Varicose veins

Lots of people have varicose veins, enlarged, twisted veins that do not move blood as effectively as they should. For most people, it is a cosmetic issue, but for some people varicose veins may cause pain. In some cases serious complications, such as phlebitis (inflammation of the veins), skin ulcers, and blood clots, can happen.

Veins move blood from your body to your heart. When the one-way valves in your veins get weak, they may allow blood to flow backward and pool in your veins. That causes your veins to get bigger.

Varicose veins usually show up in the legs and feet, because standing and walking increases the pressure on these veins. They look like bulging, bluish cords beneath the surface of your skin. Spider veins are similar to varicose veins, but they are smaller and closer to the surface of your skin.

Up to 60% of people in the U.S. have varicose veins. They are more common in women than men. You may be able to take care of varicose veins at home, or your doctor may recommend treatment.

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Signs and Symptoms

You may have the following signs and symptoms along with varicose veins:

• Noticeable dark-blue blood vessels, especially in the legs and feet (not "spidery"-looking veins, which are smaller)
• Aching, tender, heavy, or sore legs
• A burning feeling in your lower legs
• Swelling in the ankles or feet, especially after standing
• Breaks in the skin
• Itching around the vein
• Skin ulcers near your ankle, which are serious and require immediate medical attention

What Causes It?

Varicose veins develop when your veins stretch and their valves, which stop blood from flowing backward, do not work anymore. Primary varicose veins happen when the walls of your veins become weak. Many people get them as they age, as do many pregnant women.

Secondary varicose veins are most often caused by problems with veins that lie deep among the muscles and carry about 90% of the blood back to your heart. These problems include blood clots and can be serious.

Who is Most At Risk?

You are at risk for varicose veins if you have the following conditions or characteristics:

• Family history. If other members of your family have varicose veins, your risk is greater.
• Female. 3 times more common among women.
• Age. Veins fail as we get older.
• Hormonal changes related to pregnancy, premenstrual period, and menopause
• Standing for long periods
• Being overweight
• Certain diseases
• Abnormal blood flow between arteries and veins

What to Expect at Your Provider's Office

If you have pain, burning, or sudden swelling associated with varicose veins, you should see your health care provider right away. Your provider will do a physical exam of your legs while you are standing. Your doctor also may do tests to see how well your veins are working and to distinguish between primary and secondary varicose veins. Your doctor may also do an ultrasound test to look for blood clots.

Treatment Options

In many cases, you can take care of mild pain from varicose veins on your own. Avoid long periods of sitting or standing, get regular exercise, lose weight, and elevate your legs often. However, studies investigating the effectiveness of compression stockings are conflicting. Speak to your doctor.

Prevention

Regular exercise helps veins work better. Weight loss and exercise also lower the likelihood of getting blood clots.

Surgical and Other Procedures

• Sclerotherapy. A doctor injects a solution into a varicose vein that scars and closes the vein, then applies a compression dressing, in order to make the vein disappear. This can be done in your doctor's office.
• Radiofrequency ablation. A catheter is threaded into the varicose vein to heat the vein wall, causing the vein to collapse and close.
• Laser surgeries. A laser sends a burst of light onto the vein, which makes it eventually disappear.
• Stripping the vein. Removal of the vein through a series of small incisions.
• Vein surgery. Generally only used in severe cases involving leg ulcers.

Complementary and Alternative Therapies

A comprehensive treatment plan for varicose veins may include several complementary and alternative therapies (CAM). Usually these therapies try to stop varicose veins from developing or getting worse, not make existing veins disappear. Be sure to work with your doctor to find which herbs and supplements may be right for you.

Nutrition

• Eat foods rich in dietary fiber, such as whole grains. Bioflavonoids found in dark berries, dark leafy greens, garlic, and onions help keep veins healthy.
• Supplements that may help include vitamin C, vitamin E, and zinc.
• Rutin is a bioflavonoid that may shore up the walls of veins and help them work better. A number of studies have shown that flavonoids that come from rutin relieve swelling, aching, and pain from varicose veins. Some evidence suggests that rutin might do the same.
• Oligomeric proanthocyandin complexes (OPCs). OPCs are bioflavonoids found in grape seed and pine bark. Similar flavonoids are found in cranberry, hawthorn, blueberry, and other plants. Several studies suggest they may reduce leakage in veins and swelling in the legs. Taking grape seed extract, along with a vitamin C supplement, may raise blood pressure. Check with your doctor. Grape seed extract may increase the risk of bleeding, especially if you also take blood thinners such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin. Grape seed extract may also interact with a number of other medications, so ask your doctor before taking it.

Herbs

Herbal remedies may offer relief from symptoms. Herbs are generally available as dried extracts (pills, capsules, or tablets), teas, or tinctures (alcohol extraction, unless otherwise noted). People with a history of alcoholism should not take tinctures. Dose for teas is 1 heaping tsp. per cup of water steeped for 10 minutes (roots need 20 minutes).

