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Varicose veins are enlarged, swollen, and twisted superficial veins that typically appear blue or purple. They commonly develop on the legs, ankles, and feet and may cause pain, itching, or discomfort. Spider veins—thin red or purple lines near the skin surface—often accompany varicose veins.
Although they may be cosmetically concerning or uncomfortable, varicose veins are generally not dangerous. However, in more severe cases, they may lead to complications such as blood clots or skin ulcers. Many symptoms can be managed at home, while more advanced cases may require injections, laser therapy, or surgical intervention.
Common symptoms of varicose veins include:
Bulging veins: Enlarged, twisted, rope-like blue or purple veins just beneath the skin. Spider veins may appear around them.
Heavy legs: A feeling of heaviness, tiredness, or sluggishness, especially after standing or physical activity.
Itching: Localized itching around the affected vein.
Pain: Aching, soreness, or cramping in the legs—often behind the knees.
Swelling: Edema in the legs, ankles, and feet.
Skin changes and ulcers: Discoloration may occur; untreated varicose veins can lead to venous ulcers.
Most common locations:
The lower extremities—calves, ankles, and feet—are most frequently affected. Varicose veins may also occur in the pelvic region (pelvic congestion syndrome). Hemorrhoids are another form of varicosity occurring in the rectal veins.
Varicose veins develop when the vein walls weaken and the valves fail to keep blood flowing upward. As blood pressure increases inside the vein, blood begins to pool, causing the vein to enlarge, bulge, and twist.
Primary reasons the vein walls or valves weaken include:
While complications are uncommon, the following may occur in advanced cases of varicose veins:
Ulcers: Painful skin sores, often near the ankles.
Blood clots: Deep vein enlargement may cause pain or swelling; may indicate thrombosis.
Bleeding: Rarely, superficial veins may rupture.
Chronic swelling: Long-standing varicosities may cause persistent edema.
Lifestyle-related risk modifiers include:
Prolonged standing or sitting
Obesity
Pregnancy
Aging
Family history
Hormonal factors
Diagnosis is made through a physical examination—typically while the patient is standing—to assess swelling, visible enlarged veins, and symptom patterns.
Tests
A venous Doppler ultrasound is commonly used to evaluate blood flow, assess valve function, and detect possible blood clots. The test is noninvasive and painless.
The current standard procedure involves:
Vein stripping of leaky superficial axial veins
Ligation of incompetent perforator veins (connections between deep and superficial systems)
Removal of varicose branches through 1–2 mm stab incisions using a surgical hook
These tiny incisions typically heal well with minimal to no scarring.