Varicose Veins: Types, Causes, Symptoms, Complications, Diagnosis and Treatment

A varicose vein is a diseased vein whose walls have been permanently and irreversibly dilated in a specific location.

Varicose veins are hyper-dilated veins. They are observed in quite bluish or purple colors, sinuous and prominent.

It is a dilated and damaged vein through which the blood is difficult to circulate correctly and stagnates.

If left untreated, a varicose vein can be a source of serious complications, such as ulcers, phlebitis, or clots.

Varicose veins are abnormally swollen and tortuous veins often visible above the skin.

They can range from small (2 to 3 mm wide) to very large (2 to 3 cm wide).

Tiny veins are commonly referred to as ‘string veins’ or ‘ spider veins. ‘


These veins are different from varicose veins because they are much closer to or within the overlying skin.

Although they can be unsightly, they are not the same as varicose veins and can be more challenging to treat.

Reticular veins are conspicuous varicose veins present under the skin and are easily visible but considerably smaller than the more prominent knotty veins.

Reticular veins can only bulge the skin slightly, if at all, whereas varicose veins tend to produce a marked bulge of the skin.

A varicose vein is not due to accelerated aging of the body:

  • It is a pathology that results from the progressive deformation of the vein.
  • This is the consequence of chronic venous insufficiency, directly affecting the blood vessel wall.

In a usual vein, the valves provide the antireflux function:

  • They guide the blood in the direction of the heart so that it circulates in only one order.
  • Thanks to their impermeability, the valves prevent blood from stagnating.

Unlike a usual vein, the valves of a vein no longer provide their antireflux and lose their impermeability.

The blood stagnates and pools in certain vein sections, forming a varicose vein when standing up.

When deformed, the wall of the chickenpox, the varicose vein, swells and twists like a snake under the skin.

The affected vein wall presents hypertrophy and atrophy:

  • Each dilation of the vein corresponds to a pocket of blood.
  • Blood that stagnates in the bag is no longer oxygenated and releases toxins that weaken the varicose vein wall.
  • Absorbed, the wall is refined, and the vein swells.
  • The hypermediated vein swells on the surface of the skin:
  • It appears blue or purple, forming a kind of cords.

Varicose veins are described as snakes under the skin.

They appear in different places, but the most common are those that form on the back of the calves, on the inside of the leg or on the thigh.

Different types of varicose veins

Different types of varicose veins are classified according to their size and location.

The most common varicose veins are those that affect the legs and thighs.

These are generally called large varicose veins, meaning that the diameter of the vein varies between 0.6 and 4 millimeters.

There are varicose veins:

On the legs and thighs

  • This is the most common type of varicose vein.
  • It mainly affects women.
  • They are in the form of protruding, bluish, and twisted veins along the lower extremities.

At the scrotum level

  • In this case, we speak of varicocele.
  • This type of male varicose vein appears on a testicle in the form of a soft mass.

At the level of the vulva or perineum

  • This is pelvic varix.
  • Pelvic varicose veins form in the lower abdomen in women, often during pregnancy.

In the esophagus

  • They are called esophageal varices.
  • They are challenging to diagnose and usually only appear after the break.

On the face, we talk about facial varicose veins.

  • They are more delicate and more superficial than varicose veins on the legs.
  • They look like trees or spider webs on the skin, red or blue.

At the level of the rectum

  • This is the case with what we commonly refer to as hemorrhoids.


The following factors may put you at increased risk of developing varicose veins or varicose veins.

Although the causes of venous disease are not yet clearly identified, we must differentiate between varicose veins and chronic venous insufficiency, considering the risk factors.


If there are members who have suffered from varicose veins in the family, then there is a reasonably high possibility that a person may also develop varicose veins.

Of course, not all cases are genetic, but the predisposition to develop varicose veins in families with a history of varicose veins is.


Women are more likely to develop varicose or varicose veins (although 25% of cases occur in men).

Some research has indicated that increased levels of female hormones can cause relaxation of the vein walls and possible failure.

The pregnancy

The enlarged uterus can cause increased pressure on all of the veins.

In combination with elevated hormone levels, many women develop varicose veins for the first time during or shortly after pregnancy.

These veins generally worsen in later pregnancies and may improve somewhat after delivery.


As you age, the elasticity in the vein walls decreases, which increases the chance that the valves will fail and varicose veins will develop.

The obesity

Gaining or being overweight increases the risk of varicose veins or venous insufficiency.

This may be due to increased pressure on the venous system in obese individuals or disruption of valve geometry in tissues.

Losing weight often helps relieve symptoms of venous insufficiency in obese patients.

The lifestyle

People whose occupations require them to stand or sit for long periods, such as waitresses, and hairdressers, are statistically more likely to develop varicose veins than those who do not have this type of job.


Trauma can damage veins and cause valves to fail, leading to symptoms of venous insufficiency.

Trauma can mean anything from a broken leg in adolescence, to knee or hip surgery, to a blunt injury that never caused the broken bones.

It is important to share any history of past trauma with your doctor.

Symptoms of varicose veins

Varicose veins often cause no symptoms but can be cosmetically unattractive.

