Varicose Veins Explained: Symptoms, Causes, and Treatment Solutions
What are varicose veins
Varicose vein definition
Varicose veins are enlarged blood vessels that bulge just beneath the skin's surface. They can vary in size and are typically blue or purple in colour. These veins become enlarged due to the weakening of vein walls and the poor functioning of the valves inside the veins (incompetent valves).
Varicose veins are often more noticeable when standing up and may disappear when lying down. This is because gravity causes the leg veins to fill with blood when standing, making them more visible.
Varicose veins commonly occur in the lower half of the body, particularly in the legs. Some patients may also develop them in the hip or pelvic region.
Differences Between Varicose Veins and Spider Veins (Thread veins)
Spider veins and reticular veins are another type of venous disease. They are thinner and smaller than varicose veins. Spider veins may look like branches of a tree or spider webs. They can appear red or blue in colour and most often seen behind the knee, feet and on the face. Spider veins and reticular veins are usually associated with underlying vein problems.
How Varicose Veins Develop
Your heart pumps oxygen- and nutrient-rich blood through the arteries to various parts of your body, including your legs. For circulation to be complete, this blood must return to the heart and lungs for re-oxygenation via the veins. However, unlike the arteries, the veins in your legs do not have a built-in pump like the heart. Instead, blood must travel upwards against gravity, which naturally pulls it back down.
The movement of blood from the legs relies on the action of your leg muscles. When you walk or move, your muscles contract, squeezing the veins and pushing blood upward. To prevent backflow when the muscles relax, one-way valves within the veins close, ensuring blood moves in the right direction.
If these valves become damaged or weakened, they can no longer prevent blood from flowing backward. This results in blood pooling in the veins, increasing pressure, and causing them to enlarge—leading to varicose veins. This condition, known as "venous insufficiency", is the primary cause of varicose veins.
Risk factors for varicose veins
Age
As we age, vein walls and valves naturally weaken, making it harder for blood to flow efficiently.
Gender
Women are more likely to develop varicose veins than men due to hormonal changes during puberty, pregnancy, and menopause, which weaken vein walls and valves, leading to blood pooling. Hormonal contraceptives and hormone replacement therapy (HRT) can further increase the risk. Although men can also develop varicose veins, the condition is more common in women due to the effects of estrogen and progesterone on vein elasticity and circulation.
Excess weight
Excess weight increases pressure on veins, weakening their walls and valves, leading to blood pooling and varicose veins. Managing weight can help reduce the risk and improve vein health.
Job, lifestyle, prolong sitting and standing
Movement supports healthy blood flow, while prolonged sitting can slow circulation. On the other hand, standing for long periods makes it harder for blood to flow upward, as it must work against gravity.
Pregnancy
Pregnancy increases the risk of varicose veins due to hormonal changes, increased blood volume, and added pressure on veins, causing blood to accumulate and veins to enlarge.
Family history / genetics
Genetics are a major risk factor for varicose veins, as a family history increases the likelihood of developing the condition. Weak vein walls and valves can be inherited, leading to blood pooling and vein enlargement over time.
Deep vein thrombosis (DVT)
Formation of clot in the deep veins will significantly increase the risk of developing varicose veins
Varicose veins Symptoms
Common symptoms of varicose veins
Visible Bulging Veins or Spider Veins
Often unsightly and noticeable under the skin.
May cause a throbbing or heavy sensation.
Pain and Heaviness in the Legs
Typically worsens after physical activity.
Leg Fatigue and Tiredness
Persistent feelings of exhaustion in the legs.
Skin Itchiness and Venous Eczema
Irritated, dry, or inflamed skin around affected veins.
Muscle Cramps
Frequent cramping, especially at night.
Ranges from mild changes to dark pigmentation and scarring.
Inflammation and swelling of the vein, often due to a blood clot.
Open sores or ulcers, especially in advanced cases.
Bleeding
Spontaneous bleeding or bleeding with minimal injury due to fragile veins.
An uncontrollable urge to move the legs, often accompanied by discomfort.
Restless Leg Symptoms and Varicose Veins
Restless Leg Syndrome (RLS) is a condition characterized by an uncontrollable urge to move the legs, often accompanied by unpleasant sensations such as tingling, itching, or a crawling feeling. These symptoms typically worsen during periods of rest or inactivity, especially in the evening or at night, and are temporarily relieved by movement. This condition can significantly affect sleep quality and daily life, making early diagnosis and management important.
The exact cause of RLS is not always clear, but it can be related to factors such as iron deficiency, nerve disorders.
Varicose veins can contribute to symptoms similar to Restless Leg Syndrome (RLS), although they are not a direct cause of the condition.
In cases where these restless sensations are linked to venous insufficiency, varicose vein treatment can significantly relieve the symptoms. You may also have hidden varicose veins without visible bulging varicose veins or spider veins, which can lead to restless leg symptoms due to underlying venous insufficiency.
Skin changes with varicose veins
Skin changes associated with varicose veins may include prominent varicose veins, spider veins (thread veins), venous eczema, skin discolouration, corona phlebectatica, lipodermatosclerosis, and venous ulcers.
