Your body has two types of blood vessels:arteries carry oxygen- and nutrient-rich red blood from your heart to your muscles and organs, while veins return the “used” bluish blood back to your heart. The deep veins located beneath the muscles carry about 90 percent of the blood traveling from your legs back to your chest. The other 10 percent flows through veins located closer to the surface, often visible, and less well supported.

1. Overview
Your bodyhas twotypesof bloodvessels:arteriescarryoxygen- andnutrient-richredbloodfrom
your heartto yourmusclesandorgans,while veinsreturnthe “used”bluishbloodbacktoyour
heart.The deepveinslocatedbeneaththe muscles carryabout90 percentof the bloodtraveling
fromyour legsbackto your chest.The other10 percentflowsthroughveinslocatedclosertothe
surface,oftenvisible,andlesswell supported.
While yourlegmuscleshelpyourveinspumpthe bloodupward, the real workhorse isanintricate
systemof one-wayvalvesthatpreventthe bloodfromdrainingbackdownthe legunderthe force of
gravity.Inmany people,womeninparticular,thesevalvesstopworkingaswell astheyshould,
puttingadditional pressure onthe wall of the vein.
Varicose veinsresultsfromachronicdilatationof the veins,aconditioncalled“varicosity.”Whenthe
veinwallsare pushedapart,the valvesnolongerseal properly,makingitdifficultforthe musclesto
pushthe bloodupward.Insteadof flowingfromone valve tothe next,the bloodbeginstopool in
the vein,increasingvenouspressure andcausingthe veintobulge andtwist.The resultisvaricose
veins.
In some people,varicose veinsare simplyacosmeticconcern.Inothers,the conditionleadstopain
and more seriousproblems.Andinsome cases,varicose veinscansignal ahigherriskfor other
conditionsinvolvingthe circulatorysystem.Wheninflamedorclotted,theybecome hardandtender
to the touch. Increasingpressure maycause itchyskinandachinginthe affectedlimb.
If you sufferfromvaricose veins,youare notalone.Accordingtothe AmericanCollege of
Phlebology,upto50 percentof Americanwomenhave varicose veinsora relatedvenousdisorder.
Spiderveins,alsoreferredtoastelangiectasiaorbrokencapillaries,are formedbythe dilationof a
small groupof bloodvesselslocatedclose tothe surface of the skinandare mostcommonlyfound
on the legsandface.They looklike redorpurple sunbursts orbranchedor webpatternsandonly
rarelycause pain.Varicose veinsdifferfromspiderveinsinthattheyare:
larger—usuallymore thanaquarterinch indiameter—andoftendistended
darkerpurple or blue
locateddeeperthanspiderveins
tendto bulge ortwist

2. may be painful
can be relatedtomore seriousveindisorders
Varicose veinsaren’tjustacosmeticconcern.Theycan pose a healthrisk.Sometimestheyare
associatedwith:
spontaneousbleeding,whichoccursas the skinoverthe varicose veinsbecomesthin.The veinmay
be easilyinjured,evenbybedding,clothingora slightbump,andbloodlosscanbe significant,
withoutanynoticeable pain.
superficial phlebitis(ST),alsocalledsuperficial phlebitis,whichisaninflammationofaveinjust
belowthe surface of the skin.The inflammationmaybe causedbydecreasedbloodflow throughthe
vein,damage tothe veinor bloodclotting(knownasthromboses).Symptomsinclude rednessanda
firm,tender,warmvein.Localizedpainandswellingalsomayoccur.ST alsoincreasesapatient’srisk
fordeepveinthrombosis(DVT),apotentiallyseriousconditionthatinvolvesabloodclotina deep
vein.
venouslegulcers,whichcanresultwhenthe enlargedveindoesnotprovideadequatedrainage of
fluidfromthe skin;the swollenskinreceivesinsufficientoxygenandanulcerforms
Certainpeople seemtobe more predisposedtovaricose veinsthanothers,including:
Women.Theyare four timesmore likelythanmentodevelopvaricose veins.Upto 50 percentof
Americanwomenmaybe affectedatsome pointintheirlives,accordingtothe AmericanCollege of
Phlebology.
People whose familymembershave varicose veins.Heredityplaysamajorrole.
Olderpeople.Varicose veinsaffectone outof twopeople overage 50, and theyare more common
inwomenthanin men.Alsoaswomenage,varicose veinsbecome more visiblypronounced.
In addition,several factorscanleadto varicose veinsinpeople whoare predisposedtothem,
including:
changesina woman’shormonal levels,whichcanbe broughtonby pregnancy
menopause
use of birthcontrol pills,estrogen,andprogesterone
obesity
leginjury
inactivity

