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Varicosis: Causes, Symptoms and Treatment

Varicosis refers to the pathological enlargement of superficial veins, most commonly in the legs, caused by weakened vein walls and defective venous valves.

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Things worth knowing about "Varicosis"

Varicosis refers to the pathological enlargement of superficial veins, most commonly in the legs, caused by weakened vein walls and defective venous valves.

What Is Varicosis?

Varicosis (commonly known as varicose veins) is a condition in which the superficial veins become abnormally enlarged, twisted, and tortuous. The legs are most frequently affected. The diseased veins appear as bluish-green, knotted cords that bulge visibly beneath the skin.

Causes

Varicosis develops as a result of venous valve failure. Healthy venous valves ensure that blood flows in one direction toward the heart. When these valves no longer close properly, blood flows backward and pools in the veins. The resulting increase in pressure causes the vein walls to stretch and expand.

Contributing risk factors include:

Genetic predisposition: Varicosis tends to run in families
Obesity: Increases pressure on the leg veins
Prolonged standing or sitting: Impairs venous return to the heart
Pregnancy: Hormonal changes and increased abdominal pressure strain the veins
Advancing age: Connective tissue loses elasticity over time
Female sex: Women are more commonly affected than men

Symptoms

Varicosis may remain asymptomatic for a long time. Common symptoms include:

Visibly enlarged, twisted veins on the legs
Heaviness, fatigue, and a feeling of tension in the legs
Pain and cramps, particularly in the evenings or after prolonged standing
Edema (fluid accumulation) around the ankles and lower legs
Itching over the affected vein segments
In advanced stages: skin changes such as discoloration, hardening, or open sores (venous leg ulcers)

Diagnosis

Diagnosis is primarily based on a clinical examination in which the physician inspects and palpates the veins while the patient is standing and lying down. Duplex ultrasound (sonography of the veins) is the standard imaging tool and allows visualization of blood flow and identification of defective valves.

Duplex ultrasound: Standard method for diagnosis and treatment planning
Phlebography: X-ray examination using contrast agent for specific clinical questions
Light reflection rheography (LRR): Measures venous refill time

Treatment

Treatment depends on the severity of the condition and the symptoms experienced. The following options are available:

Conservative Treatment

Compression stockings: Support blood flow and relieve symptoms
Regular physical activity and elevation of the legs
Weight reduction and lifestyle modification

Sclerotherapy

A liquid or foam agent is injected into the affected vein, causing it to scar and close. The body gradually absorbs the treated vein. This approach is particularly suitable for smaller varicose veins and spider veins.

Surgical Procedures

Vein stripping: Surgical removal of the diseased vein
Ambulatory phlebectomy: Removal of branch varicosities through small skin incisions

Endovenous Procedures

Laser or radiofrequency ablation: Thermal closure of the vein from within
Endovenous adhesive therapy: Sealing the vein with a medical-grade tissue adhesive

Complications

Untreated varicosis can lead to serious complications:

Superficial venous thrombosis (thrombophlebitis): Inflammation and clot formation in a superficial vein
Deep vein thrombosis (DVT): Blood clot in the deep veins
Chronic venous insufficiency (CVI): Progressive damage to the venous system
Venous leg ulcer (Ulcus cruris venosum): A difficult-to-heal open wound on the lower leg

Prevention

The risk of developing varicosis or slowing its progression can be reduced by:

Regular physical activity such as walking, swimming, or cycling
Avoiding prolonged standing or sitting without movement breaks
Maintaining a healthy body weight
Elevating the legs whenever possible
Wearing compression stockings when a predisposition is known

References

Deutsche Gesellschaft für Phlebologie (DGP): S2k-Leitlinie Varikose, AWMF-Register Nr. 037-018, 2019.
Rabe E, Berboth G, Pannier F. Epidemiology of chronic venous disease. Wien Med Wochenschr. 2016;166(9-10):260-263.
Nicolaides AN et al. Management of chronic venous disorders of the lower limbs. Int Angiol. 2018;37(3):181-254.

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