"Varicose Veins and Spider Veins". A brochure from U.S. Department of Health and Human Services, Office on Women’s Health

1. Frequently Asked Questions
Varicose
prevent blood from f lowing backwards
as it moves up your legs. If the valves
become weak, blood can leak back
into the veins and collect there. (This
Veins and problem is called venous insufficiency.)
When backed-up blood makes the veins
bigger, they can become varicose.
Spider Veins Spider veins can be caused by the back-
up of blood. They can also be caused by
hormone changes, exposure to the sun,
http://www.womenshealth.gov and injuries.
1-800-994-9662 Q: What are varicose veins and spi-
der veins? Q: How common are abnormal leg
TDD: 1-888-220-5446
A: Varicose (VAR-i-kos) veins are enlarged veins?
veins that can be blue, red, or f lesh-
A: About 50 to 55 percent of women and
colored. They often look like cords and
40 to 45 percent of men in the United
appear twisted and bulging. They can
States suffer from some type of vein
be swollen and raised above the surface
problem. Varicose veins affect half of
of the skin. Varicose veins are often
people 50 years and older.
found on the thighs, backs of the calves,
or the inside of the leg. During preg-
nancy, varicose veins can form around Q: What factors increase my risk of
the vagina and buttocks. varicose veins and spider veins?
Spider veins are like varicose veins but A: Many factors increase a person's chances
smaller. They also are closer to the of developing varicose or spider veins.
surface of the skin than varicose veins. These include:
Often, they are red or blue. They can • Increasing age. As you get older,
look like tree branches or spiderwebs the valves in your veins may weaken
with their short, jagged lines. They can and not work as well.
be found on the legs and face and can
• Medical history. Being born with
cover either a very small or very large
weak vein valves increases your risk.
area of skin.
Having family members with vein
problems also increases your risk.
Q: What causes varicose veins and About half of all people who have
spider veins? varicose veins have a family member
A: Varicose veins can be caused by weak or who has them too.
damaged valves in the veins. The heart • Hormonal changes. These occur
pumps blood filled with oxygen and during puberty, pregnancy, and
nutrients to the whole body through menopause. Taking birth control
the arteries. Veins then carry the blood pills and other medicines containing
from the body back to the heart. As estrogen and progesterone also may
your leg muscles squeeze, they push contribute to the forming of varicose
blood back to the heart from your lower or spider veins.
page 1 body against the f low of gravity. Veins
• Pregnancy. During pregnancy, there
have valves that act as one-way f laps to
U.S. Department of Health and Human Services, Office on Women’s Health

2. Frequently Asked Questions
is a huge increase in the amount of • Heaviness
blood in the body. This can cause • Swelling
veins to enlarge. The growing uterus
also puts pressure on the veins. • Rash that’s itchy or irritated
Varicose veins usually improve within • Darkening of the skin (in severe
three months after delivery. More cases)
varicose veins and spider veins usually
• Restless legs
appear with each additional pregnancy.
• Obesity. Being overweight or obese
can put extra pressure on your veins. Q: Are varicose veins and spider
http://www.womenshealth.gov This can lead to varicose veins. veins dangerous?
1-800-994-9662 A: Spider veins rarely are a serious health
• Lack of movement. Sitting or
problem, but they can cause uncom-
TDD: 1-888-220-5446 standing for a long time may force
fortable feelings in the legs. If there
your veins to work harder to pump
are symptoms from spider veins, most
blood to your heart. This may be a
often they will be itching or burning.
bigger problem if you sit with your
Less often, spider veins can be a sign
legs bent or crossed.
of blood backup deeper inside that you
• Sun exposure. This can cause spi- can’t see on the skin. If so, you could
der veins on the cheeks or nose of a have the same symptoms you would
fair-skinned person. have with varicose veins.
Varicose veins may not cause any prob-
Q: Why do varicose veins and spider lems, or they may cause aching pain,
veins usually appear in the legs? throbbing, and discomfort. In some
A: Most varicose and spider veins appear cases, varicose veins can lead to more
in the legs due to the pressure of body serious health problems. These include:
weight, force of gravity, and task of • Sores or skin ulcers due to chronic
carrying blood from the bottom of the (long-term) backing up of blood.
body up to the heart. These sores or ulcers are painful and
Compared with other veins in the hard to heal. Sometimes they cannot
body, leg veins have the toughest job of heal until the backward blood f low
carrying blood back to the heart. They in the vein is repaired.
endure the most pressure. This pressure • Bleeding. The skin over the veins
can be stronger than the one-way valves becomes thin and easily injured.
in the veins. When an injury occurs, there can be
significant blood loss.
Q: What are the signs of varicose • Superf icial thrombophlebitis
veins? (throm-bo-f li-BYT-uhs), which
A: Varicose veins can often be seen on the is a blood clot that forms in a vein
skin. Some other common symptoms of just below the skin. Symptoms
varicose veins in the legs include: include skin redness; a firm, ten-
der, warm vein; and sometimes
• Aching pain that may get worse after
pain and swelling.
page 2 sitting or standing for a long time
• Deep vein thrombosis, which is
• Throbbing or cramping
a blood clot in a deeper vein. It can
U.S. Department of Health and Human Services, Office on Women’s Health

