Varicose Veins

In most cases, varicose veins are simply an eyesore, a collection of bloated vessels protruding from the surrounding skin. Furthermore, most varicose veins are painless. Nevertheless, they can cause substantial discomfort, pain, and skin problems. In fact, varicose veins may be a sign of underlying vein disease.

Signs and Symptoms of Varicose Veins

If the abnormal blood vessels do cause symptoms, the varicose vein sufferer may experience:

  • Heaviness in the affected leg(s)
  • Itchiness on and near the varicose vein
  • Pain
    o   At the site of the affected vein
    o   Felt throughout the affected limb
    o   Pain may be worse at night or after prolonged sitting/standing
  • Skin breakdown
    o   Skin discoloration
    o   Bleeding varicose veins
    o   Skin inflammation
    o   Skin ulceration (depressed sore in the skin)
Great Saphenous Vein Anatomy

GREAT SAPHENOUS VEIN ANATOMY

Small Saphenous Vein Anatomy

SMALL SAPHENOUS VEIN ANATOMY

Perforator Vein Anatomy with labeled veins

PERFORATOR VEIN ANATOMY

What Veins Can Become Varicose Veins?

Strictly speaking, any vein can become varicose. Fortunately, most varicose veins are limited to the leg veins. The legs have two types of veins-deep veins and superficial veins. Deep veins run deep within the legs, while superficial veins run close to the surface of the skin. Varicose veins usually develop in the superficial veins of the leg. More specifically, most varicose veins develop in the great saphenous vein or one of its branches. The great saphenous vein is the main superficial vein in the leg.

How Healthy Veins Work

Unlike arteries, veins do not have a way to generate blood pressure. Veins are wrapped in very little muscle and don’t have a pulse. Even when they are healthy, veins tend to be floppy. For veins to do their job of bringing the blood back to the heart, they rely on muscles of the legs to contract and squeeze the blood through the veins. Consequently, every time you walk and stretch or otherwise move your legs, the muscles squeeze the veins and push blood through them.

Varicose Vein Anatomy: Difference between normal and varicose veins

As a result of venous insufficiency, an otherwise healthy vein turns into a varicose vein.

A healthy vein contains small pieces of tissue called valves scattered along their length. Ideally, when the muscles of the legs squeeze blood within the leg veins, the blood can only move in one direction because the valves prevent the backflow of blood. If the valves stop working, the vein can become varicose.

What Causes Varicose Veins?

Varicose veins develop because of excess strain on your veins, which is why they are so common in the legs. The pressure increases in your legs when you’re standing, walking or running. Compared with the veins in your neck or chest, they undergo a lot more strain. In time, all of that use and pressure has an impact on the many valves that help keep your veins functional.

An untreated, varicose vein, will eventually create branch varicose veins or tributaries, commonly seen at the surface of the skin.

Vein valves may become overworked and diseased. The valves, in essence, become non-functional. The medical term for this is “incompetent.” Incompetent valves in the veins do not help propel blood back toward the heart. Instead, blood can pool in the veins, a condition called venous insufficiency. When blood has pooled for too long, the walls of the vein dilate. The result is a vein that appears bulging and twisted.

Who Gets Varicose Veins?

In short, many people get varicose veins. In the United States, one in four adults has varicose veins.1 As many as 11 million men and 22 million women have varicose veins in the US. They are increasingly prevalent as we age. The first signs usually appear when a person reaches their 40’s (though they can also develop in younger people). Without varicose vein treatment, the condition tends to progress with age. Each lesion will manage to get bigger and increase in number. Likewise, additional varicose vein symptoms can emerge with age in the absence of definitive varicose vein treatment.

Women develop varicose veins more often than men, partially because pregnancy puts increased strain on the blood flow back up the leg.  More specifically, multiple pregnancies can increase your risk for varicose veins. Hormonal changes in a woman’s life also play a role.

Other common risk factors for varicose veins include standing for long periods of time, a sedentary lifestyle and obesity. The risk increases as you age. Trauma to your legs can also be a risk factor.

When to Seek Treatment from a Vein Specialist

There are three main groups of people who seek treatment from a vein specialist for varicose veins:

  • People who find their varicose veins cosmetically unappealing (unsightly, embarrassing, ugly)
  • People who are experiencing symptoms from their varicose veins
  • People who want to avoid further varicose vein symptoms

In essence, anyone who is unhappy with their legs for any reason—be it cosmetic or medical—should strongly consider speaking with a vein specialist to discuss varicose vein treatment.

  1. Piazza G. Varicose Veins. Circulation. 2014;130(7):582-587. doi:10.1161/circulationaha.113.008331