Varicose veins: a cosmetic matter or a vein disease?

A blue or purple vein on one person’s calf does not trouble them, and a prominent vein on another keeps them awake at night. In everyday talk both are called “varicose veins”. But medically they are not the same thing.

Two veins, two meanings

The UK’s National Health Service (NHS) describes spider veins of the legs, also called thread veins, as tiny, coloured veins that are usually harmless. It describes varicose veins as swollen, twisted veins under the skin that may stand out and look lumpy.

The cause of varicose veins is in the vein valves. The NHS says that when the valves do not work properly, blood collects in the vein, which swells and twists.

Only cosmetic, or does it have symptoms too?

The look of the vein cannot tell you. The symptoms can give a clue. The NHS lists these as the symptoms of varicose veins:

• Pain, aching or heaviness in the leg
• Swelling of the ankle and lower leg
• Itching, skin discolouration, dryness and flaking
• Getting worse after standing for a long time and better when the leg is raised

If you have a prominent vein and none of these, the problem is probably mostly one of appearance, but “probably” is not enough, because without an examination we do not know the state of the deep veins and valves. The NHS says varicose veins may get worse without treatment, but this usually happens very slowly over several years.

Complications

The NHS says varicose veins do not usually cause serious problems, but these may happen:

• Bleeding
• Varicose eczema: itchy, dry, flaking skin over the veins
• A venous ulcer: a sore that is slow to heal and is usually on the inner side of the lower leg between the knee and ankle
• A superficial clot: the vein becomes hard and painful
• Deep vein thrombosis

So the answer to “is it only cosmetic?” depends on the vein. If the vein has symptoms or the skin over it has changed, it is no longer only cosmetic.

Which sign should not be left for later?

The NHS says to see a doctor if you have pain, itching or swelling in the leg, a sore that has not healed in two weeks or veins that are getting worse. If a varicose vein bleeds, call 115 (the emergency number in Iran; outside Iran, your local emergency number) and, until help arrives, raise the leg and press on the spot. A hard, painful, warm and red vein should also be shown the same day, because it may come from a clot. Sudden swelling and pain in one leg needs assessment the same day, and if you also have shortness of breath or chest pain, call 115 (the emergency number in Iran; outside Iran, your local emergency number). The full list is under “When should I call urgently?”.

What does the examination say?

The doctor sees your whole leg and takes a history: when the symptoms started and whether varicose veins run in the family (Mayo Clinic). Then a Doppler ultrasound is usually needed. The Mayo Clinic names it as the standard way to assess varicose veins, and the American Vascular Surgery and American Venous Forum guideline recommends that the assessment of varicose veins be completed with a Doppler of both venous systems, superficial and deep.

A Doppler shows something that looking cannot: in which vein the blood flows back and whether the deep vein is healthy.

Do all varicose veins need a procedure?

No. The NHS says treatment is not always needed. Depending on the symptoms and the Doppler result, the options range from daily care and compression stockings to a procedure on the vein (sclerotherapy, laser or radiofrequency inside the vein, surgery). Which suits you is shown by an examination and a Doppler. The varicose veins page describes these methods.

If only the appearance bothers you

If the vein has no symptoms or complications and only its appearance bothers you, the decision to act is yours and your doctor’s. Insurers do not all cover treatment done only for appearance; ask your own.

Summary

A prominent vein is not only an appearance and is not always a disease. The symptoms, the skin and the blood flow are the three things that make the decision. If you do not know which group your vein belongs to, an examination and a Doppler will answer. And if you develop pain and swelling that come on suddenly, redness and warmth in one leg or shortness of breath, do not wait for a planned examination.