3. Frequently Asked Questions
cause a “pulling” feeling in the calf, used to see the veins’ structure, check the
pain, warmth, redness, and swelling. blood flow in your veins, and look for
However, sometimes it causes no sig- blood clots. This test uses sound waves to
nificant symptoms. If the blood clot create pictures of structures in your body.
travels to the lungs, it can be fatal. Although less likely, you might have
a venogram. This test can be used to
Q: Should I see a doctor about vari- get a more detailed look at blood f low
cose veins? through your veins.
A: You should see a doctor about varicose If you seek help for your varicose veins,
veins if: there are several types of doctors you
http://www.womenshealth.gov
can see, including:
• The vein has become swollen, red,
1-800-994-9662 • A phlebologist, which is a vein spe-
or very tender or warm to the touch
TDD: 1-888-220-5446 cialist
• There are sores or a rash on the leg
or near the ankle • A vascular medicine doctor, who
focuses on the blood system
• The skin on the ankle and calf
becomes thick and changes color • A vascular surgeon, who can perform
surgery and do other procedures
• One of the varicose veins begins to
bleed • An interventional radiologist, who
specializes in using imaging tools
• Your leg symptoms are interfering
to see inside the body and do treat-
with daily activities
ments with little or no cutting
• The appearance of the veins is caus-
• A dermatologist, who specializes in
ing you distress
skin conditions
If you’re having pain, even if it’s just
Each of these specialists do some or all
a dull ache, don’t hesitate to get help.
of the procedures for treating varicose
Also, even if you don’t need to see a
veins. You might start out by asking your
doctor about your varicose veins, you
regular doctor which specialist he or she
should take steps to keep them from
recommends. You also might check with
getting worse (see How can I prevent
your insurance plan to see if it would pay
varicose veins and spider veins?).
for a particular provider or procedure.
Q: How are varicose veins diag- Q: How are varicose and spider
nosed? veins treated?
A: Your doctor may diagnose your vari- A: Varicose veins are treated with lifestyle
cose veins based on a physical exam.
changes and medical treatments. These
Your doctor will look at your legs while
can:
you’re standing or sitting with your legs
dangling. He or she may ask you about • Relieve symptoms
your symptoms, including any pain • Prevent complications
you’re having. Sometimes, you may have
• Improve appearance
other tests to find out the extent of the
problem and to rule out other disorders. Your doctor may recommend lifestyle
page 3
changes if your varicose veins don’t
You might have an ultrasound, which is
U.S. Department of Health and Human Services, Office on Women’s Health

