Sign up
Log in
EspañolSave big on your prescriptions.
Get the free SingleCare app
Get the free SingleCare app
Always free for consumers
Quickly access discount cards
Over a billion dollars saved
4.8 average rating
Text a link to download the app
Phone number
Scan to download the app
In our image-conscious culture, any superficial defect can provoke a storm of embarrassment. Sometimes, though, appearance may be more than skin deep. While small visible veins, like spider veins, are solely a cosmetic concern, varicose veins—large, swollen, dark veins bulging out of the leg—often point to a more serious medical problem with the leg’s major veins. This underlying problem has the potential of getting much worse. When varicose veins erupt on the legs, the solution isn’t to cover them up, but to see a doctor.
What are varicose veins?
Varicose veins are visibly distended superficial veins with a width of 3 mm or more. They are immediately identifiable and usually occur on the ankle, calf, or back of the knee.
Other visible veins, such as spider veins (telangiectasias) and reticular veins are often mistaken for varicose veins. Although they are blue or purple like varicose veins, they are smaller and don’t bulge out as much, if at all. Spider veins are visible veins less than 1 mm wide and look like small, flat, dark lines on the skin. Reticular veins are a little bit wider; from 1 mm and 3 mm wide. Like varicose veins, spider veins and reticular veins are commonly found on the legs, but they can appear on the face as well.
Unlike spider and reticular veins, varicose veins are usually caused by chronic superficial venous insufficiency (CVI), a potentially serious condition that can progress and result in serious complications such as:
- Swelling of the leg (edema)
- Venous ulceration
- Serious blood clot conditions such as deep vein thrombosis (DVT)
Venous insufficiency—also called venous reflux—is the backward flow (reflux) of blood in the veins due to problems with valves in the veins.
The venous blood in the legs is returned to the heart through two main trunks: the deep veins and the saphenous veins. Deep veins, as the name suggests, are large veins deep in the legs, nested within the muscles. The great saphenous vein, however, runs just below the skin along the inner leg. Blood flows into the saphenous veins from the superficial veins lying right below the skin. Valves in the saphenous veins are designed to allow blood to flow towards the heart, but close up and block any backward flow of blood.
The great saphenous vein joins a deep vein – the femoral vein – near the groin. Blood pressure in the femoral vein is higher than in the saphenous vein, but the valves keep the blood from flowing back into the saphenous vein. When the valves have a problem and don’t close completely, blood in the high-pressure femoral vein starts flowing backward into the lower-pressure saphenous vein. Excess blood begins to pool in the superficial veins that feed into the saphenous vein, particularly the veins in the ankle and lower calf. This pooled blood causes the veins to swell up and become varicose.
There are other, less common causes of varicose veins. In most cases, however, varicose veins are not a surface vein here and there, but a problem with the largest veins in the leg.
Almost one in four adults have varicose veins. Genetics play a large part. The primary risk factor for varicose veins is having family members with the condition. Other risk factors include:
- Being born a female
- Aging
- Excess weight, or obesity
- Pregnancy
- Smoking
- Standing or sitting for long periods
There is no cure for varicose veins. Treatment largely consists of managing the symptoms, but surgery can be used to correct venous insufficiency. Even with surgery, however, varicose veins often recur.
How are varicose veins diagnosed?
Varicose veins are primarily diagnosed by their physical appearance. A physical examination and ultrasonography will determine the extent of the venous insufficiency to indicate the most appropriate treatment.
Most people will first talk to a general practitioner who will manage the condition with conservative treatment. If venous insufficiency is serious enough or the patient wants to remove the damaged veins, the condition will be treated by a dermatologist, plastic surgeon, or vascular surgeon.
The healthcare provider will first examine the leg. Varicose veins are easily identifiable: distended veins, usually purple or blue, with a width of 3 mm or more.
Varicose veins, though visible, may not be symptomatic. When symptoms do occur, they are primarily related to the venous reflux that is responsible for varicose veins:
- Heaviness in the leg
- Tenderness, burning, or itching in the area around the vein
- Skin discoloration
- Difficulty exercising
- Leg fatigue
In the physical examination, the doctor will perform tests, such as elevating the leg, to assess how well venous valves are working.
When the doctor has sufficient evidence for venous reflux, guidelines call for a color duplex venous ultrasound to image both the superficial and deep veins in the leg. This will help determine the distribution of varicose veins, the source and path of the reflux, and the integrity of both the deep veins and saphenous veins.
Varicose veins treatment options
Varicose veins are not curable. The goal of treatment is to manage symptoms and prevent complications.
Conservative treatments
Varicose veins are most commonly treated using compression stockings, leg elevation, and lifestyle changes such as weight loss and exercise.
Medications
Conservative treatment will rely on over-the-counter pain relievers to manage any pain or discomfort. Small varicose veins may be removed using injections of sclerosing (scar-making) agents. These drugs damage the inner lining of the varicose vein, and scar tissue grows back and blocks the vein. The body forms new veins, and the varicose vein is gradually re-absorbed by the body.