Hidden Varicose Veins
Hidden varicose veins refer to a condition where faulty veins are present inside the legs but are not visibly bulging on the skin’s surface. Research suggests that 9-20% of adults may have this condition, experiencing varicose vein symptoms without the typical visible signs.
This occurs when the valves inside the veins fail, leading to blood leakage and poor circulation. Just like visible varicose veins, hidden varicose veins can cause discomfort and may require treatment to relieve symptoms and prevent complications.
If you experience leg swelling, skin discolouration, itchiness, fatigue, or pain without visible varicose veins, you may be suffering from hidden varicose veins.
When to seek medical attention
It is advisable to seek medical attention for varicose veins if symptoms worsen, including increased pain, swelling, skin discolouration, sores, or ulcers. If you have venous insufficiency and experience symptoms of restless legs, treating your varicose veins may help alleviate these symptoms.
In some cases, hidden varicose veins (also known as non-visible varicose veins) may be present beneath the skin, causing symptoms like leg heaviness, aching, and swelling without visible bulging veins. A Doppler ultrasound scan can help detect these underlying vein issues and guide appropriate treatment.
If varicose veins begin to bleed, immediate medical care is crucial, as this could indicate a medical emergency. Additionally, individuals should consult a healthcare provider if they notice signs of deep vein thrombosis, such as redness, warmth, or swelling in the leg, or symptoms of pulmonary embolism, including chest pain and difficulty breathing.
How are varicose veins and hidden varicose veins diagnosed
Varicose veins and hidden varicose veins are diagnosed through a combination of a clinical examination by a vascular specialist and advanced imaging tests. During the clinical examination, the specialist assesses the legs for visible signs such as bulging veins, skin discolouration, swelling, and symptoms like tenderness or heaviness. The patient may be asked to stand, as varicose veins often become more prominent in an upright position.
To confirm the diagnosis and identify any underlying vein issues, a doppler ultrasound scan is performed. This non-invasive test uses sound waves to visualise the veins, assess blood flow, and detect valve dysfunction or venous reflux—a key cause of varicose veins. The ultrasound helps the specialist determine the severity of the condition and guides the development of an effective treatment plan.
In some cases, additional diagnostic tests may be necessary for a more detailed evaluation, including:
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CT Venogram / MR Venogram– Provides a high-resolution image of the veins using contrast dye to detect blockages or abnormalities.
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Direct Venography – An X-ray-based test using contrast dye injected into the veins to map venous flow and identify issues.
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Intravascular Ultrasound (IVUS) – A catheter-based ultrasound that gives real-time, high-definition images of vein walls and blood flow, useful for complex cases.
These advanced imaging techniques ensure precise diagnosis and help tailor the most effective treatment plan for each patient.
Complications of varicose veins
Health risks associated with varicose veins
If left untreated, varicose veins and chronic venous insufficiency can lead to leg swelling, fatigue, and a sensation of heaviness, along with skin discolouration, venous eczema, and slow-healing ulcers. The condition may also result in superficial thrombophlebitis, an inflammatory response in the veins, as well as an increased risk of bleeding from varicose veins. Additionally, many individuals experience symptoms of restless legs, which may improve with proper vein treatment. Seeking medical attention can help prevent complications and improve overall vascular health.
Impact on quality of life
Varicose veins can have a significant impact on an individual’s quality of life, often causing discomfort, pain, and self-consciousness about their appearance. These symptoms can interfere with daily activities and overall well-being. Feelings of heaviness in the legs and nighttime cramps may disrupt sleep and limit physical activity, ultimately affecting overall health and reducing lifestyle satisfaction.
Varicose Vein and Venous Insufficiency Treatment
Non-surgical (conservative) management of varicose veins
Non-invasive approaches, including lifestyle modifications, leg elevation, and compression stockings, are commonly recommended as first-line treatments for varicose veins. While these strategies can help alleviate symptoms such as swelling and discomfort, it is important to note that they do not cure venous insufficiency or eliminate varicose veins.
Minially invasive treatments of varicose veins
At Dr. Soroush Sohrabi Clinics in Dubai, the latest technologies for venous treatment are offered to patients based on their individual needs. Minimally invasive treatments for varicose veins include endovenous laser ablation (EVLA/EVLT), radiofrequency ablation (RFA), mechanochemical ablation (ClariVein®), micro-phlebectomy, sclerotherapy, and TRLOP. These procedures provide effective solutions with minimal downtime. For more details on each treatment, please refer to the dedicated pages on our website
Open surgery
Saphenofemoral junction ligation, saphenopopliteal junction ligation, and vein stripping are now rarely performed due to the advancement of minimally invasive techniques for treating varicose veins.
Achieving Healthy, Vein-Free Legs with Expert Varicose Vein Treatment in Dubai
At Dr. Soroush Sohrabi's Clinics in Dubai, there are various methods available to manage and treat varicose veins and venous insufficiency. The most effective approach is tailored to each individual's condition, lifestyle, severity of the disease, and personal expectations. A customised treatment plan ensures optimal results while addressing both medical and aesthetic concerns, providing patients with advanced, minimally invasive solutions for varicose vein management.