3. strainin the abdominal region,fromrepeatedheavylifting,pregnancyorconstipation(ahemorrhoid
isactuallya varicose vein)
In additiontohormonal changes,pregnancycausesbothanincreasedvolumeof bloodand
increasedpressure fromthe abdomen,whichinturncausesveinstoenlarge.The goodnewsis
varicose veinsdue topregnancyoftenimprove withinthree monthsafterdelivery.However,with
successive pregnancies,these abnormalveinsare more likelytoenlarge further.
Diagnosis
Many cases of varicose veinsare clearlyvisible,withthe knotted,twistedorbulgingdarkenedveins
showingbeneaththe skinof the thighandlowerlegs.And,yourlegsmaybe swollen.If youhave
varicose veins,youmayalsoexperiencepaininthe legs,especiallyafterstandingorsittingstill fora
longtime.Some womendescribethe painasfeelingsof fatigue,heaviness,aching,burning,
throbbing,crampingorrestlessness.
Severe varicose veinscanmake yourskinitchyor leadto a skinconditionsimilartoeczemaor even
ulcerson yourlowerlegs.Keepinmindthatnotall legdiscomfortiscausedbyvaricose veins.Any
persistentorsevere symptomswarrantavisitto yourhealthcare professional.
Veindisordersare notalwaysvisible.If youcan’tsee any symptoms,or,tohelpdeterminethe cause
and severityof the problem, yourhealthcare professional mayconductanoninvasive ultrasoundor
othervasculartest.
Be sure to call your healthcare professionalif swellingbecomesincapacitatingorif the skinover
your varicose veinsbecomesflaky,ulcerated,discoloredorprone tobleeding.Inaddition,if you
have redness,warmthandburningpaininthe area of a vein,call yourhealthcare professional,
because thiscan be a signof phlebitisora bloodclot.
Treatment
Because varicose andspiderveinsare congestedwithblood,theyreallyaren’tdoingtheirjob
anymore.Fortunately,there are usuallyplentyof other,healthyveinstotake over.Somostof these
unwantedveinssimplyaren’tnecessaryandcanbe removed.Butwhile invasivetreatmentisan
option,don’trushto the operatingroom.There are simplerthings youcantry first,including:

