Varicose veins are dilated twisted veins that are visible to the naked eye. They often appear blue or purple and can occur anywhere where the veins returning blood to the heart are not strong. They are most commonly seen in the legs, since standing and walking increase the pressure on veins in the lower body. The skin above varicose veins is raised and can be felt. Varicose veins are in the group of chronic venous diseases that also include spider veins (telangiectasias) and reticular veins. It is not uncommon for people to confuse spider and reticular veins with varicose veins. Recommended Read:  10 Practical Ways to Control Blood Pressure Varicose Veins vs Spider Veins Varicose veins differ from other chronic venous diseases in location and appearance. Like varicose veins, spider veins commonly occur in the legs. However, they may also be seen in the face. Spider veins are also much smaller than varicose veins. They can be either red or blue, and look like spider webs. Varicose Veins vs Reticular Veins The size of reticular veins is typically in the range between the sizes of varicose and spider veins. They often appear as bluish-green or purple in color and can be found near groups of spider veins.

Varicose veins typically are only of cosmetic concern. However,  a wide range of symptoms, of varying severity, have been reported. Potential symptoms include: Visible, raised, twisted bluish-purple veins Aching pain Heaviness in the legs Enhanced pain following long periods of sitting or standing Itching Bleeding of the varicose veins Red skin discoloration associated with pain Eczema Superficial thrombophlebitis (inflammation of superficial veins due to a blood clot along with a reddening of the skin) Bleeding Loss of subcutaneous tissue Lipodermatosclerosis (inflammation of fat under the epidermis of the lower extremities) Venous ulcers Severe cases also serve as risk factors for thrombotic disorders , which can also have other deleterious effects on mental and physical health. There are four risk factors for varicose veins. They are as follows: Hormonal/Sex Women are more likely to develop varicose veins than men, suggesting that hormones may influence the likelihood of developing varicose veins. Varicose veins are also more common in women during pregnancy and in women taking contraceptives with estrogen. Lifestyle Prolonged standing or sitting can cause compression of the blood vessels and reduce blood flow. Thus, it is vital to alternate between standing and sitting throughout the day. Smoking Acquired Pregnancy:  During pregnancy, the body contains more blood .

Veins carry blood from tissues in the body back to the heart, to be pumped through the lungs, and to be replenished with oxygen and recirculated. When returning from the lower extremities, the veins have to work against gravity to move the blood to the heart. There are many mechanisms in place to assist in this task. Veins have elastic walls. They are also equipped with valves that open to allow blood to move toward the heart and close to prevent backflow. There are several mechanisms that contribute to the development of varicose veins, including: · Venous hypertension · Venous valvular incompetence · Changes in the vein walls · Inflammation · Alterations in shear stress Venous hypertension Venous hypertension is high blood pressure in the veins. It is commonly caused by chronic venous reflux or the backflow of blood due to weak vein walls. Obstruction of venous outflow may also contribute to hypertension. In addition to elastic vein walls, and functioning valves, veins need calf muscle function to pump blood from the lower extremities back to the heart. The calf muscle, which is considered the second heart of the body, provides the force needed to push the blood up. Thus, calf muscle failure can also cause venous hypertension.

Physical Examination Varicose veins are diagnosed by a physical examination of the legs, focusing on assessment of pain in the legs. The examination is performed while the patient is standing. Through this assessment, the physician aims to determine location, type, extent and possible cause of the varicose veins. The medical provider investigates the patient for skin redness (erythema), tenderness, or skin hardening (induration). These are signs of a blood clot in the superficial veins. The exam will also involve identification of other signs of chronic venous diseases such as: Recommended Read:  Complications & Diagnosis of DVT Edema (swelling) Hyperpigmentation (darkening of a patch of skin) Lipodermatosclerosis (inflammation of fat under the epidermis of the lower extremities) Atrophie Blanche (raised painful purple skin) Ulcer formation Brodie-Trendelenburg Test Following the physical examination, the patient may undergo the Brodie-Trendelenburg test to determine if the type of vein affected is deep or superficial. To perform the test, the patient lies down with their legs elevated at a 45-degree angle. Once the veins are drained, a tourniquet is placed around the thigh. The patient then stands up. If the veins located far away from the tourniquet fill up quickly, the patient likely has a deep venous insufficiency.

If left untreated, varicose veins can become more serious, and lead to the development of the following:   Edema in the lower limbs Ulcers Blood clots Bleeding Ulcers may result from the buildup of fluid over time, due to the increased blood pressure in varicose veins. Ulcers are typically found near the ankles. Prior to ulcer formation, the skin typically becomes discolored. Blood clots and edema may result from the enlargement of deep veins. Signs of a blood clot include an immediate swelling of the leg. Blood clots could lead to the development of thrombophlebitis: inflammation of the vein due to a blood clot. In cases where the vein is very close to the surface of the skin, it may rupture and bleed as well. How can varicose veins be prevented? Because muscle activity helps pump blood back to the heart, the best way to reduce the risk of developing varicose veins is to improve muscle tone and circulation. This can be done by participating in the following: Exercising Weight management Eating a high-fiber, low-salt diet Avoiding tight clothing around the legs Avoiding high heels Elevating the legs Alternating between sitting and standing Avoiding sitting with legs crossed