Leg Varicose Veins | Venous Disease

Leg varicose veins are a venous disease that can range from mild fatigue and swelling to prominent, rope-like veins. This article examines their causes, symptoms, types and treatments.

Most of us, when we hear the word varicose veins (Varicose veins in English), picture prominent, swollen veins. Varicose veins refer to a group of enlarged, prominent veins. Although varicose veins can affect almost any part of the body, including the head, neck, arms and torso, leg varicose veins are more common because of the body's anatomy, gravity and the pressure exerted on the legs.

You may ask: What are varicose veins and how do they develop? This question can be answered in simple terms as follows.

Blood Circulation and the One-Way Valves of the Veins

Your heart sends oxygen-rich blood through the arteries to every part of your body, including the tips of your toes. However, returning this blood to the heart is not an easy task. Blood in the lower limbs must overcome gravity to return to the heart. The veins are responsible for carrying this blood back.

To prevent blood from flowing downward again, the veins contain delicate, one-way valves. These valves work like check valves: when blood moves toward the heart, the valves open and then close immediately after the blood passes, preventing gravity from pulling the blood downward.

The Difference Between Healthy Veins and Varicose Veins

In a healthy person, this system works in perfect coordination. The calf muscles contract during walking and act as an auxiliary pump, pushing blood upward, while the valves prevent it from flowing backward.

However, when the walls of the veins lose their elasticity or become weak for various reasons, the veins widen. As a vein widens, the edges of the one-way valves can no longer meet properly and close completely. As a result, a gap forms, allowing blood to leak backward and collect in the lower parts of the vein. This pooling of blood and the increased internal pressure cause the vein to swell, twist and bulge. This is what we know as leg varicose veins.

The Main Veins Involved in Venous Insufficiency in the Legs

Two major veins can play a key role in the development of varicose veins: the great saphenous vein and the small saphenous vein.

Small Saphenous Vein

This vein extends from the back of the ankle to the back of the knee and drains blood from the outer part of the lower leg. Therefore, varicose veins that develop behind the knee and around the ankle may result from insufficiency or dysfunction of this vein. Insufficiency in this area usually causes swelling and pain around the outer ankle and the back of the lower leg.

Because this vein is close to a nerve, its treatment requires a high degree of precision. Its symptoms are similar to those associated with the great saphenous vein, except that a smaller area of the leg is affected.

Great Saphenous Vein

This is the longest superficial vein in the body, extending from the ankle to the groin. It drains deoxygenated blood from the superficial tissues of the lower leg and knee. Insufficiency at the point where this vein joins the femoral vein in the groin is the most common cause of large, rope-like varicose veins throughout the leg, leading to swollen, twisted veins and blood pooling.

Statistics on Varicose Veins

One reputable medical journal reports that the global prevalence of varicose veins ranges from 2% to 73%. You may find it interesting that geographical differences contribute to this wide variation, with the condition being more prevalent in developed and Western countries. Researchers attribute this to sedentary lifestyles and diets high in carbohydrates.

In fact, varicose veins are a relatively common vascular condition, affecting approximately 20% of the population and nearly one-third of men and women aged 18 to 64.

Below, we will discuss the most important factors that cause varicose veins.

Factors That Cause Leg Varicose Veins

Some of the most important factors that contribute to leg varicose veins include the following:

• Family History or Genetics

If a family member or close relative has varicose veins or conditions such as high blood pressure, cardiovascular disease, or even metabolic disorders, the likelihood of developing this condition may be higher.

• Sex

Numerous studies have shown that leg varicose veins are more common in women than in men. The reason for this is not yet entirely clear. However, hormonal changes and pregnancy may play an important role.

Estrogen causes the vein walls to relax, while progesterone may facilitate vein dilation. For this reason, the risk of developing varicose veins increases significantly during puberty, pregnancy and menopause. Although women are more likely to develop varicose veins for reasons such as pregnancy and hormonal changes, this does not mean that men cannot develop them. Varicose veins in men

• Age

Age is recognized as a major and key factor in this condition because, as people get older, the calf muscles and the valves in the veins of the legs become weaker. The condition has been observed more frequently in people aged 70 and older.

Mechanical wear and tear on the valves over decades of activity can cause the veins to weaken in older age. However, varicose veins can sometimes also occur in children and adolescents for various reasons, so they should not be considered a condition that affects only older men and women.

• Pregnancy and Childbirth

Hormonal and physiological changes during pregnancy place additional pressure on the leg veins, increasing the likelihood of developing this condition. The more pregnancies and childbirths a person has had, the greater their exposure to this risk. An increase in the mother's blood volume and the physical pressure of the uterus on the pelvic veins can prevent blood from draining easily from the legs, making the veins more susceptible to pregnancy-related varicose veins.