External laser thermal ablation
In laser therapy, a dermatologist destroys visible veins by directing laser light at the skin above the vein. Laser therapy is a standard and effective treatment at eliminating spider veins. It can also be used for small and large varicose veins. For larger varicose veins, endovenous laser therapy is performed, which involves inserting a laser catheter into the problematic veins.
Surgery
The ultimate aim of surgery is to reduce the reversal of blood flow into the saphenous vein. This is usually done by closing off the connection between the saphenous vein and the femoral vein (ligation). Then, the surgeon may either cauterize the entire saphenous vein (endovascular treatment) or completely remove it (stripping). When the targeted, superficial vein is no longer available, the body will redirect blood from other superficial veins to the deep veins by growing new blood vessels.
- Ligation and stripping: A common procedure for varicose veins that involves tying off the junction between the saphenous vein and the femoral vein, inserting a wire down the length of the saphenous vein, and stripping the entire vein out of the body.
- Endovenous thermal ablation (EVTL): Another common procedure that involves closing off the junction between the saphenous vein and the femoral vein, inserting a catheter into the saphenous vein, and cauterizing (burning) the entire length of the saphenous vein. The vein can be cauterized using a laser or radiofrequency energy from endovenous laser therapy or radiofrequency ablation.
In some cases, surgeries that preserve the saphenous vein may be used for milder cases or cosmetic surgery. These include:
- Ambulatory phlebectomy: As an outpatient procedure that requires local anesthesia, ambulatory phlebectomy involves removing the varicose portion of a superficial vein.
- Valvuloplasty: In rare cases, a patient may be a candidate for the surgical repair of the saphenous vein valve at its junction with the femoral vein. Valvuloplasty is an option for those with valve dysfunctions since birth.
Varicose veins medications
Most patients with varicose veins will be treated conservatively with compression bandages, lifestyle changes, and pain medications. Sclerosing agents are generally reserved for only the smallest varicose veins.
Analgesics
Pain and discomfort caused by varicose veins can be managed with over-the-counter NSAIDs (nonsteroidal anti-inflammatory drugs), such as aspirin or ibuprofen, or pain relievers such as acetaminophen.
Phlebotonics
Some studies have shown that over-the-counter dietary supplements, such as horse chestnut extract, may help ease varicose vein symptoms. Called phlebotonics, the long-term effectiveness and safety of these supplements have not been established.
Sclerosing agents
Instead of surgically removing a varicose vein, a physician might inject a sclerosing agent (or sclerosant) into the damaged vein. The drug kills and partly destroys the inner lining of the vein it comes in contact with. The body responds by forming scar tissue which then closes off the vein. The body then forms new veins, and the old vein is gradually reabsorbed by the body and fades from view.
The most common sclerosants used for varicose veins are Asclera (polidocanol) and sodium tetradecyl sulfate. Both can be injected as a solution or a microfoam. Foam sclerotherapy decreases the risk of the drug spreading in the bloodstream and damaging other blood vessels.
Sclerosant injections are safest and most effective for only the smallest varicose veins, or those that measure around 3 millimeters wide or less. Sclerosing agents are more commonly used to treat spider veins and reticular veins.
What is the best medication for varicose veins?
Compression stockings, lifestyle changes, and surgery are the treatments of choice for varicose veins. While drugs may help with spider veins and reticular veins, they may not be as safe or effective for all but the smallest varicose veins. There is, then, no best medication for varicose veins. Instead, healthcare professionals use an entire set of tools to manage the condition.
| Best medication for varicose veins | ||||
|---|---|---|---|---|
| Drug Name | Drug Class | Administration Route | Standard Dosage | Common Side Effects |
| Aspirin | NSAID | Oral | Dosage varies depending on your doctor’s instructions | Upset stomach, heartburn, bleeding |
| Motrin (ibuprofen) | NSAID | Oral | 200 mg to 400 mg every four to six hours | Nausea, bleeding, stomach pain |
| Tylenol (acetaminophen) | Analgesic | Oral | 650 mg every four to six hours | Nausea, vomiting, headache |
| Asclera (polidocanol) | Sclerosing agent | Intravenous injection | Dose depends on the size and extent of the varicose vein | Injection site reactions, such as swelling, pain, irritation, or darkened skin around the injection site |
| Sotradecol (sodium tetradecyl sulfate) | Sclerosing agent | Intravenous injection | Dose depends on the size and extent of the varicose vein | Injection site reactions, such as swelling, pain, irritation, or darkened skin around the injection site |
What are the common side effects of varicose veins medication?
All medications may have side effects, and different classes of medications have different side effects. However, this is not a complete list, and you should consult with your healthcare professional for possible side effects and drug interactions based on your specific situation.
