Blood travels in vessels called arteries and veins. Arteries take blood with oxygen and nutrients away from the heart to body cells. Veins carry blood back to the heart after cells get the oxygen and nutrients. Varicose veins are enlarged, twisted-looking veins that lie close to the skin’s surface. They occur most often in the legs. Leg muscles help support veins and push blood up toward the heart. Valves in veins help stop blood from falling down or pooling in the legs.
For many people, varicose veins are mostly a cosmetic problem. For others, they cause symptoms and more serious problems, such as blood clots, skin ulcers, or blood circulation disorders.
The cause is weakening or failure of valves in veins to stop blood from pooling in the legs. They aren’t contagious or inherited but do run in families. They’re more common in older people, women, overweight people, and people who stand in one place for long periods.
Symptoms include legs that ache or feel heavy, especially after standing or sitting for long periods. Others are bulging, bluish veins along the thigh or ankles or across the knees; swelling; and dry, itchy skin. Skin color changes, thin skin, ulcers, and infection of soft tissue (cellulitis) can occur near the ankles.
The health care provider makes a diagnosis from a leg examination and symptoms. If a blood clot is suspected, the health care provider may order ultrasonography to look for the clot.
Treatment includes staying off your feet as much as possible, wearing elastic support stockings, having sclerotherapy, and having surgery. For people without symptoms and no ulcers or skin breakdown, observation, exercise, losing weight, raising the legs, and elastic stockings are used. Stockings can be knee-high, thigh-high, or pantyhose length and should cover the veins.
In sclerotherapy, the doctor injects sclerosing solutions or a sclerosing foam into a small dilated vein that’s causing symptoms. The solutions make the veins collapse and scar.
Surgery is usually used if other treatments don’t help symptoms; if ulcers, leg swelling, skin breakdown, and leg clots occur; and if people have cosmetic concerns. The most common surgery is called ligation (tying) and stripping. A certain large vein is tied and pulled out of the leg. Many smaller varicose veins are branches of this large vein. The smaller veins are injected with sclerosing solution. The leg is then wrapped with elastic bandages.
Endovenous laser ablation (EVLA) involves targeting the vein walls internally with a laser beam to shrink them.
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