Varicose veins in the legs: what it is and how it manifests

Varicose veins, or varicosity, are persistent dilation and tortuosity of veins that become visible under the skin. Most often the process affects the lower limbs, in which case it is called varicose disease of the lower extremities. Below are the mechanism, signs, diagnosis, and the point at which to see a doctor.

What varicose veins are

Varicose veins are a pathological process in which the diameter of the vein lumen increases, the wall thins, and nodes form in certain areas: aneurysm-like local dilations. Visually, varicose veins in the leg are dilated and tortuous veins on the foot, lower leg, and thigh: they look swollen, may feel like indurations, and may bulge above the skin. Varicose veins can be located in different parts of the body, but the legs are most often affected; dilation of the veins of the rectum underlies hemorrhoids, and dilation of the veins of the spermatic cord is called varicocele. Varicose veins are common and usually not dangerous, but without treatment they can worsen—as a rule, very slowly, over several years.

How the veins of the legs are structured and why they dilate

Veins carry blood to the heart, and the veins of the legs have valves that allow blood to flow in one direction. If the valves are weakened or damaged, blood flows backward and accumulates in the vein—it becomes overfilled and stretches. The lumen enlarges, the wall loses tone, and tortuous segments and nodes form. Changes more often affect the superficial veins; the superficial veins of the leg include, in particular, the great saphenous vein, and dilation of such veins is usually what is visible under the skin.

Causes and risk factors of varicose veins

The main cause is hereditary predisposition: the disease occurs in people whose venous wall is weakened due to a genetic mutation. Heredity does not mean inevitability: the timing of onset and rate of progression probably depend on additional factors—a sedentary lifestyle and desk work, increased physical exertion with lifting and carrying heavy objects. The risk is higher in older people, in women, with obesity, lack of physical activity, and a family history of varicose veins; the disease of the veins more often manifests during pregnancy. The association with high-heeled shoes is discussed, but there are no reliable data: studies are few, samples are small, and conclusions contradict each other.

Signs of varicose veins in the legs

In addition to appearance, there may be pain, aching heaviness in the legs, swelling of the feet and lower legs, and skin changes: itching, discoloration, dryness, and flaking. After prolonged standing the symptoms worsen, and in a lying position with the legs elevated they decrease. Dilated veins differ from vascular “spider veins”—small red, blue, or purple veins, usually harmless. The severity of changes is described by stages:

• Stage 1—complaints are present, vascular “spider veins” or a network are visible on the skin.
• Stage 2—visible enlarged veins or nodes filled with venous blood; the likelihood of thrombus formation is increased.
• Stage 3—swelling is added to the dilated veins, typically by the end of the day.
• Stage 4—trophic changes: darkening of the skin, its inflammation, and in severe cases skin atrophy and trophic ulcers.
• Stages 5 and 6—healed and unhealed trophic ulcer, respectively.

Stage 0, in which complaints are present but no vein dilation is found on examination and investigations, is distinguished by only some specialists.

How disease of the veins of the lower extremities is diagnosed

The diagnosis is often established already on examination; sometimes additional investigations are needed. The main method is duplex ultrasound scanning: it confirms the diagnosis and helps plan treatment. The doctor assesses whether there are symptoms and complications, since this determines whether intervention is needed: in the absence of complaints, treatment is not always required, while for pain, heaviness, swelling, itching, or skin changes, the patient is referred to a specialist.

Possible complications and when to see a doctor

Complications include trophic ulcers, bleeding from a dilated vein, and further progression of the disease. A routine reason to see a doctor is pain, itching, or swelling in the legs, worsening appearance of the veins, as well as a wound on the leg that does not heal for 2 weeks. A separate reason for an urgent consultation is bleeding from a varicose vein.

Varicose veins by themselves are not a reason to call an ambulance. 103 or 112 are needed if a dilated vein is bleeding and the bleeding cannot be stopped.

This material is for reference: it describes the disease but does not replace a doctor’s consultation—examination and ultrasound are more accurate than any text.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer