August 10, 2012
Dear Mayo Clinic:
I have varicose veins in my legs, and they really bother me. What causes them? Is there any reliable way to get rid of varicose veins?
Varicose veins are enlarged, bulging veins, usually blue or purple, that commonly appear in the legs. They develop when blood pools in veins, causing them to stretch. Effective treatments are available. But finding the right treatment for your situation depends in large part on where the problem is occurring.
Veins bring blood to the heart from the rest of the body. To do this, the veins in the legs must work against gravity. Contraction of lower limb muscles helps to pump blood back to your heart. Valves in the veins open as blood flows toward the heart, then close to stop blood from flowing backward.
Varicose veins frequently develop when large veins deep in the legs lose their ability to efficiently return blood to the heart. That causes the blood to back up into other veins closer to the surface and bulge outward.
A number of factors can raise a person's risk for varicose veins. As people age, varicose veins become more common because, over time, wear and tear can affect the valves within veins and make them prone to leak. Smoking and obesity are significant risk factors for varicose veins, as is having a job that requires long periods of standing or sitting. Family history seems to play a role. And women are more likely than men to get varicose veins.
Varicose veins are usually not dangerous, but many people don't like the way they look. They can also cause symptoms, such as swelling, a feeling of throbbing or heaviness in the leg, and pain after standing. In some cases, skin damage can result from varicose veins. Rarely, a blood clot may form if a large amount of blood pools within a varicose vein. That situation can potentially be serious because a clot that breaks free and travels to the heart or lungs (pulmonary embolism) can be fatal.
When considering the best treatment for varicose veins, an important factor is to determine the source of the problem. Using ultrasound to examine veins deep in the leg is often the first step. If those veins are not pumping effectively, treatment needs to be targeted there in order to reduce pressure in the other veins.
If a vein near the surface of the skin (superficial vein) requires treatment, a common approach is radiofrequency ablation. During this procedure, a thin probe is inserted into the vein and the tip of the probe is heated. The heat causes the vein to collapse and seal shut. This does not cause circulation problems because other veins in the leg can take on larger volumes of blood. In addition to radiofrequency ablation, a procedure called ambulatory phlebectomy may be used to remove varicose veins closer to the skin surface through a series of tiny skin punctures.
If the varicose veins are not severe, less-invasive treatment options are usually recommended. Wearing compression stockings may help veins and leg muscles move blood more efficiently. Quitting smoking, exercising, losing weight, avoiding long stretches of standing or sitting, elevating the leg, and wearing loose-fitting clothing can help ease symptoms of varicose veins and may prevent them from getting worse.
Before you decide on a treatment for varicose veins, talk to your doctor about your situation, as well as any health risks or possible side effects of procedures you may be considering. Keep in mind that successful treatment of varicose veins can take some time. Multiple treatments may be necessary to effectively eliminate all varicose veins. Be aware, too, that even after treatment, varicose veins may redevelop.
— Jerry Brewer, M.D., Dermatology, Mayo Clinic, Rochester, Minn.