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Varicose veins are twisted, enlarged veins near the surface of the skin. They are most common in the legs and ankles. They usually aren't serious, but they can sometimes lead to other problems.
Varicose veins are caused by weakened valves and veins in your legs. Normally, one-way valves in your veins keep blood flowing from your legs up toward your heart. When these valves do not work as they should, blood collects in your legs, and pressure builds up. The veins become weak, large, and twisted.
Varicose veins often run in families. Aging also increases your risk.
Being overweight or pregnant or having a job where you must stand for long periods of time increases pressure on leg veins. This can lead to varicose veins.
Varicose veins look dark blue, swollen, and twisted under the skin. Some people do not have any symptoms. Mild symptoms may include:
More serious symptoms include:
Varicose veins are common and usually aren't a sign of a serious problem. But in some cases, varicose veins can be a sign of a blockage in the deeper veins called deep vein thrombosis. If you have this problem, you may need treatment for it.
Your doctor will look at your legs and feet. Varicose veins are easy to see, especially when you stand up. Your doctor will check your legs for tender areas, swelling, skin colour changes, sores, and other signs of skin breakdown.
You might need further tests if you plan to have treatment or if you have signs of a deep vein problem.
Home treatment may be all you need to ease your symptoms and keep the varicose veins from getting worse. You can:
If you need treatment or you are concerned about how the veins look, your options may include:
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Varicose veins are enlarged veins that usually occur just under the skin (superficial veins). Varicose veins are likely to be caused by one or more factors, including:
Varicose veins often run in families. You may be born with defective valves or weak walls in your veins, or you may develop them later in life.
Varicose veins are more common in women than in men. And varicose veins happen more often as people get older.
Varicose veins often develop during pregnancy. They might become less prominent after pregnancy and may disappear completely.
Less commonly, varicose veins may be a sign of a more serious problem that may sometimes need treatment. These serious problems can include:
You may not have symptoms with varicose veins. Most people identify varicose veins by the appearance of twisted, swollen, bluish veins just beneath the skin.
If you have symptoms of varicose veins, they tend to be mild and may include:
More severe symptoms or complications include:
Symptoms of varicose veins may become more severe a few days before and during a woman's menstrual period.
Most varicose veins aren't a serious medical problem, but they sometimes can lead to complications.
Complications can include:
Varicose veins most often are a result of problems in the superficial veins just under the skin. But they can happen along with problems or disease in the deep veins and perforating veins, which connect the deep and the superficial veins. Complications are much more common when varicose veins are caused by or linked with these deeper veins.
Factors that increase your risk of developing varicose veins include:
Call your doctor if you have varicose veins and:
Varicose veins are common and are generally not a serious health problem. With a doctor keeping an eye on the condition, most people can manage varicose veins with home treatment, such as exercising, wearing compression stockings, and elevating the legs.
Your family doctor or general practitioner can diagnose, treat, and monitor varicose veins and most of the complications they may cause.
Minimally invasive procedures or surgery may be done by:
The most important tools in diagnosing varicose veins are the physical examination and medical history. Varicose veins are typically diagnosed based on their appearance, and no other special tests are needed to confirm the diagnosis.
If a problem with the deep veins or complications are suspected based on your symptoms and examination, other tests may be done.
Duplex Doppler ultrasound is the most commonly used non-invasive test that can help your doctor study blood flow in your leg veins.
An ultrasound might be done if you are considering having a procedure to treat varicose veins.
The goals of varicose vein treatment are to reduce symptoms and prevent complications. For some, the goal may be improved appearance. Home treatment—such as exercising and wearing compression stockings—is typically the first approach.
If home treatment does not help, there are procedures or a surgery that can treat varicose veins. These include:
Treatment may be needed to remove the damaged veins, treat complications, or correct an underlying problem that is causing the varicose veins. The size of your varicose veins affects your treatment options. Generally, larger varicose veins are treated with ligation and stripping, laser treatment, or radiofrequency treatment. In some cases, a combination of treatments may work best. Smaller varicose veins and spider veins are usually treated with sclerotherapy or laser therapy on your skin.
Some people may want to improve how their legs look, even though their varicose veins are not causing other problems. In these cases, a procedure or surgery may be appropriate—as long as there are no other health problems that make these treatments risky.
If you are thinking about having a vein treatment, you may want to know which treatment is best for you. No single approach is best for treating all varicose veins. Talk to your doctor about your choices.
If you are considering a surgery or procedure, consider some questions about treatment. For example, you may want to ask how much the examination and treatment cost.
All treatment methods—including all types of surgery, sclerotherapy, laser, and radiofrequency ablation—can scar or discolour the skin.