• Horse chestnut (Aesculus hippocastanum): Several scientific studies show that horse chestnut helps symptoms of chronic venous insufficiency, a condition associated with varicose veins. Make sure you use a trusted brand of horse chestnut, because homemade preparations can contain a toxic compound. DO NOT use horse chestnut if you have liver or kidney disease, or take blood-thinning medication, diabetes medications, or lithium. DO NOT take more than the recommended dosage. People who are allergic to latex may also be allergic to horse chestnut.
• Pycnogenol (Pinus pinaster): Studies suggest that pycnogenol, a pine bark extract, helps relieve symptoms of chronic venous insufficiency such as leg pain and heaviness. In some cases, it worked better than horse chestnut. Pycnogenol seems to stimulate the immune system, so people who have autoimmune diseases, such as rheumatoid arthritis or lupus, or those who take drugs to suppress their immune systems, should not take pycnogenol.
• Gotu kola (Centella asiatica): Several studies also suggest that gotu kola can help relieve symptoms of chronic venous insufficiency, including swelling and leakage from veins. DO NOT take gotu kola if you have liver disease. Gotu kola can interact with many medications that are processed by the liver, and may raise the risk of liver damage. Gotu kola can also interact with sedative medications, including clonazepam (Klonopin), lorazepam (Ativan), phenobarbital (Donnatal), and zolpidem (Ambien). To be safe, ask your doctor before taking gotu kola.
• Butcher's broom (Ruscus aculeatus): A few studies show that butcher's broom reduced swelling compared to placebo in people with chronic venous insufficiency. Butcher's broom may interact with some blood pressure medications and stimulant medication, including some over-the-counter allergy and decongestant medications. Some people may find it acts like a stimulant. Ask your doctor before taking butcher's broom.

Homeopathy

Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

Arnica Montana, for people whose legs appear bruised, and who have swollen veins that are painful to the touch. The legs tend to ache all over and feel worse with movement, but better when lying down.

Calcarea carbonica, for people with painful varicose veins who are easily fatigued and have poor circulation, with cold hands and feet. There may be a tendency toward being overweight and feeling anxious when working too much. The person may have a taste for sweets.

Hamamelis, for large varicose veins that may be tender to the touch. The legs may appear purple or bruised and may sting, and the person may also have bleeding hemorrhoids.

Pulsatilla, for swollen veins that feel heavy and warm at night, and ache. Symptoms are worse with warmth and better with cold.

Physical Medicine

Cold compresses of witch hazel (Hamamelis virginiana) and yarrow (Achillea millefolium) tea may provide temporary relief from pain and burning.

Prognosis/Possible Complications

Varicose vein disease is a long-lasting (chronic) condition. New varicose veins often form after treatment.

Following Up

Walking after sclerotherapy is important to help promote healing.

If you have had surgical treatment, contact your health care provider if you develop severe pain, tenderness, swelling, scabs, or blisters.

Supporting Research

Aesculus hippocastanum (Horse chestnut). Monograph. Altern Med Rev. 2009 Sep;14(3):278-83. Review.

Arcangeli P. Pycnogenol in chronic venous insufficiency. Fitoterapia. 2000;71:236-44.

Belcaro G, Rosaria Cesarone M, Ledda A, Cacchio M, Ruffini I, Ricci A, et al. O-(beta-hydroxyethyl)-rutosides systemic and local treatment in chronic venous disease and microangiopathy: an independent prospective comparative study. Angiology. 2008 Feb-Mar;59 Suppl 1:7S-13S.

Brinkhaus B, Lindner M, Schuppan D, Hahn EG. Chemical, pharmacological and clinical profile of the east Asian medical plant Centella asiatica. Phytomedicine. 2000;7:427-48.

Bush RG, bush P, Flanagan J, Fritz R, Gueldner T, Koziarski J, McMullen K, Zumbro G. Factors associated with recurrence of varicose veins after thermal ablation: results of the recurrent veins after thermal ablation study. Scientific World Journal . 2014;2014:505843.

Gohel MS, Davies AH. Pharmacological agents in the treatment of venous disease: an update of the available evidence. Curr Vasc Pharmacol. 2009 Jul;7(3):303-8. Review.

Kiesewetter H, Koscielny J, Kalus U, et al. Efficacy of orally administered extract of red vine leaf AS 195 (folia vitis viniferae) in chronic venous insufficiency (stages I-II). A randomized, double-blind, placebo-controlled trial. Arzneimittelforschung. 2000;50:109-17.

Koch R. Comparative study of venostatin and pycnogenol in chronic venous insufficiency. Phytother Res. 2002:16:S1-S5.

Meissner MH, Gloviczki P, Bergan J, Kistner RL, Morrison N, Pannier F, et al. Primary chronic venous disorders. J Vasc Surg. 2007 Dec;46 Suppl S:54S-67S. Review.

Naoum JJ, Hunter GC. Pathogenesis of varicose veins and implications for clinical management. Vascular. 2007 Sep-Oct;15(5):242-9. Review.

Naoum JJ, Hunter GC, Woodside KJ, Chen C. Current advances in the pathogenesis of varicose veins. J Surg Res. 2007 Aug;141(2):311-6.

Petrassi C, Mastromarino A, Spartera C. Pycnogenol in chronic venous insufficiency. Phytomedicine. 2000;7:383-8.

Rathbun SW, Kirkpatrick AC. Treatment of chronic venous insufficiency. Curr Treat Options Cardiovasc Med. 2007 Apr;9(2):115-26.

Sharma A, Drumsta D, Lee D. Duplex Ultrasonagraphy in the Management of Varicose Veins. Ultrasound Clinics . 2013;8(2).

Shingler S, Robertson L, Boghossian S, Stewart M. Compression stockings for the initial treatment of varicose veins in patients without venous ulceration. Cochrane Database Syst Rev. 2013;12;CD008819.

Thompson R, Lewis A, Weir C. Patient-reported quality of life after radiofrequency ablation of varicose veins compared to conventional surgery. Ir J Med Sci. 2013;182(4):639-42.

Vanscheidt W, Jost V, Wolna P, et al. Efficacy and safety of a Butcher's broom preparation (Ruscus aculeatus L. extract) compared to placebo in patients suffering from chronic venous insufficiency. Arzneimittelforschung. 2002;52:243-250.

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Supplements

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Review Date: 1/5/2015  

Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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