Varicosities are abnormally dilated and tortuous veins that usually appear in the lower extremities. Varicosities in general occur as a result of an underlying problem with reverse venous flow, also known as venous insufficiency syndrome.
Healthy veins have one-way valves that are located at various levels, superficial to deep. They redirect blood in a systematic fashion from the outermost surface of the body toward the center and ultimately to the heart. At each step, these valves prevent backflow of blood. When these valves become incompetent and "leaky," blood back flows; this results in an increase in venous pressure in superficial veins. Since the superficial venous system operates as a low-pressure system, repeated increases in venous pressure result in enlarged and tortuous veins. In essence, varicosities are normal veins that have become dilated because of increased venous pressure set in motion by incompetent valves.
Most commonly, varicosities are either varicose veins or spider veins, which are also known as telangiectases. These varicosities are on the surface and visible. They can be uncomfortable, annoying, or just cosmetically concerning. Normal pregnancies may be complicated by mild to severe vulvovaginal varicosities.
Deeper varicosities are a sign of more significant problems and can result in serious and chronic conditions if left unrecognized and untreated. For instance, lipodermatosclerosis (LDS), which is associated with fat necrosis and recurrent ulcerations, can be a manifestation of untreated chronic venous insufficiency. In advanced cases of LDS, the proximal part of the lower extremity swells up as a result of the chronic venous obstruction. The distal part of the lower extremity in turn shrinks from all of the chronic ulcerations and fat necrosis. This combination results in an "inverted champagne bottle" appearance of the lower extremity. Occasionally an acute form of LDS can occur, and it is important to not misdiagnose it as cellulitis, inflammatory morphea, or erythema nodosum.
ICD10CM: I83.90 – Asymptomatic varicose veins of unspecified lower extremity
Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome) – Perform blood test to evaluate for iron-deficiency anemia, thrombocytopenia, and polycythemia; check urine for hematuria, and check stool for blood.
Varicose veins (varicosities) are twisted, enlarged veins at the skin surface. The word comes from the Latin word varix, which means "twisted."
Varicose veins occur due to poor functioning (malfunction) of valves in the deeper leg veins (venous insufficiency), making blood back up (pool) in the legs, with the resulting pressure causing surface veins to enlarge.
Who’s At Risk
Varicose veins affect up to 60% of American adults. Women are more often affected than men.
You are at greater risk if you:
Have other family members with varicose veins
Stand for long periods of time
Varicose veins often first occur during pregnancy, when the growing baby exerts pressure on the mother's leg veins.
Signs & Symptoms
Bulging, cord-like, twisted, soft, blue-to-purple swellings are seen on the legs, anywhere from the groin to the ankle. Many times there are no symptoms, but some people complain of burning, throbbing, muscle cramping, swelling, or an achy or heavy feeling in the legs.
Compression stockings (to help blood return to the heart and give extra support to the damaged veins) are the first thing to try. This may be difficult, as you must search for the proper kind, and they are tighter and require more effort to put on than regular hose and socks. However, wearing compression stockings is the most important thing you can do and will be required by any doctor you see.
For the maximum benefit, compression stockings must be worn every day and put on when first getting out of bed, before gravity has a chance to cause the legs to swell. Non-prescription compression (or pressure) stockings are sold in many pharmacies and medical supply stores. They are also available on the Internet. Many styles, colors, and strengths are available. Make sure they fit properly. You may need to measure your leg to assure proper fit. For people with arthritis, there are devices to help you put on compression stockings.
To prevent varicose veins from getting worse:
Avoid tight clothing, which holds back blood from returning to the heart
Elevate your legs
Avoid long periods of standing
When to Seek Medical Care
See your doctor if compression stockings do not improve your symptoms, if you have a breakdown in the skin (ulcer), or if you have severe swelling or pain in your leg.
You might also see a doctor if you are concerned with how the veins appear and are considering having them removed. Insurance will usually not cover treatment of varicose veins for cosmetic reasons.
If you have any signs of infection or skin breakdown, antibiotics or special dressings may be recommended.
An exam will be done to evaluate blood flow (circulation) in your leg. An ultrasound test may be done to check for a blood clot.
You may be referred to a vein specialist (phlebologist) to discuss treatment options, which include:
Endovenous (inside the vein) laser
Bolognia, Jean L., ed. Dermatology, pp.1635. New York: Mosby, 2003.