Varicose veins: More than a cosmetic concern

Your leg veins face a constant uphill battle, working against gravity to transport blood from your feet back up to your heart. But sometimes, the one-way valves inside them weaken, allowing blood to trickle backward and pool inside the veins. Over time, the veins just under the surface of the skin (called superficial veins) can become engorged and twisted, bulging visibly.

Known as varicose veins, this common problem is unsightly and often uncomfortable, causing symptoms such as pain, aching, and a feeling of heaviness in the legs. And for some people, varicose veins are a harbinger of more serious problems.

One complication is a blood clot inside a varicose vein, called superficial vein thrombosis. Causes include dehydration (which makes the blood thicker and more prone to clot) and injury. "A small section of the vein turns hard, red, and painful," says Dr. Sherry Scovell, a vascular surgeon who specializes in venous disease at Harvard-affiliated Massachusetts General Hospital. If that happens, go to the emergency room for an ultrasound, she advises.

Clots and other complications

The superficial veins connect to large veins deeper inside the leg, which means a small clot can move to a deep vein and grow. "About 25% of people with superficial vein thrombosis also have deep-vein thrombosis," says Dr. Scovell. Deep-vein thrombosis (DVT) poses a serious threat if the clot breaks off and travels to a blood vessel serving the lung, causing a potentially life-threatening blockage called a pulmonary embolism.

"We used to treat superficial vein clots with a small dose of ibuprofen and a warm compress," says Dr. Scovell. Now, doctors prescribe an anti-clotting drug such as apixaban (Eliquis) or rivaroxaban (Xarelto) for 45 days to help prevent DVT. Treating varicose veins can help reduce this risk.

Left untreated, varicose veins can also cause other complications. Blood can leak from the damaged valves and pool in the ankles, causing swelling and skin changes characterized by a brown discoloration. As the problem advances, the damaged layer of the skin breaks down to the point where even a tiny nick or scratch can result in an oozing, open wound (a venous ulcer) that's prone to infection.

What you can do

Varicose veins run in families and become more common with age. They're also more prevalent among women, in part because of the increase in blood volume that occurs during pregnancy. Being overweight also raises your risk, as does prolonged standing or sitting.

Three simple strategies can help prevent and improve varicose veins.

Get moving. Exercise that works your calf muscles — like walking — helps; so do calf raises. Point and flex your feet if you have to sit for long periods of time (for example, during air travel or long car rides).

Put your feet up. Give your legs a break by elevating your feet at the end of the day, and even during the middle of the day, if possible. This can relieve pressure on the veins to help keep them healthy.

Pull on compression stockings. These snug elastic socks are tighter at the ankle than at the calf, squeezing your legs slightly to help keep blood moving.

People also need to wear compression stockings for at least two weeks after a vein ablation treatment (see "Vanquishing varicose veins"), says Dr. Scovell. Many people are initially reluctant but then end up wearing them even longer because the stockings make their legs feel so great, she says. "These aren't the thick, beige stockings your grandmother wore. They come in different colors, patterns, lengths, and compression levels," says Dr. Scovell, who wears thigh-high black compression stockings that resemble tights every day at work. You can find them online or in drugstores. But if you have a serious vein-related complication, a medical supply store may be your best option for finding the most appropriate product.

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