• Occupation

Some activities that require prolonged standing or sitting can increase the likelihood of swelling and prominent veins in the legs. When the calf muscles do not contract, the “muscle pump” which drives venous blood flow remains inactive and blood becomes trapped in the legs.

• Obesity and Excess Weight

Obesity and excess weight place pressure on the veins in the legs, impairing their function and causing blood to flow backward toward the lower legs. In addition, fat tissue produces inflammatory substances that can endanger the health of the inner lining of blood vessels. This factor may pose a greater risk for women than for men.

It is worth noting that obesity and excess weight are commonly assessed using the body mass index (BMI), which provides an approximate indication of body mass relative to height.

For a more detailed review of all the underlying causes and risk factors of this condition, we recommend reading the specialized article on the causes of leg varicose veins.

Classification of the Types of Leg Varicose Veins

This condition can be classified into different types based on the size of the swollen veins, severity, extent of involvement and location. Prominent veins may appear red, blue, purple, green or sometimes dark violet.

In terms of size, leg varicose veins may be very small and superficial, known as telangiectasias, spider veins or spider (spider) veins. They may also become larger and more prominent, in which case they are referred to as bulging varicose veins. Very prominent and severe cases are commonly called trunk varicose veins.

• Spider Veins in the Legs

Spider veins are a milder and smaller type of varicose vein. They look like spider webs, which is the reason for their name. Although they are often considered a cosmetic problem, in some cases they may indicate insufficiency in deeper veins or in the veins that feed them.

In fact, spider veins are small blood vessels connected to larger blood vessels and are part of the circulatory system. Because they are close to the surface of the skin, they are easily visible and are often red, blue or purple. They commonly appear on the legs or face.

Spider veins are often not very dangerous or painful and may be bothersome mainly from an aesthetic or cosmetic perspective. However, it is important to note that, in some cases, the presence of these veins may indicate chronic varicose veins or venous insufficiency and dysfunction in the vascular system. For this reason, a medical examination is considered necessary.

Picture of spider varicose veins in a patient who was treated by Dr. Behnam Vaghfi.

• Reticular or Net-Like Varicose Veins of the Legs

Reticular varicose veins are small, delicate, bluish-purple veins that are interconnected like a network. This type of varicose vein often does not cause any problems and may be bothersome to patients for cosmetic reasons. However, ignoring them may lead to the progression of venous insufficiency, as their presence indicates relative weakness in the blood vessel walls.

They are larger than spider veins and are located deeper within the skin. In medical terminology, these veins are also called “feeder veins” because they often transfer blood pressure to spider veins and help them persist. Therefore, to achieve definitive treatment of spider veins, these reticular networks must be treated first.

Trunk Varicose Veins of the Legs

Trunk varicose veins are large, twisted veins whose shape and size have changed to such an extent that they protrude and bulge, making them easily visible beneath the outer layer of the skin. This type of venous swelling may be painful and bothersome.

This condition is mainly caused by insufficiency in the main veins of the legs (the great or small saphenous veins). Due to the complete failure of the valves, large volumes of blood accumulate in these veins.

This type of varicose vein can occur in two forms:

• Mildly prominent varicose veins (mild trunk varicose veins): These usually develop due to increased pressure inside the veins and must be evaluated.

• Severely prominent varicose veins (severe trunk varicose veins): These are, in fact, the most dangerous type of varicose veins.

An important point about this type of varicose vein is that half of the people with severe rope-like varicose veins have no symptoms, such as pain or heaviness, and therefore do not pursue treatment. However, these varicose veins are highly progressive and can lead to serious complications, such as thrombosis and blood clots within the veins, pulmonary embolism or severe venous ulcers, which may consequently cause wound infections and severe bleeding.

• Deep and Secondary Varicose Veins

This type of varicose vein occurs in the deep, major veins inside the legs. It cannot be seen with the naked eye and is usually caused by obstruction, previous injuries or thrombosis.

If you are wondering whether leg varicose veins are related to the heart, click here.

If you develop this type of condition or abnormality, be sure to seek treatment under the supervision of a specialist.

Learn more: Types of Leg Varicose Veins

Important Signs and Symptoms of Leg Varicose Veins

The symptoms of varicose veins cover a very broad spectrum. People with small varicose veins or rope-like varicose veins may have no symptoms and may seek medical care solely for cosmetic reasons.

Various studies have shown that small spider veins and sometimes, trunk varicose veins have no symptoms! On the other hand, there is no direct relationship between the severity of varicose veins and their symptoms. This means that larger varicose veins do not necessarily cause more symptoms. A patient with small spider veins may complain of severe fatigue, pain and leg swelling, while another patient with trunk varicose veins may have no symptoms at all.