4. Walkregularly,whichhelpsimprove muscletone andcirculation.
Reduce yourbodyweight.
Findseveral timesduringthe daywhenyoucanelevate yourlegsfor10 to 15 minutes.
Wear compressionhose orstockings,whichcanbe purchasedatmost pharmacies.Theyhelpyour
legmusclespushbloodupwardbyconcentratingpressure nearthe ankles.Speciallymanufactured
gradient-compressionsupportstockingsare the mosteffective forcontrollingsymptoms.Theymay
alsopreventworseningof the conditionandavoidthe needforfuture treatment.
Take an over-the-counteranti-inflammatorydrugsuchasaspirinor ibuprofentoalleviate occasional
swellingandpain.
If these conservative methodsdon’tworktoyoursatisfaction,you shoulddiscusswithyourhealth
care professionalthe possibilityof tryingone ormore corrective measures,suchas:
Sclerotherapycanbe usedto treatboth varicose andspiderveins,butitisusuallyreservedfor
people whose varicoseveinsare small (lessthansix millimeters).The procedureisperformedina
healthcare professional’soffice andcausesonlyminimal discomfort.A tinyneedle isusedtoinject
the veinswithsclerosing(hardening)solution,whichirritatesthe liningof the vein.Inresponse,the
veincollapsesandisreabsorbed.Multiple branchveinscanbe treatedatthe same sclerotherapy
session,andthe procedure canalsobe repeatedif varicose veinsreappear.Complicationsmay
include:
developmentof groupsof fine,redbloodvesselsnearthe injectionsitesof largervesselsonthe
thighs,some of whichdisappearontheirownandothersrequire treatment
muscle cramps,whichgo awayin 10 to 15 minutes
temporaryswellingof yourfeetorankles
redbumpsat the sitesof the injections,whichfade withinafew days.
bruising,whichusuallyfadesafteraweekortwo
pigmentation(brownlinesorspots) aroundthe treatedvein,whichusuallydisappear
superficial thrombophlebitis
In addition,if youdevelopsmallpainful ulcersatthe injectionsite,informyourhealthcare
professionalimmediately.
Althoughsclerotherapyworkswell forspiderveins,studiesshow thatitisnot as effectiveassurgery
for treatingvaricose veinsandthatrecurrence ratesare high.

5. Endovenouschemical ablation,alsoknownasultrasound-guidedsclerotherapy,involvesthe
injectionof achemical irritant—calledasclerosant—intoaveinwhilethe doctorwatchesthe
processon an ultrasoundscreen.Thisprocessenablestreatmentof veinsthatcan’tbe seenbecause
theyare furtherbeneaththe skin.
External laser/lightsource treatmentsare generallyusedonlytotreatspiderveinsorverysmall
varicose veinsandmaybe combinedwithsclerotherapy.A laserorlightbeamispulsedontothe
veinstoseal them and cause themto dissolve.Multiple treatmentsare usuallyrequired.
Endovenousradiofrequencyablationinvolvesusingradiofrequencytoshrinkandseal the deeper
varicose veinsof the legs.Thismethodhasreplacedsurgeryforamajorityof patients.Usuallydone
ina healthcare professional’soffice underlocal anesthesia,asmall catheterisinsertedintothe
damagedveinanddeliversradiofrequencyenergytothe veinwall,causingittoheat.Asit warms,it
collapsesandseals.
Surgery
Surgeryisgenerallyusedtotreatlarge varicose veinsandhasbeenshowntobe effective,withmost
patientsreportingsatisfactionwiththeirprocedure.Surgeryforvaricose veinscanbe performed
usinglocal,spinal orgeneral anesthesia.Mostpatientsreturnhome the same dayasthe procedure.
Surgical optionsinclude:
ligation,ortyingoff of a vein
stripping,orremoval of a longsegmentof veinbypullingitoutwitha special instrument
PIN stripping,anupdatedversionof veinstrippingthatusesa “perforate invaginate(PIN) stripper.”
The tip of the PIN stripperissewntothe endof the vein,andas the PIN stripperisremoved,the vein
isstrippedout
ambulatoryphlebectomy,orremoval of veinsthroughaseriesof tinyincisions;oftendone inan
office underlocal anesthesia
endoscopicveinsurgery,whichisusuallyreservedforadvancedcasesinvolvinglegulcers.The
surgeoninsertsathinvideocameraintothe patient’slegtovisualizeandclose varicose veinsand
thenremovesthe veinsthroughsmall incisions.
Unfortunately,notreatmentcanpreventveinsfrombecomingvaricose.Varicose veinssometimes
recur afterany formof treatment,butit’snotthe same veincomingback;it’sa differentvein
becomingaffected.