Treatment can be more difficult for deep veins that are damaged or for perforating veins, which connect the deep and superficial veins. These veins may be treated with surgery, radiofrequency ablation, or sclerotherapy, or a combination of these treatments.
Varicose veins may be prevented to some extent by:
Home treatment is recommended for most people with varicose veins that aren't causing more serious problems. Home treatment can relieve symptoms, slow down the progress of varicose veins, and prevent complications such as sores or bleeding. For many people with varicose veins, home treatment is the only treatment they need.
These measures may help you avoid surgery or other medical treatment for your varicose veins. But you may still want surgery or a procedure if you are not satisfied with their appearance or your symptoms are not well controlled.
Home treatment includes the following:
Superficial varicose veins can sometimes cause minor problems like bruising or bleeding if you scratch or cut the skin over a larger vein. Small blood clots may occasionally form in the surface veins (superficial phlebitis). Most of these problems can be safely treated at home.
Signs of a small blood clot in a superficial varicose vein (superficial phlebitis) include tenderness and swelling over the vein. The vein may feel firm. If your doctor has told you how to care for superficial phlebitis, follow his or her instructions.
Medicines are not generally used to treat varicose veins.
Surgery for varicose veins includes tying off (ligation) and removing (stripping) larger veins. Surgery may be used to treat varicose veins if:
Less invasive procedures are another option to treat varicose veins. Less invasive procedures are more commonly done than surgery. These procedures can give good results with less risk than surgery. These procedures include laser treatment (including endovenous laser); phlebectomy, or stab avulsion; and radiofrequency treatment.
The size of your varicose veins affects your treatment options. Typically, larger varicose veins are treated with ligation and stripping, endovenous laser treatment, or radiofrequency treatment. For some people, a combination of treatments may work best. Smaller varicose veins and spider veins are usually treated with laser therapy on your skin or sclerotherapy.
Some people may want to have surgery to improve how their legs look, even though their varicose veins are not causing other problems. Surgery may be appropriate in some cases as long as you don't have other health problems that make the treatment risky.
Keep in mind that surgery for varicose veins done only for cosmetic reasons (that is, not medically necessary) is usually not covered by provincial health plans, but it may be partially covered by private insurance.
In some cases, a combination of surgery and sclerotherapy may be used to treat varicose veins. Sclerotherapy is a non-surgical procedure in which a chemical is injected into the vein, causing the vein to close off.
There are several non-surgical, minimally invasive vein treatments for treating varicose veins.
Sclerotherapy is a non-surgical procedure in which a chemical is injected into the vein, causing the vein to close off.
Some people may want to have vein treatment to improve how their legs look, even though their varicose veins are not causing other problems. Vein treatments may be appropriate in some cases as long as you don't have other health problems that make the treatment risky.
Keep in mind that vein treatments done only for cosmetic reasons are not likely to be covered by provincial health plans, but they may be partially covered by private insurance.
Complications of varicose veins may require further treatment, especially if you have developed severe varicose veins or chronic venous insufficiency.
Other Works ConsultedGloviczki P, et al. (2011). The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. Journal of Vascular Surgery, 53(16S): 2S–48S. DOI:10.1016/j.jvs.2011.01.079. Accessed December 29, 2014.Khilnani NM, et al. (2010). Multi-society consensus quality improvement guidelines for the treatment of lower extremity superficial venous insufficiency with endovenous thermal ablation from the Society of Interventional Radiology, Cardiovascular Interventional Radiological Society of Europe, American College of Phlebology, and Canadian Interventional Radiology Association. Journal of Vascular and Interventional Radiology, 21(1): 14–31.Kundu S, et al. (2010). Multi-disciplinary quality improvement guidelines for the treatment of lower extremity superficial venous insufficiency with ambulatory phlebectomy from the Society of Interventional Radiology, Cardiovascular Interventional Radiological Society of Europe, American College of Phlebology, and Canadian Interventional Radiology Association. Journal of Vascular and Interventional Radiology, 21(1): 1–13.Raju S, Neglen P (2009). Chronic venous insufficiency and varicose veins. New England Journal of Medicine, 360(22): 2319–2327.Tisi P (2011). Varicose veins, search date January 2010. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
Current as of: March 4, 2020
Author: Healthwise StaffMedical Review: E. Gregory Thompson MD - Internal MedicineAdam Husney MD - Family MedicineDavid A. Szalay MD - Vascular SurgeryMartin J. Gabica MD - Family Medicine
Current as of: March 4, 2020
Author: Healthwise Staff
Medical Review:E. Gregory Thompson MD - Internal Medicine & Adam Husney MD - Family Medicine & David A. Szalay MD - Vascular Surgery & Martin J. Gabica MD - Family Medicine
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