Therefore, do not necessarily consider the absence of symptoms a good sign! Over time, these trunk varicose veins may develop complications such as blood clots and pulmonary embolism, skin discoloration, eczema and venous ulcers. This state of being “asymptomatic” should not lead to the condition being ignored, because large volumes of stagnant blood are present in trunk varicose veins, creating a risk of serious complications, including silent superficial thrombophlebitis and pulmonary embolism.

Symptoms of varicose veins include the following:

1. Early Symptoms of Varicose Veins

• Itching and burning over varicose veins

• Pain and muscle cramps in the legs, especially during sleep or when the legs are hanging down

• Leg swelling and heaviness

• Premature leg fatigue

• Restless legs: an intense urge to move the legs to relieve venous pressure.

2. More Advanced Symptoms of Varicose Veins

As the condition progresses, the following symptoms may also develop:

• Skin symptoms

  Over time, the skin becomes dry and inflamed, with itching and burning. Gradually, the subcutaneous fat diminishes and the skin becomes thickened and leathery. The skin around the lower legs may also change color, becoming dark brown. If the symptoms persist, ulcers may gradually develop. Venous ulcers usually occur near the ankle and may become infected or cause severe bleeding.

Although we have discussed these signs and symptoms, it is worth noting that a doctor diagnoses this condition through an examination and methods used to assess blood flow in vessels and veins, such as Doppler ultrasound, as well as other diagnostic methods that we will discuss below.

To learn about all the clinical signs and when it is appropriate to see a doctor, the article Symptoms of Leg Varicose Veins may be helpful.

Medical Diagnosis of Leg Varicose Veins

In addition to a consultation and physical examination, a doctor may use other methods to assess the condition of the blood vessels and varicose veins more precisely. The most common non-invasive methods used to diagnose varicose veins include:

Doppler Ultrasound

This is a widely used method for detecting blood flow and measuring its speed in the veins.

Duplex Ultrasound

This diagnostic method is considered a complement to Doppler ultrasound and is used to show the shape and structure of veins or investigate the cause of blood flow obstruction.

Venography

This type of imaging uses X-rays to evaluate the condition and health of the veins.

Plethysmography

You may have heard of this method more often in connection with lung diseases. However, it is also used to assess changes in the pressure and volume of blood flow in the veins of the legs.

CT Scan and MRI

In some cases, a doctor may need to examine the venous circulation network more extensively, for example, in the pelvic region. CT scans and MRI are therefore used for further evaluation.

You can read the article Diagnosis of Leg Varicose Veins for full details about the diagnostic process and how vascular ultrasound is performed.

Ways to Prevent Varicose Veins from Progressing

Although some factors contributing to varicose veins, such as genetics or family history are beyond our control, we can help prevent the development or progression of venous insufficiency by making simple but consistent lifestyle changes. Following preventive measures helps improve venous circulation and reduces the pressure exerted on vein walls.

Picture of the appearance of trunk varicose veins that was treated in Dr. Behnam Vaghfi's super specialized varicose vein clinic.

The most important prevention and self-care measures include:

Avoid prolonged standing or sitting: If your job requires you to remain stationary for hours, try to walk a few steps or move your ankles every 30 minutes to keep the calf muscle pump active.

Elevate your legs: At the end of the day or during rest, keeping your legs above heart level for 15–20 minutes helps the blood accumulated in the lower limbs return to the heart more easily.

Regular physical activity and exercise: Engaging in light aerobic exercises, such as brisk walking, cycling and swimming, has a remarkable effect on strengthening the leg muscles and improving venous blood flow.

Weight management and a healthy diet: Maintaining a normal weight and following a diet rich in fiber and water are very beneficial for preventing constipation and reducing pressure on the pelvic blood vessels.

Wearing appropriate clothing and footwear: Avoid wearing tight trousers, tight socks and high-heeled shoes for long periods, as they interfere with blood circulation.

Follow the complete prevention plan in the article [Preventing Leg Varicose Veins].

How Are Varicose Veins Treated?

As mentioned, varicose veins can take different forms depending on their severity, depth, and the type of blood vessels affected. In the past, surgery, which is an invasive procedure, was considered the only treatment for varicose veins alongside medication. However, advances in medical science and technology have made numerous convenient treatment options available today.

The treatment method for leg varicose veins should be selected by a specialist. The available treatments include:

• Endovenous laser treatment: One of the most advanced and minimally invasive methods. Laser energy is used to close the damaged vein so that blood flow is redirected to healthy blood vessels. This procedure is performed without the need for general anesthesia.

• Sclerotherapy (injection treatment): An effective method for eliminating spider and reticular veins. A special substance called a sclerosant is injected into the vein, damaging its walls so that the vein is gradually absorbed by the body.

• Phlebectomy and modern surgical methods: When varicose veins require surgical intervention, modern surgical techniques are used to remove or close the defective and incompetent vein.