6. Before undergoinganyprocedure forvaricose orspiderveins,be sure totell yourhealthcare
professionalif you’ve everhadbloodclotsinyourlungsor legs.
Healthcare professionalswhospecialize inthe treatmentof varicose veinsinclude:
general surgeons,physicianswitha specialtyinperformingsurgery
vascularsurgeons,physicianswithaspecialtyintreatingbloodvessels
dermatologists,whospecialize inthe diseasesof the skin
phlebologists,whospecialize inthe fieldof medicine thatdealswithveindiseases.In2005, the
AmericanMedical Associationofficiallyrecognizedphlebologyasaself-designatedspecialtyfor
physicians.
Unfortunately,some treatmentcentersspecializinginvaricose veinshave beencaughtbythe
Federal Trade Commissionmakingunfairpromises topatients.Keepinmindthatnotreatmentfor
varicose veinsisever100 percenteffective,andthere isnevera100 percentguarantee thatother
veinsinyourlegswon’tbecome varicose.
Some companiesdistribute herbsorover-the-counterdietsupplementswithclaimstheypreventor
cure varicose veins.While some of these supplementsclaimtohave beenshownintestingto
improve circulationorimpactveinsinotherways,keepinmindthatherbsandsupplementsare not
regulated,andthere isnoguarantee of quality,safetyorefficacy.Alsorememberthatthere isno
100 percentcure for or preventionof varicose veins.Andkeepinmindthatit’simportanttodiscuss
cost of treatmentsandout-of-pocketexpensesbecauseyourhealthinsurancemaynotcoverthe
cost of the procedure.
Prevention
You can’t helpbeingawoman,havingbeenbornintoafamilythatsuffersfromvaricose veinsor
evengettingolder.Butthere are a fewthingsyoucando to headoff varicose veinsorkeepthem
frombecomingmore prominent,swollenanddistorted,suchas:
Avoidstandingorsittingforlongperiodsinthe same position.Take breaksfromanoffice jobtoget
up and move around,orwhenyou’re drivingforlongperiods,getoutandstretchyourlegs.If you
workin a “standing”professionlike teachingorretail sales,stretchandexercise yourlegsasoftenas
possible toincrease circulationandreduce pressure buildup.Whenpossible,wearsupportstockings
as notedbelow.

7. Try to elevate yourlegswhenresting.
Walkfor exercise,anddoitregularly.Stayingfitkeepsyourlegmusclestoned,yourbloodflowing
and yourweightundercontrol.
Include high-fiberfoodsinyourdietsince constipationcancontribute tovaricose veins.High-fiber
foodsinclude freshfruits,vegetablesandwhole grains.
Wear graduatedcompressionsupporthose.
Use regularsunprotection(some unwantedspiderveinsonthe face maybe relatedtosun
exposure).
Facts to Know
About90 percentof the “used”bloodtravelingfromyourlegsbackto your chestiscarriedby the
deepveinslocatedwithinthe muscles.Veinabnormalitieshere aren’tvisible butcanbe painful or
evenresultindangerousbloodclots.
The other 10 percentof the bloodreturningtoyourheart travelsthroughveinsclosertothe surface;
varicose veinshere canbe visiblyswollen,knotted,twistedorbulging.
Accordingto the AmericanCollegeof Phlebology,upto50 percentof Americanwomenhave
varicose veinsora relatedvenousdisorder.
Varicose veinsare more likelyto occurin olderwomen.Alsoaswomenage,varicose veinsbecome
more visiblypronounced.
Spiderveins,alsoreferredtoastelangiectasiaorbrokencapillaries,are formedbythe dilationof a
small groupof bloodvesselslocatedclose tothe surface of the skinandare mostcommonlyfound
on the legsandface.They looklike redorpurple sunburstsorbranchedor webpatterns.
Pregnantwomenoftendevelopvaricose veinsforanumberof reasons:Inadditiontohormonal
changes,pregnancycausesbothan increasedvolumeof bloodandincreasedpressure fromthe
abdomen,whichinturncause veinstoenlarge.The goodnewsisvaricose veinsdue topregnancy
oftenimprove withinthree monthsafterdelivery.However,withsuccessive pregnancies,these
abnormal veinsare more likelytoremain.
Varicose veinsaren’tjustacosmeticconcern.Theycan pose a healthriskandare associatedwith
the developmentof skinulcers;phlebitis,whichisaninflammationof the vein;orbloodclots.
Thoughit may require several sessionsandthe veinsmayfade onlygradually,sclerotherapy,a
procedure performedinahealthcare professional’soffice,canresultinsignificantimprovementin
the appearance of spiderveins.Studiesshow thatitisnot as effective assurgeryfortreating
varicose veins,however,andthatrecurrence ratesare high.
While there are several treatmentoptionsforsmall varicoseveinsandspiderveins,large varicose
veinsmayrequire radiofrequencyclosure and/orsurgery.

