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Varicose Vein Problems – Causes, Symptoms & Treatment

Varicose vein problems refer to symptoms caused by enlarged, twisted veins – most commonly in the legs. They result from weakened vein valves and can cause pain, swelling, and skin changes.

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Things worth knowing about "Varicose Vein Problems"

Varicose vein problems refer to symptoms caused by enlarged, twisted veins – most commonly in the legs. They result from weakened vein valves and can cause pain, swelling, and skin changes.

What Are Varicose Vein Problems?

Varicose vein problems (medically known as varicosis or varices) describe complaints arising from permanently enlarged, twisted, and bulging veins – primarily in the legs and lower limbs. The affected veins lose their normal shape and function because the valves inside them no longer close properly. Studies estimate that 15–25% of adults are affected by varicose veins requiring treatment.

Causes

Varicose veins develop due to weakness in the venous valves and vein walls. Normally, these valves prevent blood from flowing backward. When they fail, blood pools and the vein walls stretch and enlarge. Contributing risk factors include:

Hereditary predisposition: A family history significantly increases the risk.
Prolonged standing or sitting: Occupations with limited movement place added strain on the venous system.
Obesity: Increased pressure on the venous system promotes the development of varicose veins.
Pregnancy: Hormonal changes and uterine pressure on pelvic veins encourage varicose veins.
Age: Vein walls lose elasticity over time.
Sex: Women are more commonly affected than men.

Symptoms

Varicose vein problems can present with a wide range of symptoms. Some individuals notice only cosmetic changes initially, while others experience significant discomfort:

Visibly enlarged, bluish-purple veins beneath the skin
Heaviness, fatigue, and tension in the legs
Pain or aching along the affected veins
Ankle and leg swelling (oedema), especially in the evening
Itching or tingling over the affected vein areas
In advanced cases: skin changes, pigmentation, or poorly healing wounds (venous leg ulcers)

Diagnosis

Diagnosis of varicose vein problems involves a combination of clinical examination and imaging:

Inspection and palpation: The physician visually assesses and feels the affected veins.
Duplex ultrasound: An ultrasound technique that visualises blood flow and venous valve insufficiency – the standard method for accurate assessment.
Phlebography: An X-ray examination using contrast dye – less commonly used today.

Based on findings, the severity is classified using the CEAP classification (C0–C6) to guide appropriate treatment planning.

Treatment

Conservative Measures

Milder varicose vein problems and accompanying symptoms can be managed with non-surgical approaches:

Compression therapy: Medical compression stockings or bandages promote venous return and reduce swelling.
Exercise: Regular walking, swimming, or cycling activates the calf muscle pump and supports venous circulation.
Leg elevation: Relieves the venous system and alleviates symptoms.
Venotonic medications: Herbal preparations such as horse chestnut extract (aescin) may help relieve mild symptoms.

Minimally Invasive and Surgical Procedures

For more significant varicose vein problems, several medical interventions are available:

Sclerotherapy: A sclerosant is injected into the affected vein, causing it to scar and shrink.
Endovenous thermal ablation: The vein is closed from the inside using laser (EVLT) or radiofrequency (RFA) energy.
Phlebectomy: Surgical removal of affected vein segments through small incisions.
Stripping surgery: Surgical removal of the main saphenous vein in severe cases.

Possible Complications

Untreated varicose vein problems can lead to serious secondary conditions, including:

Superficial venous thrombosis (thrombophlebitis): Inflammation and clotting in a superficial vein.
Deep vein thrombosis (DVT): In rare cases, a clot may extend into the deep veins.
Venous leg ulcer (ulcus cruris venosum): Chronic, poorly healing wounds as a result of long-term venous stasis.

Prevention

Although genetic predisposition cannot be changed, the risk of developing varicose vein problems can be reduced through the following measures:

Incorporate regular physical activity and avoid prolonged standing or sitting
Maintain a healthy body weight
Wear compression stockings in high-risk occupations or during long journeys
Elevate the legs regularly
Avoid smoking, as nicotine damages blood vessel walls

References

German Society of Phlebology (DGP) – S2k Guideline on Varicose Veins (2019/2022). Available at: www.awmf.org
Rabe E et al. – Epidemiology of chronic venous disorders in geographically diverse populations. International Angiology, 2012.
Eberhardt RT, Raffetto JD – Chronic venous insufficiency. Circulation, 2014;130(4):333–346.

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