Varicose Veins

What Are Varicose Veins?

Varicose veins are tortuous, enlarged veins.  Any vein may become varicose, but the veins most commonly affected are those in your legs and feet.  This is because standing and walking upright increase the pressure within your leg veins.  The picture above right shows a good example of a varicose vein in the right leg, before and after EndoVenous Laser Therapy, or EVLT.


For many people, varicose veins and spider veins are simply a cosmetic concern.  For other people, varicose veins can cause aching pain, itchiness, heaviness, numbness and discomfort in the legs.  Sometimes the condition leads to more serious problems such as “browning” or discoloration of the skin, leg swelling, skin ulcers, and even bleeding.


Varicose veins are a common condition in the United States, affecting up to 25 percent of men and up to 45 percent of women.  Treatment may involve self-help measures, such as wearing compression stockings, or procedures by your doctor to close or remove the veins.

What Causes Varicose Veins?

Your veins carry blood from your capillaries back to the heart.  In your legs, this means that the blood must flow upward, against gravity.  Consequently, all of your leg veins contain one-way valves which prevent the blood from back-flowing.  Over time, these valves can fail to close tightly, allowing blood to pool in your lower legs and feet, and causing the characteristic bulging and twisting of varicose veins.  Once these valves are damaged, they cannot be repaired.  Nobody really knows why these valves are damaged in the first place, but many doctors believe there are certain risk factors which increase your likelihood of developing varicose veins.  Risk factors include:  family history of varicose veins, multiple pregnancies for a woman, and prior trauma to the affected leg.  Contrary to popular belief, jobs which require standing for long periods of time do not seem to “cause” varicose veins, although it may make the symptoms worse if you already have vein problems.


The damaged vein and valves will slowly worsen with time.The diagrams below illustrate the pathology associated with these damaged valves and how they relate to poor blood flow and the formation of varicose veins.


In this diagram, the red arrows indicate normal blood flow.  The one-way valves inside the vein only allow the blood to flow upward, back to the heart. These normal valves will close when standing or when there is increased pressure, thus preventing the back-flow of blood downward toward the feet.  This is a normal diagram of venous blood flow in the leg.


In this diagram, the red arrows indicate abnormal blood flow.  The valves in the superficial vein are broken and no longer function properly. This allows blood to flow in the wrong direction, downward toward the feet, when standing or with increased pressure.  Notice also that the vein containing the broken valves has now increased in size and become “varicose” due to the increased pressure.
Varicose Vein

What Are The Symptoms?

 Some people with varicose veins do not experience any symptoms at all.  When painful signs and symptoms do occur, they may include some of the following:


    *    Aching, cramping, or throbbing
    *    Heaviness in the affected leg
    *    Burning, numbness, or tingling
    *    Itching
    *    Night cramps and soreness after laying down for bed
    *     Skin ulcers around your ankles
    *    Worsening symptoms with prolonged standing or sitting
    *    Improved symptoms with walking


Varicose veins vary in color and may appear skin color, dark purple, or blue.  They commonly appear on the lower legs and thigh, but can form anywhere from your groin to your ankle.


Spider veins are similar to varicose veins, but they are smaller and appear like spider webs.  Spider veins are found closer to the skin’s surface and are often red or blue.  They occur on the legs, but can also be found on the face.

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