Varicose veins are abnormal veins that become large and tortuous. As a result, varicose veins bulge out and can be seen at the surface of the skin. They appear as rope-like structures protruding out from the skin and can occur throughout the legs and ankles.
Varicose veins typically start to develop in the second and third decade of life, and women are affected more frequently and earlier in life than men. This has been linked to female hormones that are thought to decrease vein wall elasticity. Varicose veins occur due to venous reflux disease, in which vein valves do not function and blood backs up in the legs.
Varicosities are related to a family history of varicose veins in at least a third of patients. Some of the known risk factors for the development of varicose veins include pregnancy, obesity, lifestyle related to prolonged standing and history of blood clots leading to chronic vein injury. Patients who are older tend to have more severe varicose vein changes, but not infrequently, young patients also encounter advanced varicose vein symptoms.
Varicose veins can manifest as a wide variety of symptoms depending on how advanced the disease process is. Initially, patients may have nonspecific complaints of pressure such as aches and heaviness in the calves that are especially present at the end of the day and are relieved with leg elevation. This can be accompanied by swelling located in the areas of the ankles and lower calves.
Patients usually resolve most if not all their symptoms after a night of rest, but the symptoms promptly return once their daily activities are resumed. At this stage of the disease, patients may have visible clusters of very small red or blue veins called spider veins, as well as slightly larger reticular veins. As the disease progresses, patients develop large, bulging veins, which appear either individually or in clusters.
At later stages of the disease, increased blood pressure spreads into surrounding tissues and initiates chronic skin changes. Patients can develop irreversible skin discoloration that is especially seen in the inner ankle areas. Skin becomes dry, scaly, thinned and prone to infections known as cellulites. At this point of the chronic venous disease, patients may suffer from frequent calf ulcers that start either spontaneously or after even minimal injury. These ulcers are deep, heal poorly, are long-lasting and often recur. They are frequently a source of a significant number of patients