Full details about treatment methods and how to choose the best medical approach are explained in the specialized article [Treatment of Leg Varicose Veins].

What Happens If Varicose Veins Are Left Untreated?

Some people believe that varicose veins are merely a cosmetic issue and will improve over time or with rest. However, the reality is that varicose veins are a progressive vascular condition. If venous insufficiency and blood pooling in the legs are not managed and treated in time, they can gradually lead to serious local and systemic complications that significantly affect a person's quality of life.

Pain and discomfort

This condition causes pain, heaviness in the legs, and severe fatigue, making prolonged standing or sitting difficult. Therefore, if the condition is left untreated, the person may unfortunately have to endure ongoing pain and discomfort.

Lipodermatosclerosis: Thickening and leathery changes in the skin

When blood flow and oxygen delivery to the tissues decrease, the skin may develop changes such as dryness, itching, or discoloration. Over time, these changes can cause the skin to lose its normal appearance and become thickened and leathery.

Severe leg swelling

This occurs as a result of fluid accumulating in the tissues of the legs.

Venous ulcers

Venous ulcers are one of the serious complications of varicose veins and usually develop around the ankle. These ulcers are not easy to treat and may also become infected or cause severe bleeding.

Blood clots in the veins or deep vein thrombosis (DVT)

In this condition, blood clots form in the deep veins of the legs. In addition to causing severe pain, these clots can travel to the lungs and cause a pulmonary embolism.

Vascular problems

Varicose veins can interfere with the function of other veins and blood vessels and affect them as well.

Reduced daily functioning

Pain and discomfort caused by this condition may prevent the affected person from participating in social activities, exercising and engaging in other daily activities.

Reduced self-confidence

When the appearance of the legs changes because of swollen veins and colored blood vessels becoming visible beneath the skin, many patients experience reduced self-confidence or feel embarrassed about showing their legs.

For more information about these complications and the long-term consequences of ignoring the condition, see the article [Complications of Leg Varicose Veins].

Self-Assessment Guide and Risk Classification for Leg Varicose Veins

Understanding the severity of varicose veins can help you take the most appropriate treatment action at the right time and prevent irreversible complications. Many people do not know how severe their symptoms are or when they should consult a specialist.

The following section provides a self-assessment questionnaire and a risk-level table to help you make decisions quickly.

Answering the following questions can help you estimate the severity of your venous insufficiency:

1. Do you experience mild heaviness or fatigue in your legs at the end of the day without seeing any prominent veins?

2. Do you notice purple or red, spider-web-like veins on the skin of your legs?

3. Do you experience persistent nighttime cramps, bothersome pain or swelling around your ankles?

4. Have prominent, thick, twisted, rope-like veins developed on your calves or thighs?

5. Has the skin around your ankles developed discoloration, dark brown patches, severe dryness or open ulcers?

6. Have you recently experienced sudden swelling, redness, warmth and severe pain in one leg?

How to Interpret and Evaluate Your Answers

Count the number of “yes” answers to the questions above to assess the condition of your leg veins:

1–2 “yes” answers (mild level): You may be in the early stages of varicose veins or have spider veins. Management through exercise, lifestyle modifications, and Class 1 compression stockings may be possible.

3–4 “yes” answers (moderate level): Your venous valves may be incompetent. To prevent the condition from progressing, you should consult a vascular specialist and undergo duplex ultrasound.

5–6 “yes” answers (severe level / warning): You may have advanced complications or be at risk of blood clots. You need urgent medical assessment at a specialized vascular clinic.

By comparing your symptoms with the following table, you can identify your risk level and the necessary medical action:

Summary

Varicose veins are a condition that develops because of weakness and insufficiency in the walls and valves of the veins. This vascular condition occurs most commonly in the legs and has several different forms. Genetics, obesity, prolonged standing or sitting and an unhealthy lifestyle are among the most important factors that may contribute to its development.

The article [What Makes Varicose Veins Worse?] examines the factors that contribute to varicose veins in detail.

This condition can be diagnosed and treated by a specialist and effective, convenient treatment options are available today.

FAQ

1. Are varicose veins dangerous?

In most cases, varicose veins do not pose a serious danger. However, if the condition becomes chronic or severe, it may cause complications such as blood clots, ulcers, or infections. Therefore, it should be evaluated by a specialist.

4. Can varicose veins be definitively treated?

Yes. Unlike in the past, effective and convenient treatments such as laser treatment, sclerotherapy, and phlebectomy are now available.

5. Why have I developed varicose veins?

Varicose veins may develop for various reasons, including genetics, age, sex, hormonal changes, pregnancy, obesity, and prolonged standing or sitting.

6. Do varicose veins cause cancer?

No. To date, no direct link between varicose veins and cancer has been identified.