HEART & BLOOD Cardiovascular System • Aortic aneurysm • High blood pressure (hypertension) • High blood cholesterol • Thrombophlebitis • Rheumatic fever • Varicose veins • Heart arrhythmias • Atrial fibrillation • Endocarditis • Aortic valve stenosis • Aortic valve regurgitation • Mitral valve stenosis • Mitral valve regurgitation • Pulmonary hypertension • Raynaud's disease • Long QT syndrome • Mitral valve prolapse • Pericarditis • Cardiomyopathy • Myocarditis • Arteriosclerosis / Atherosclerosis • Peripheral arterial disease (PAD) • Low blood pressure (hypotension) • Aortic dissection • Lymphedema • Pulmonary valve stenosis • Ventricular septal defect (VSD) • Tetralogy of Fallot • Coarctation of the aorta • Atrial septal defect (ASD) • Patent ductus arteriosus (PDA) • Left ventricular hypertrophy • Bundle branch block • Heart murmurs • Patent foramen ovale • Transposition of the great arteries • Hypoplastic left heart syndrome • Sudden cardiac arrest • Prehypertension • Tricuspid atresia • Ebstein's anomaly • Buerger's disease

Note: All links within content go to MayoClinic.com

Varicose veins are gnarled, enlarged veins. The word varicose comes from the Latin root varix, which means "twisted." Any vein may become varicose, but the veins most commonly affected are those in your legs and feet. That's because you stand and walk upright, which increases the pressure in the veins in your lower body.

For many people, varicose veins and spider veins — a common, mild and medically insignificant variation of varicose veins — are simply a cosmetic concern. For other people, varicose veins can cause aching pain and discomfort. Sometimes the condition leads to more serious problems. Varicose veins may also signal a higher risk of other disorders of the circulatory system.

Varicose veins are a common condition in the United States, affecting up to 60 percent of all Americans. Women, especially older women, are more likely than men are to have this problem. Treatment may involve self-help measures, or procedures by your doctor to close or remove veins.

Signs and symptoms of varicose veins may include:

• An achy or heavy feeling in your legs, and burning, throbbing, muscle cramping and swelling in your lower legs. Prolonged sitting or standing tends to make your legs feel worse.
• Itching around one or more of your veins.
• Skin ulcers near your ankle, which represent a severe form of vascular disease and require immediate attention.

Varicose veins are dark purple or blue in color and may appear twisted and bulging — like cords. They commonly appear on the backs of the calves or on the inside of the legs. But, they can form anywhere on your legs, from your groin to your ankle.

Spider veins are similar to varicose veins, but they're smaller. Spider veins are found closer to the skin's surface and are often red or blue. They occur on the legs, but can also be found on the face. Spider veins vary in size and often look like a spider's web or a tree branch.

Other types of varicose veins include:

• Venous lakes. These are pools of blood in the veins, often found on the face and neck.
• Reticular veins. These flat, blue veins under the skin often appear behind the knee.
• Telangiectases. These are fine clusters of blood vessels similar to spider veins, reddish in color and often found on the face or upper body.

Occasionally, veins deep within the legs become enlarged. In such cases, the affected leg may swell considerably. Any sudden leg swelling that may or may not be accompanied by pain and redness warrants urgent medical attention, as it may indicate a blood clot — a condition known medically as thrombophlebitis.

Arteries carry blood from your heart to the rest of your tissues. Veins return blood from the rest of your body to your heart, so the blood can be recirculated. To return blood to your heart, the veins in your legs must work against gravity. Muscle contractions in your lower legs act as pumps, while toned, elastic vein walls help blood return to your heart. Tiny one-way valves in your veins open as blood flows toward your heart then close to stop blood from flowing backward.

Varicose veins occur when the valves in your veins malfunction. As you get older your veins can lose elasticity, causing them to stretch. When this happens, blood that should be moving toward your heart may flow backward. Blood pools in your veins, and your veins enlarge and become varicose. The veins appear blue because they contain deoxygenated blood, which is in the process of being recirculated.

Some pregnant women develop varicose veins. Pregnancy increases the volume of blood in your body, but decreases the flow of blood from your legs to your pelvis. This circulatory change is designed to support the growing fetus, but it can produce an unfortunate side effect — enlarged veins in your legs. Varicose veins may surface for the first time or may worsen during late pregnancy, when your uterus exerts greater pressure on the veins in your legs. Hemorrhoids are varicose veins located in and around the anus.

These factors increase your risk of developing varicose veins:

• Age. Aging causes wear and tear on the valves in your veins that help regulate blood flow. Eventually, that wear causes the valves to malfunction.
• Sex. Women are more likely than men are to develop the condition. Hormonal changes during pregnancy, premenstruation or menopause may be a factor. Female hormones tend to relax vein walls. Taking hormone replacement therapy or birth control pills may increase your risk of varicose veins.
• Genetics. If other family members had varicose veins, there's a greater chance you will too.
• Obesity. Being overweight puts added pressure on your veins.
• Standing for long periods of time. Your blood doesn't flow as well if you're in the same position for long periods.

Self-help measures can help you ease the pain of varicose veins and may prevent them from getting worse. But if you're concerned about how your veins look and feel and self-care measures haven't stopped your condition from getting worse, see your doctor.

In making a diagnosis, your doctor will examine your legs while you're standing and will look for swelling. He or she may also ask you to describe the pain and aching in your legs. Finally, your doctor may perform an ultrasound test to see if there's any evidence of a blood clot. Your primary care doctor may recommend that you see a doctor who specializes in vein conditions (phlebologist) or a doctor who treats skin conditions (dermatologist or dermatology surgeon).