In some cases, varicose veins cause heaviness in the legs, sometimes with symptoms of cramps and itching.

Many women notice that their varicose veins become more prominent and symptomatic during pregnancy.

In many patients, these problems will resolve after the baby is born.

Unfortunately, the symptoms of varicose veins are pretty nonspecific, and it is difficult to relate the threat of symptoms to the severity of the venous disease. Still, the venous disease has been shown to affect the quality of life significantly.

In some cases where varicose veins are large, ulcers can form on the lower leg (venous ulcers), affecting the quality of life.

These ulcers can often be cured with simple dressings and stockings without the need for surgery or other interventions.

Many people think about the visual appearance of varicose veins: raised, curved, swollen, purplish, or knotted veins, but they may not realize that the feelings they are experiencing may be symptoms of vein disease.

They may think that what they feel is normal. When symptoms of vein disease occur, they are the following:

  • Pain, throbbing or generalized in the legs.
  • Fatigue and heaviness in the legs, feeling tired or heavy.
  • Tingling, itching, and burning
  • Tenderness in the legs and around the veins.
  • Swelling in the legs Vein problems is 8 to 10 times more likely to cause leg swelling than other causes combined.

Varicose vein symptoms generally progress over time without treatment.

Complications of untreated varicose veins

Without treatment, symptoms can progress to more severe complications.

The most severe complications of vein disease are thrombosis or phlebitis.

Superficial thrombophlebitis

This is due to the formation of blood clots in the varicose vein.

Superficial varicose veins become red, hot, tender, and painful, and blood clots form in the superficial veins.

This can take many weeks to resolve. Sometimes when severe phlebitis has resolved, varicose veins can disappear.

deep vein thrombosis

It is a blood clot that forms in a deep vein in the body.

They can break off and cause a pulmonary embolism, heart attack, or stroke.

Chronic venous insufficiency

The development of brown discoloration of the skin at the ankle (pigmentation), varicose eczema, and thickening of the tissues around varicose veins are signs of more extensive tissue damage.

Ulceration of varicose veins

When the tissue damage becomes terrible enough, ulcers can develop on the skin just above the ankle.

Many patients are concerned when they hear the term ulceration, but it only means that there has been a loss of skin and that the tissues under the skin are exposed.

They are later stages of vein diseases. These ulcers are sores that take a long time to heal or do not heal.

The skin may also turn reddish or brown.


Varicose vein bleeding is relatively uncommon, especially in large bulbous varicose veins.

If bleeding does occur, it tends to be from very shallow and more minor venous blisters on the skin.

Vein bleeding can be challenging to control. It may even require hospital treatment.


The diagnosis of venous diseases is simple and non-invasive. First, your health history is reviewed, and then a brief physical exam is performed.

When evaluating varicose veins or spider veins, it is essential to know the root cause of the problem.

Venous ultrasound is the primary tool vascular surgeons use to evaluate leg veins.

Ultrasound works by measuring sound waves in tissue and generating images.

From these images, you can see which veins are working well and leaking blood into the legs, causing increased pressure.

Most commonly, the causative vein will be the greater saphenous vein, which runs under the skin from the ankle to the groin, on the inner leg and thigh.

The ultrasound will evaluate the greater saphenous vein and the other significant veins in the leg to see if there is insufficiency.

Furthermore, this study can also tell us if blood clots in the veins can be potentially dangerous. The ultrasound should take approximately 30-45 minutes.

Duplex ultrasound is a type of vascular ultrasound procedure performed to evaluate the blood flow and structure of the veins in the legs.

The term “duplex” refers to two ultrasound modes used: Doppler and B-mode.


To a large extent, treatment will depend on where the main vascular problems in varicose veins occur, the distribution and tortuosity, and the severity of the veins.


This is still a common form of treatment for varicose veins and is an effective way to remove veins.

Radiofrequency ablation

This is a newer method of treating varicose veins.

It is a replacement for surgery but may need complementary treatment, either with injections or minor avulsions to the visible veins.

Ablation involves inserting a thin, flexible tube called a catheter into a varicose vein.

The tip of the catheter heats the walls of the varicose veins with radiofrequency energy and destroys the tissue in the vein.

Once destroyed, the vein can no longer carry blood and is absorbed by the body.

Intravenous láser therapy

It is similar to radiofrequency ablation.

It is also a replacement for the surgical removal part but may not treat all visible varicose veins.

Laser treatment is a type of treatment for varicose veins.

Until recently, laser treatment was used primarily to treat spider veins on the face. However, newer laser technology can now also effectively treat varicose veins.

The vein closes, and the body eventually absorbs it.

Injection sclerotherapy

It is used in all types of varicose veins, and a microinjection technique can be used for the veins of the strands.

It may not be as effective as other techniques for more prominent varicose veins.

This procedure involves a saline or chemical solution injected into the veins and causes them to harden so that they do not fill with blood.

Compression socks

This may be all that is needed if pain and swelling are the main problems.

The correct degree of storage must be used after proper adjustment.

Many patients find it very effective for symptoms, although it can be inconvenient, especially in hot weather.

These elastic stockings compress the veins and prevent blood from flowing backward.