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Varicose Veins & Chronic Venous Insufficiency

Varicose veins are enlarged, twisted leg veins caused by failing vein valves. In chronic venous insufficiency, blood pools in the legs, causing swelling, aching, and skin changes.

Cardiovascular
Varicose veins are enlarged, twisted veins visible beneath the skin, most often in the legs. They develop when the one-way valves inside leg veins weaken and leak, allowing blood to flow backward and pool. When valve failure is widespread and long-standing, the result is chronic venous insufficiency — persistently elevated pressure in the leg veins that causes swelling, skin changes, and sometimes open sores. These conditions are among the most common circulatory problems, affecting women more often than men and becoming more frequent with age. Causes and Risk Factors: Vein valves fail for a combination of reasons:
  • Heredity: A family history of varicose veins is one of the strongest predictors.
  • Age and hormones: Valves and vein walls weaken over time, and pregnancy raises both blood volume and pressure on pelvic veins.
  • Prolonged standing or sitting: Occupations that keep you on your feet let gravity work against the veins all day.
  • Excess weight: Increases pressure in the leg veins.
  • Prior blood clots: A previous deep vein thrombosis can permanently damage vein valves, a cause known as post-thrombotic syndrome.
  • Leg injury or surgery: Trauma and some orthopedic procedures damage veins directly or limit the calf-muscle pumping that normally pushes blood back toward the heart.
Symptoms: Beyond their appearance, diseased veins cause a characteristic set of complaints that typically worsen through the day and improve with leg elevation:
  • Aching, heaviness, or throbbing: Especially after long periods of standing.
  • Swelling: Around the ankles and lower legs, usually worse by evening.
  • Itching, cramping, and restless legs: Common and often underappreciated symptoms.
  • Spider veins: Fine red or blue web-like clusters just under the skin surface often accompany larger varicosities. On their own they are a cosmetic concern rather than a medical one.
  • Skin changes: With advanced venous insufficiency, the skin near the ankles can darken, thicken, and become fragile, eventually breaking down into slow-healing venous ulcers.
Diagnosis: Diagnosis begins with an examination of the legs while standing. The key test is a venous duplex ultrasound, a painless scan that maps blood flow and shows exactly which valves are leaking and whether a clot is present. Your physician will also check the arterial circulation — including for peripheral arterial disease — because compression therapy must be used cautiously when arteries are also narrowed. Where there is any doubt, an ankle-brachial index — a painless comparison of the blood pressure at the ankle with the blood pressure in the arm — confirms that the arterial supply can tolerate compression. A helpful overview is available from Johns Hopkins Medicine. Treatment: Treatment progresses from conservative measures to office-based procedures:
  • Compression stockings: The foundation of care — graduated compression counteracts pooling and relieves aching and swelling.
  • Lifestyle measures: Elevating the legs, walking regularly, maintaining a healthy weight, and avoiding long uninterrupted periods of standing or sitting.
  • Endovenous ablation: A thin catheter uses heat to seal the leaky vein from the inside, done in the office with local anesthesia.
  • Sclerotherapy and phlebectomy: Injections that close smaller veins, and removal of surface varicosities through tiny incisions.
Complications: Untreated venous insufficiency tends to progress slowly, and a few complications are worth recognizing early:
  • Stasis dermatitis: Itchy, scaly, reddish-brown skin at the ankles caused by chronic fluid leakage into the tissues. It is often mistaken for other forms of dermatitis and responds to moisturizers, topical steroids, and consistent compression.
  • Superficial thrombophlebitis: A tender, firm, reddened cord along a surface vein from clotting and inflammation. It is usually managed with compression and anti-inflammatory medication, but it should be examined to confirm the clot has not extended into the deep veins.
  • Bleeding: A thin-walled varicose vein sitting close to the skin can bleed briskly after a minor bump. Lying down, elevating the leg, and applying firm direct pressure will control it.
  • Ulceration: Open sores just above the inner ankle that heal slowly and tend to return unless compression is continued long term.
When to Seek Immediate Care: Seek prompt medical attention for sudden swelling or pain in one leg (a possible blood clot), bleeding from a varicose vein, or a leg sore that is not healing. Leg swelling and aching are easy to dismiss, but effective treatment can dramatically improve comfort and prevent skin breakdown. The internal-medicine team at Zimmer Medical Group evaluates leg vein symptoms, orders ultrasound when needed, and refers to vein specialists for procedures.

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