Varicose veins

Varicose veins, also known as spider veins or varicosities, are blood vessels, usually in your legs, that become noticeably enlarged and twisted. They look blue or red, and they often are itchy or painful. Varicose veins are also called a varicosity.

It’s important to monitor varicose veins because they tend to worsen over time. You can take steps at home to relieve pain and achiness and prevent more serious problems. If self-care doesn’t relieve varicose veins, a vascular surgeon, vascular medicine specialist or interventional radiologist can tell you about options that will help.

The first sign of varicose veins may be visible. You might notice that veins in your legs are enlarged, swollen or twisted. They may appear red or blue.

Symptoms of varicose veins include:

• Aching, heaviness, itching or pain in your legs
• Cramps in your calf or thigh, often at night or when you suddenly stand
• Restless legs syndrome
• Swollen ankles or feet
• Visible, swollen veins

Untreated, some varicose veins cause more severe symptoms, such as:

• Leg swelling
• Pain in your leg or calf (claudication) after sitting or standing for long periods
• Scaly, irritated skin that may crack easily
• Skin that changes color, hardens or thickens on your ankles or legs
• Sores (ulcers) on your skin that do not heal easily

Some people who have varicose veins may develop deep vein thrombosis (DVT). DVT occurs when blood clots form in the blood vessels in your legs. The clots can break loose and move to your lungs, causing a pulmonary embolism. If you have varicose veins and notice a hot, sore area in your leg, seek immediate medical care.

Varicose veins develop when tiny valves in your blood vessels don’t work the way they should. Your veins carry blood from your feet and legs back to your heart. When these veins are healthy, one-way valves inside the leg veins move the blood up toward the heart. But when these leg veins don’t close tightly, blood flow becomes sluggish. Blood collects in the vein, causing a varicosity or swollen vein.

Varicose veins are a common problem that affects many people, especially women, as they age. For most people, varicose veins aren’t severe. But if they worsen, they can cause pain, swelling, skin problems and blood clots.

Risk factors for varicose veins include:

• Standing or sitting for long periods
• Being pregnant, overweight or female
• History of blood clots in your legs
• Family history of varicose veins
• Being born with valves that don’t work properly

Usually, we diagnose varicose veins with a physical exam. We examine your legs and note any swelling, visible veins, skin color changes or sores. We ask about your lifestyle, including if your work or other activities require you to stand for long periods.

If you have severe symptoms, or if you’re considering surgery, we may perform venous duplex ultrasound. This test enables your doctor to check the blood flow in your veins and look for any blood clots in your leg. A duplex ultrasound test uses sound waves to provide images of how blood flows through your veins. Your doctor can usually perform this noninvasive test in the office.

In many cases, home treatment is enough to reduce discomfort from varicose veins and keep them from worsening. Your provider may recommend:

• Avoid standing or sitting for long periods: try to move around throughout the day. Even small movements can help.
• Don’t cross your legs: crossing your legs can close off veins and damage the valves. Instead, try to sit with feet flat on the floor.
• Elevate your feet: prop your legs up at a level higher than your heart. Do this for 15 minutes at a time, several times a day.
• Increase your activity: getting more exercise can improve your circulation and help you avoid weight gain. You might try walking, swimming or cycling.
• Maintain a healthy weight: try a doctor-supervised weight loss plan if you are overweight. If you are at a healthy weight, try to avoid putting on additional weight.
• Treat leg wounds: take care of any open sores on your legs or feet. Talk to your doctor about the proper care, including appropriate lotions or creams for cracks or dry skin. Find out if you are a candidate for treatment at the Penn Center for Wound Healing and Reconstruction.
• Wear compression stockings: these tight-fitting stockings gently squeeze your legs. They reduce swelling by helping blood move up toward your heart.

Procedures and surgeries

In some cases, your doctor may recommend a procedure to treat varicose veins. Penn provides a wide range of treatments for varicose veins.

We offer:

• Endovenous radiofrequency ablation (RFA): we insert a fine tube (sheath) into the vein. Then we thread the RFA device into the sheath. The device heats the vein to seal it shut.
• Phlebectomy: phlebectomy is a minimally invasive vascular procedure. Your doctor makes small incisions in your leg near the damaged vein. Then the doctor removes the vein. You can go back to your usual activities, wearing compression stockings for a few weeks.
• Sclerotherapy: your doctor injects a chemical solution or salt water into the vein. The vein hardens and disappears. Your body redirects blood flow to other veins. You may have several treatments to resolve the varicose veins.
• Nonthermal ablation: we may close the veins using a glue-like product, which avoids potential heat damage to surrounding structures.
• Vein stripping: vein stripping removes the saphenous vein, a large vein in your leg. Your doctor may recommend this technique if other treatments don’t work. We use small incisions to tie off the vein and remove it. Your body uses other blood vessels to reroute blood flow.