8. No treatmentforvaricose veins isever100 percenteffective,andthere isnevera100 percent
guarantee thatotherveinsinyourlegswon’tbecome varicose.
KeyQ&A
What causesvaricose veins?Bothyourlegmusclesandvalveswithinyourveinsworktogetthe used
bloodfromyourlegs back up to yourheart.Whenthe valvesstopworkingaswell astheyshould-
whichcan be causedby heredity,abdominal pressure,increasedpressurefromprolongedstanding,
obesity,hormonal changes,aginganda numberof otherfactors-the bloodpoolsinthe vein,
stagnatingthere andcausingthe veintobulge or twist.
Are varicose veinsdangerous,orjustmore of a cosmeticissue?Althoughtheycanbe painful and
unsightly,inmostcases,superficial orvisible varicose veinsdon’tleadtofurthercomplications.If
youare concerned,yourhealthcare professionalcanconductsome painlessteststodetermine the
severityof the problemandascertainif anyof the deeperveinsare affected.
My varicose veinsare visible,butnotverybothersome.DoIneedto have themremoved?Probably
not.If onlysurface veinsare affected,the conditionisusuallyharmless.Youwouldprobablybe
feelingmore painorothersymptomsif deeperveinswere abnormal,whichcanleadtomore serious
problems.However,youmaywantto talkto yourhealthcare professional aboutthese concerns.
My legsalwaysseemtobe tiredandachy. Do I have varicose veins?Legpaincanbe causedby a
numberof factors or conditions.If the painseemstobe broughtonby standingorsittingfor
prolongedperiods,youcouldhave varicose veins.Butif youhave novisible symptoms,the onlyway
to determine the cause of yourpainisto have some testsdone byyour healthcare professional.
I’mpregnantand have developedvaricoseveins.Will theygoaway?Varicose veinsdue topregnancy
oftenimprove withinthree monthsafterdelivery.However,withsuccessive pregnancies,these
abnormal veinsare more likelytoremain.
My general practitionerdoesn’tthinkmysuperficial varicose veinsare problematic, butI’dlike to
have themremovedforcosmeticreasons.WhoshouldIsee?The bestideaisprobablytogeta
referral fromyourhealthcare professional orfroma friendorfamilymemberwhohasbeen
successfullytreated.The typesof healthcare professionalsbestsuitedtotreatingvaricose veinsare
mostlikelyvascularorgeneral surgeons,dermatologistsandphlebologists.
Will myvaricose veinscome backif I have themremoved?Once the veinisremoved,it’sgone
forever.However,youverywell coulddevelopvaricosityinotherveins.
I saw an advertisementfora “veinclinic”thatmade all sortsof promisesaboutpermanentlymaking
my varicose veinsdisappearwithnoriskorpain.What’sthat all about?Keepinmindthatnomedical
treatmentisever100 percentrisk-freeandcannotbe 100 percentguaranteed.Whileit’strue that
once a varicose veinisremovedsurgically,itwill notreappear,thatdoesn’tmeanyouwill foreverbe
free of varicose veins.Otherveinscandevelopproblems.Rememberthatsurgeryisa rather drastic
measure. The lessdrasticcorrective measuressuchassclerotherapyorlasertreatmentsare byno

9. means100 percenteffective100 percentof the time.Andnone of the corrective measurescanbe
guaranteedtobe totallypain-free.