4. Frequently Asked Questions
cause many symptoms. If symptoms are with healing and decrease swelling.
more severe, your doctor may recom- This treatment is very effective when
mend medical treatments. Some treat- done correctly.
ment options include: Possible side effects include:
Compression Stockings • Stinging, red and raised patches of
Compression stockings put helpful skin, or bruises where the injection
pressure on your veins. There are three was made. These usually go away
kinds of compression stockings: shortly after treatment.
• Support pantyhose, which offer the • Spots, brown lines, or groups of fine
least amount of pressure. These also red blood vessels around the treated
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often are not “gradient” or “gradu- vein. These also usually go away
1-800-994-9662 ated.” That means they provide shortly after treatment.
TDD: 1-888-220-5446 pressure all over instead of where it
is needed most. • Lumps of blood that get trapped
in the vein and cause inf lamma-
• Over-the-counter gradient compres- tion. This is not dangerous. You can
sion hose, which give a little more relieve swelling by applying heat and
pressure. They are sold in medical taking aspirin. Your doctor can drain
supply and drugstores. the trapped blood with a small pin-
• Prescription-strength gradient prick at a follow-up visit.
compression hose, which offer the There is a type of sclerotherapy called
greatest amount of pressure. They ultrasound-guided sclerotherapy (or
are sold in medical supply and drug- echo-sclerotherapy). This type of
stores. You need to be fitted for sclerotherapy uses ultrasound imaging
them by someone who has been to guide the needle. It can be useful
trained to do this. in treating veins that cannot be seen
Sclerotherapy on the skin’s surface. It may be used
Sclerotherapy (SKLER-o-ther-a-pee) is after surgery or endovenous techniques
the most common treatment for both if the varicose veins return. This
spider veins and varicose veins. The procedure can be done in a doctor’s
doctor uses a needle to inject a liquid office. Possible side effects include skin
chemical into the vein. The chemi- sores, swelling, injection into an artery
cal causes the vein walls to swell, stick by mistake, or deep vein thrombosis (a
together, and seal shut. This stops the potentially dangerous blood clot).
f low of blood, and the vein turns into Surface Laser Treatments
scar tissue. In a few weeks, the vein In some cases, laser treatments can
should fade. This treatment does not effectively treat spider veins and smaller
require anesthesia and can be done in varicose veins. This technique sends
your doctor's office. You can return to very strong bursts of light through the
normal activity right after treatment. skin onto the vein. This makes the vein
The same vein may need to be treated slowly fade and disappear. Not all skin
more than once. Treatments are usually types and colors can be safely treated
done every four to six weeks. You may with lasers.
page 4 be asked to wear gradient compression No needles or incisions are used, but
stockings after sclerotherapy to help the heat from the laser can be quite
U.S. Department of Health and Human Services, Office on Women’s Health

5. Frequently Asked Questions
painful. Cooling helps reduce the pain. connected veins can be treated with
Laser treatments last for 15 to 20 min- sclerotherapy or other techniques.
utes. Generally, two to five treatments Surgery
are needed to remove spider veins in Surgery is used mostly to treat very
the legs. Laser therapy usually isn’t large varicose veins. Types of surgery
effective for varicose veins larger than for varicose veins include:
3 mm (about a tenth of an inch). You
• Surgical ligation and stripping.
can return to normal activity right after
With this treatment, problem veins
treatment.
are tied shut and completely removed
Possible side effects of lasers include: from the leg through small cuts in
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• Redness or swelling of the skin right the skin. Removing the veins does
1-800-994-9662 after the treatment that disappears not affect the circulation of blood
TDD: 1-888-220-5446 within a few days in the leg. Veins deeper in the leg
• Discolored skin that will disappear take care of the larger volumes of
within one to two months blood. This surgery requires general
anesthesia and must be done in an
• Burns and scars from poorly per- operating room. It takes between one
formed laser surgery, though this is and four weeks to recover from the
rare surgery. This surgery is generally safe.
Endovenous Techniques Pain in the leg is the most common
(Radiofrequency and Laser) side effect. Other possible problems
These methods for treating the deeper include:
veins of the legs, called the saphenous • A risk of heart and breathing
(SAF-uh-nuhs) veins, have replaced problems from anesthesia
surgery for most patients with severe
varicose veins. These techniques can be • Bleeding and congestion of
done in a doctor’s office. blood. But, the collected blood
usually settles on its own and
The doctor puts a very small tube, does not require any further
called a catheter, into the vein. A small treatment.
probe is placed through the tube. A
device at the tip of the probe heats up • Wound infection, inf lammation,
the inside of the vein and closes it off. swelling, and redness
The device can use radiofrequency or • Permanent scars
laser energy to seal the vein. The proce-
• Damage of nerve tissue around
dure can be done using just local anes-
the treated vein. It’s hard to avoid
thesia. You might have slight bruising
harming small nerve branches
after treatment.
when veins are removed. This
Healthy veins around the closed vein damage can cause numbness,
take over the normal f low of blood. burning, or a change in feeling
The symptoms from the varicose vein around the scar.
improve. Usually, veins on the surface
of the skin that are connected to the • A deep vein blood clot. These
treated varicose vein will also shrink clots can travel to the lungs and
page 5 after treatment. If they don’t, these heart. The medicine heparin may
U.S. Department of Health and Human Services, Office on Women’s Health