Sometimes, extremely painful ulcers may form on the skin near varicose veins, particularly near the ankles. Ulcers are the result of long-term "water logging" of these tissues, caused by increased pressure of blood within affected veins. Brownish pigmentation usually precedes the development of an ulcer. Ulcers require urgent medical attention.

Fortunately, treatment usually doesn't mean a hospital stay or a long, uncomfortable recovery. Less invasive techniques generally allow varicose veins to be dealt with on an outpatient basis. Self-help measures — such as exercising, losing weight, not wearing tight clothes, elevating your legs and avoiding long periods of standing or sitting — can ease pain and prevent varicose veins from getting worse. Varicose veins that develop during pregnancy generally improve without medical treatment within three months after delivery.

If your varicose veins don't respond to self-help or if they're more severe, your doctor may advise one of these treatments:

• Sclerotherapy. In this procedure, your doctor injects small- and medium-sized varicose veins with a solution that scars those veins. The process closes the veins, forcing your blood to reroute to healthier veins. In a few weeks, treated varicose veins should fade. Although the same vein may need to be injected more than once, sclerotherapy is effective if done correctly. In addition, a new and improved type of sclerotherapy, called microsclerotherapy, uses improved solutions and injection techniques that increase the success rate for removal of spider veins. Sclerotherapy doesn't require anesthesia and can be done in your doctor's office.
• Laser surgeries. Doctors are using laser procedures more commonly to close off smaller varicose veins and spider veins, especially on the upper body and the face. In the past, varicose veins in the legs didn't respond consistently to laser treatments, and some doctors doubted whether laser surgery actually worked. Now, however, new technology in laser treatments can effectively treat varicose veins in the legs. Laser surgery works by sending strong bursts of light onto the vein, which makes the vein slowly fade and disappear. No incisions or needles are used.
• Catheter-assisted procedures. In one of these treatments, your doctor inserts a thin tube (catheter) into an enlarged vein and heats the tip of the catheter. As the catheter is pulled out, the heat destroys the vein by causing it to collapse and seal shut. This procedure is usually done for larger varicose veins. Other catheter-assisted methods use a blade to destroy varicose veins or radio waves to close them.
• Vein stripping. This procedure involves removing a long vein through small incisions. This is an outpatient procedure for most people. Removing the vein won't affect circulation in your leg because veins deeper in the leg take care of the larger volumes of blood.
• Ambulatory phlebectomy (fluh-BEK-to-me). Your doctor removes smaller varicose veins through a series of tiny skin punctures. Local anesthesia is used in this outpatient procedure. Scarring is generally minimal.
• Endoscopic vein surgery. You might need this operation only in an advanced case involving leg ulcers. Your surgeon uses a thin video camera inserted in your leg to visualize and close veins. Only small incisions are needed.

When it comes to treatment options for varicose veins, it pays to be a cautious health consumer. Advertisements claiming "unique," "permanent" or "painless" methods to remove varicose veins may be appealing, but they may not actually measure up to those claims. Before undergoing any procedure, ask your doctor about any health risks and possible side effects.

You may want to inquire about treatment costs, as well. Most insurance policies don't cover the expense of elective cosmetic surgery for varicose veins. However, in many cases, if you have signs or symptoms such as swelling and bleeding, insurance may cover the treatment.

Current treatments for varicose veins and spider veins are highly successful. However, it's possible that varicose veins can recur.

There's no way to completely prevent varicose veins. But improving your circulation and muscle tone can reduce the risk of developing varicose veins or getting additional ones. To improve circulation and muscle tone, follow these tips:

• Exercise. Get your legs moving. Walking is a great way to encourage blood circulation in your legs. Your doctor can recommend an appropriate activity level for you.
• Control your weight. Shedding excess pounds takes unnecessary pressure off your veins.
• Watch what you wear. Avoid high heels. Low-heeled shoes work calf muscles more, which is better for your veins. Don't wear tight clothes around your waist, legs or groin. Tight panty-leg girdles, for instance, can restrict circulation.
• Elevate your legs. To improve venous circulation, take several short breaks daily to elevate your legs above the level of your heart. For example, lie down with your legs resting on three or four pillows.
• Avoid long periods of sitting or standing. Make a point of changing your position frequently to encourage blood flow. Try to move around at least every 30 minutes.
• Don't sit with your legs crossed. This position can aggravate circulation problems.

Wearing compression stockings is often the first approach to try before moving on to other treatments. Compression stockings are worn all day long. They steadily squeeze your legs, helping veins and leg muscles move blood more efficiently. The amount of compression varies by type and brand.

Some people think of compression stockings as being uncomfortable and unstylish, but their negative fashion reputation is no longer deserved. Stockings today come in a variety of strengths, styles and colors. With the variety offered, you're likely to find a stocking that you're comfortable wearing.

Compression stockings are sold at most pharmacies and medical supply stores. Prices vary. Prescription-strength stockings also are available.

When purchasing compression stockings, make sure that they fit properly. Using a tape measure, you or your pharmacist can measure your legs to ensure you get the right size and fit according to the size chart found on the stocking package. Compression stockings should be strong but not necessarily tight. If you have weak hands or arthritis, getting these stockings on may be difficult. There are devices to make putting them on easier.

You may be tempted to try one of the many herbal supplements that claim to prevent varicose veins or get rid of them. The active ingredient in most of the products is horse chestnut. It may be possible that herbal supplements will beneficially affect some signs and symptoms of varicose veins, but it's not likely that herbal supplements will do much to eliminate the veins or relieve the pain they might cause. Additionally, there are concerns about the purity of herbal supplements because the Food and Drug Administration doesn't regulate these products as closely as they do prescription medications.