Patient Education | Peripheral Venous Disease
What Are Varicose Veins?Varicose veins are swollen and twisted veins that are visible just under the surface of the skin. They appear most commonly in the legs, but also can develop in other parts of the body.
Veins are blood vessels that carry blood from the tissues of the body to the heart. In the heart, blood is pumped to the lungs to pick up oxygen. The oxygen-rich blood is then pumped out to the body through the arteries. From the arteries, blood flows through tiny blood vessels called capillaries, where it gives up its oxygen to the body´s tissues. The blood then returns back to the heart through the veins to pick up more oxygen.
Veins have one-way valves that help to keep the blood flowing toward the heart. When the valves don´t work well, blood backs up and pools in the veins. This causes them to swell and become varicose veins.
Varicose veins usually don´t cause medical problems. On occasion, they require treatment for pain, skin problems, blood clots, or other complications. People may choose to have cosmetic treatment to improve the appearance of varicose veins.
Related Vein Problems
A number of other types of vein problems are related to varicose veins.
Spider Veins
Spider veins are a smaller version of varicose veins. They occur in the capillaries, which are the smallest blood vessels in the body. Spider veins are commonly found on the legs and face, and they usually resemble a spider web or tree branch in shape. They can be red or blue. Spider veins are usually not a medical concern.
Telangiectasias
Telangiectasias (tel-AN-juh-ek-TA-ze-uhs) are small clusters of blood vessels that look similar to spider veins. They are red in color and are commonly found on the upper body, including the face. They can develop during pregnancy and in people who have certain genetic disorders, viral infections, and other medical conditions (such as liver disease). Newly developed telangiectasias are often a reason to see a doctor.
What Causes Varicose Veins?
Veins, especially those in the legs, have to pump the blood "up hill" to the heart, against gravity. Inside the veins are one-way valves that help with pumping action and prevent blood from flowing backward. These valves allow blood to flow in only one direction, toward the heart. Varicose veins develop when the valves become weakened, damaged, or don´t work well.
Weakness in the valves may be due to weakness in the walls of the veins. This weakness tends to be associated with certain factors, including increasing age, a family history of varicose veins, or high pressure inside veins due to overweight or pregnancy.
When the walls of the veins are weak, they lose their normal elasticity, like an overstretched rubber band. This makes them longer and wider and causes the flaps of the valves to separate. Blood is then able to flow backward through the valves, filling the vein and stretching it even more. The vein becomes enlarged, swollen, and often twisted trying to squeeze into its normal space.
The illustration shows the location of leg veins, which can become varicose veins. Figure A shows a normal vein with working valves and normal blood flow. Figure B shows a varicose vein with deformed valves, abnormal blood flow, and thin, dilated (stretched) walls.
Populations Affected
About 25 million Americans are affected by varicose veins. They are most common in people aged 30 to 70.
Risk Factors
Risk factors for developing varicose veins include:
- Genetics. Having a family member with varicose veins may increase the risk for developing them. Approximately half of the people who get varicose veins have a family history of them.
- Age. The normal wear and tear of aging may cause valves to weaken and not work as well.
- Gender. Women are two to three times more likely to develop varicose veins than men. Up to half of American women have varicose veins. Changes in hormones due to puberty, pregnancy, menopause, or taking birth control pills may increase a woman's risk of developing varicose veins.
- Pregnancy. During pregnancy, the growth of the fetus increases the pressure on the veins in the legs. Varicose veins that occur during pregnancy usually improve within 3 to 12 months following delivery.
- Overweight and obesity. Having extra weight on the body can put additional pressure on the veins.
- Prolonged standing or sitting, particularly with legs bent or crossed. When standing or sitting with legs bent or crossed, the veins have to work harder to pump the blood up to the heart.
How Are Varicose Veins Diagnosed?
Varicose veins are often diagnosed based simply on the appearance of the veins. For varicose veins in the legs, your doctor will examine your legs while you are standing or seated with your legs dangling. Your doctor may also ask you to describe pain or any other symptoms. Some diagnostic tests may be done to rule out other disorders or conditions.
Specialists Involved
The following specialists may be involved in your medical care if you have varicose veins:
- A vascular medicine specialist or vascular surgeon (blood vessel system specialist)
- A dermatologist (skin specialist)
Outlook
People with varicose veins often require only simple self-care measures, such as performing certain leg exercises, wearing compression stockings, and avoiding long periods of sitting or standing. For those who are concerned about the appearance of varicose veins, several cosmetic treatments are available. Although uncommon, in some cases, complications such as pain, skin ulcers, and blood clots can develop. A variety of medical and surgical procedures are used to treat varicose veins in these more complicated cases.