6. Frequently Asked Questions
be used to reduce the chance strength. Focus on exercises that work
of these dangerous blood clots. your legs, such as walking or running.
But, heparin also can increase the • Control your weight to avoid plac-
normal amount of bleeding and ing too much pressure on your legs.
bruising after surgery.
• Don’t cross your legs for long times
• PIN stripping. In this treatment, when sitting. It’s possible to injure
an instrument called a PIN stripper your legs that way, and even a minor
is inserted into a vein. The tip of the injury can increase the risk of vari-
PIN stripper is sewn to the end of cose veins.
the vein, and when it is removed, the
http://www.womenshealth.gov vein is pulled out. This procedure • Elevate your legs when resting as
1-800-994-9662 can be done in an operating room or much as possible.
an outpatient center. General or local • Don’t stand or sit for long periods
TDD: 1-888-220-5446
anesthesia can be used. of time. If you must stand for a long
• Ambulatory phlebectomy. With time, shift your weight from one
ambulatory phlebectomy (AM-byoo- leg to the other every few minutes.
luh-TOHR-ee fluh-BEHK-toh- If you must sit for long periods of
mee), tiny cuts are made in the skin, time, stand up and move around or
and hooks are used to pull the vein take a short walk every 30 minutes.
out of the leg. Only the parts of • Wear elastic support stockings and
your leg that are being pricked will avoid tight clothing that constricts
be numbed with anesthesia. The your waist, groin, or legs.
vein is usually removed in one treat-
• Avoid wearing high heels for long
ment. Very large varicose veins can
periods of time. Lower-heeled shoes
be removed with this treatment while
can help tone your calf muscles to
leaving only very small scars. Patients
help blood move through your veins.
can return to normal activity the day
after treatment. Possible side effects • Eat a low-salt diet rich in high-
of the treatment include slight bruis- fiber foods. Eating fiber reduces the
ing and temporary numbness. chances of constipation, which can
contribute to varicose veins. High-
fiber foods include fresh fruits and
Q: How can I prevent varicose vegetables and whole grains, like
veins and spider veins? bran. Eating less salt can help with
A: Not all varicose and spider veins can the swelling that comes with vari-
be prevented. But, there are some steps cose veins.
you can take to reduce your chances of
getting new varicose and spider veins.
These same things can help ease discom- Q: Can varicose and spider veins
fort from the ones you already have: return even after treatment?
• Wear sunscreen to protect your skin A: Current treatments for varicose veins
from the sun and to limit spider and spider veins have very high success
veins on the face. rates compared to traditional surgi-
cal treatments. Over a period of years,
page 6 • Exercise regularly to improve your
leg strength, circulation, and vein
U.S. Department of Health and Human Services, Office on Women’s Health

7. Frequently Asked Questions
however, more abnormal veins can this problem under control.
develop because there is no cure for The single most important thing you
weak vein valves. Ultrasound can be can do to slow down the development
used to keep track of how badly the of new varicose veins is to wear gradi-
valves are leaking (venous insufficien- ent compression support stockings as
cy). Ongoing treatment can help keep much as possible during the day. n
For more information
http://www.womenshealth.gov For more information on varicose and spider veins, call womenshealth.gov at 1-800-994-
9662 or contact the following organizations:
1-800-994-9662
TDD: 1-888-220-5446 National Heart Lung and Blood American Society for Dermatologic
Institute (NHLBI) Surgery
Phone Number: 301-592-8573 Phone Number: 847-956-0900
Internet Address: http://www.nhlbi.nih.gov Internet Address: http://www.asds.net
The American College of Phlebology The American Venous Forum
Phone Number: 510-346-6800 Phone Number: 978-744-5005
Internet Address: http://www.phlebology.org Internet Address: http://veinforum.org
American Academy of Dermatology Society of Interventional Radiology
Phone Number: 847-240-1280; Toll-Free: Phone Number: 703-691-1805; Toll-Free:
866-503-SKIN (7546) 800-488-7284
Internet Address: http://www.aad.org Internet Address: http://www.sirweb.org
Reviewed by:
Robert J. Min, M.D.
Chairman of Radiology
Weill Cornell Medical College
Melvin Rosenblatt, M.D.
Chairman, Public Education Committee
American College of Phlebology
All material contained in this FAQ is free of copyright restrictions, and may be copied,
reproduced, or duplicated without permission of the Office on Women's Health in the
Department of Health and Human Services. Citation of the source is appreciated.
Content last updated June 2, 2010.
page 7
U.S. Department of Health and Human Services, Office on Women’s Health