along the affected vein, which is then removed in several pieces. This technique is mainly used to treat smaller veins.

A number of other approaches offer an alternative to conventional vein removal. These include:

  • Radiofrequency ablation: Heat generated by electromagnetic waves (radio waves) is used to close off veins.
  • Endovenous laser ablation: This treatment also involves heating the vein from the inside to close it off, but lasers are used instead of radio waves.
  • Transilluminated powered phlebectomy ("Trivex"): Here a tiny rotating blade is inserted into the vein to cut it, and the vein tissue is then removed using suction.

A procedure known as sclerotherapy can be used to treat small and medium-sized varicose veins. It involves injecting a liquid or foam into the vein to close it off.

Learn more

Everyday life

Standing in the same position for a long time increases the risk of blood building up in the veins. This is also true if you sit with your legs crossed for long time periods, which makes it harder for the veins to do their job. Moving around and changing position as often as possible might help relieve discomfort. Many people report that pain in their legs gets better if they sit down and put their feet up (elevate their legs).

Exercise and movement might help the blood in your legs flow more freely. If you are overweight, losing weight can take some pressure off your legs.

What would you like to share with us?

We welcome any feedback and ideas. We will review, but not publish, your ratings and comments. Your information will of course be treated confidentially. Fields marked with an asterisk (*) are required fields.

Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?”

Recommend this article

You can permanently activate a button here. Please read our privacy policy.