Varicose Veins

The human body has three types of blood vessels: arteries, capillaries, and veins. Arteries carry blood from the heart to the body’s periphery, branching into smaller vessels. The smallest vessels, called capillaries, deliver nutrients and oxygen to cells and remove metabolic waste. Capillaries merge to form larger vessels called veins, which return blood to the heart.

Veins are structurally weaker than arteries, with less firm and elastic walls, understandable since arterial walls withstand much higher blood pressure. Veins contain valves that ensure blood flows only toward the heart, preventing backflow to the capillaries.

Arteries lack valves because high pressure from the heart’s pumping prevents backflow, similar to water in pipes as long as pumps are active.

Blood pressure in veins is low. Any pressure increase in a vein segment pushes blood backward, which valves normally prevent. Varicose veins develop when increased venous pressure, due to external compression or internal blockage, causes veins to dilate. If blood flow is obstructed, blood is rerouted through “collateral veins,” increasing pressure and causing further dilation.

Numerous superficial veins lie under the skin across the body. Minor dilations are visible almost anywhere, but significant venous dilations, indicating serious disorders, appear under the skin of the chest, abdomen, and legs.

Over 20% of people over 30 have varicose veins in their legs, with women affected far more than men. This condition is both a medical and social issue, causing as many lost work hours as the flu.

Varicose veins in the legs are considered a disease of civilization, common in developed countries due to modern lifestyles. Limited movement, lack of exercise, and prolonged standing hinder normal venous blood flow to the heart.

Movement aids leg circulation. When a person moves their leg or contracts leg muscles, blood is pushed toward the heart, reducing venous pressure. This is known as the “muscle pump.” In people who stand for long periods (e.g., salespeople, waiters), the muscle pump is underused, causing blood to pool and pressure to rise in veins. Valves yield to this pressure, allowing small, then increasing, amounts of blood to flow backward, leading to vein dilation.

Prolonged high pressure in veins causes further dilation, elongation, and twisting. Untreated, elongated veins form tangled clumps or large knots. Blood pooling extends back to capillaries.

This increases capillary pressure, reducing fresh blood supply. The skin and subcutaneous tissue receive less nutrition and oxygen, causing the skin to thin, become malnourished, and turn brown, eventually becoming paper-thin. Ultimately, the skin may break down, forming an ulcer.

Varicose veins can cause vein inflammation (phlebitis), often linked to blood clotting (thrombosis). A clot may partially or fully block a vein. A dislodged clot can travel through the bloodstream, causing restricted circulation in tissues or organs (thromboembolism).

Rarer causes include congenital vein defects, particularly in valves, or hereditary weak connective tissue, which supports organs and blood vessels like bones but is softer.

Pregnancy can cause varicose veins due to increased abdominal pressure affecting major veins and general bodily changes. Tumors, scars, or cysts may compress veins externally, impeding blood flow.

Varicose veins are easily recognizable. They may be small, a few centimeters long, or extensive, winding like a drill or snake from the foot to the upper thigh.

Minor dilations may cause no significant issues, but even small varicose veins can lead to leg pain and rapid fatigue. Pain worsens at night, especially during menstruation. Slight swelling in the calves causes tightness, heaviness, and sensations like “ants crawling,” burning, tingling, or itching. Severe, painful leg muscle cramps may occur. Swelling, especially around the ankle, appears even after brief standing.

Many medications treat varicose veins, mostly pharmaceutical, but traditional remedies exist—some are ingested, others applied directly to affected skin. Oral medications are supplementary and cannot fully manage varicose veins.

Only two methods offer lasting results: surgical removal of affected veins and injection therapy (sclerotherapy). In sclerotherapy, a doctor injects medication into the vein while the patient lies down, then applies an elastic bandage worn for weeks after the last injection.

This closes the vein, reducing it to a thin tissue strip, but not all veins can be sclerosed. Many doctors avoid this method due to frequent vein re-dilation. Sclerotherapy creates a clot that gradually dissolves, potentially reforming a channel within a year or two, making the vein functional again.

Surgical removal is the most reliable treatment. Over 1,800 years ago, Roman physician Galen removed varicose veins with a blunt hook. Despite its age, this method remains effective and often yields the best results. Early-stage improvement can be achieved with short rest periods and elevated legs. During sleep, legs should be raised at least 10 centimeters to improve blood flow in veins strained by prolonged standing or sitting.