NSAIDs (nonsteroidal anti-inflammatory drugs) and analgesics are widely available and generally safe. NSAIDs can interfere with blood clotting, so their most serious side effects include bleeding, stomach pain, and gastrointestinal ulcers.
Sclerosing agents typically cause injection site reactions. These reactions may include swelling, irritation, pain, or redness around the injection site. However, these side effects are typically mild and go away on their own. The most serious side effects occur if the sclerosing agent spreads to other parts of the circulatory system, causing blood clots in the deep veins. Deep vein thrombosis (DVT) is a serious medical condition that can cause stroke, heart attack, pulmonary embolism, or death. Severe allergic reactions, including anaphylactic shock, have also been reported with sclerosing agents.
What is the best home remedy for varicose veins?
Varicose veins cannot be cured completely by medicine, surgery, herbs, or home remedies. The condition, however, can be managed. The goal of home treatment is to reduce blood pooling in the legs.
Exercise
Sitting or lying around much of the day is a major risk factor for varicose veins. Walk, cycle, exercise, and move around to help move blood through the legs.
Elevate the legs
Elevating the legs to heart level is a standard, successful treatment for reducing the backward flow of blood into the leg’s superficial veins. At the very least, keep your legs propped up when sitting.
Move the legs
Don’t sit or stand for long periods of time. When you need to sit—at work or on an airplane—get up every ten or fifteen minutes to stand or move around. If you need to stand, sit down every 15 or 20 minutes for one or two minutes.
Wear compression stockings
Another standard and well-proven treatment that dramatically reduces symptoms are compression stockings. By putting pressure on the superficial and saphenous veins, compression stockings prevent blood from flowing backward into those veins. The compression strength to aim for is 20 mmHg to 30 mmHg of pressure, but more severe cases may require pressures between 30 mmHg and 40 mmHg. Ideally, the stocking should at least reach the upper calf, but thigh-highs are best.
Lose excess weight
Varicose veins are far more common in people with excess weight. Also, the extra weight contributes to swelling and pain due to varicose veins.
Eat a healthy diet
Diet has been definitively linked to varicose veins and the severity of symptoms. Eat a nutritious and balanced diet. Avoid salty foods that cause the body to retain water. High-fiber and flavonoid-rich foods can also help reduce varicose vein symptoms.
Frequently asked questions about varicose veins
Which is the best treatment for varicose veins?
For most patients with varicose veins, conservative treatment involving compression stockings, leg elevation, and lifestyle changes are sufficient to manage the condition. More serious cases may involve surgery to remove or cauterize the saphenous vein.
Can varicose veins go away on their own?
Varicose veins are not curable and will not go away on their own.
How can I get rid of varicose veins at home?
Varicose veins are not curable. They can be reduced in size by wearing compression stockings, elevating the leg, and making lifestyle changes such as exercising or losing weight.
Is walking good for varicose veins?
Walking is an excellent exercise for reducing the symptoms of varicose veins. Other good low-impact exercises include swimming, biking, and aquatic exercise.
Is varicose vein treatment dangerous?
Conservative treatments such as leg compression, leg elevation, and lifestyle changes are very safe. Minor surgical treatment, such as the surgical removal of a varicose vein (ambulatory phlebectomy) are also fairly safe. Endovascular ablation, the surgical removal or ablation of the saphenous vein, and sclerosing agents will have side effects such as bruising and pain. The most severe side effects of surgical or sclerosant treatment include ulcerations that result in infections or blood clots that travel from the treated area.
What is the best medicine for varicose veins?
For most people, varicose veins can be treated without relying on medications except for the occasional over-the-counter pain reliever.
How dangerous is sclerotherapy?
Sclerotherapy is generally safe and effective for smaller varicose veins measuring less than 3 mm. For larger varicose veins, sclerotherapy starts to lose its effectiveness and increase the risk of complications. Long-term adverse effects of scleropathy may include discomfort, lumps, and discoloration in larger varicose veins. Although rare, sclerotherapy also carries a risk of the drug traveling through the bloodstream, damaging healthy veins, and causing dangerous blood clots.
What are the side effects of sclerotherapy?
The most common side effects of scleropathy include bruising, swelling, irritation, and discoloration around the injection site. More serious side effects include the formation of blood clots that travel to other areas of the body (deep vein thrombosis), allergic reactions, and skin death, or necrosis. However, serious side effects are rare.
Do varicose veins need to be treated?
Varicose veins will get worse if they are not treated. Fortunately, conservative treatment involving compression stockings, leg elevation, and lifestyle changes are sufficient to manage the condition in most cases.
How does apple cider vinegar help varicose veins?
Apple cider vinegar, either ingested or applied topically, has not been shown to have any effect on varicose veins.
Related resources for varicose veins
- Varicose Veins
- Varicose veins: diagnosis and treatment
- CEAP Classification of Venous Disorders
- Chronic Venous Insufficiency: Prevalence and Effect of Compression Stockings
- Role of Surgery in the Treatment of Varicose Veins
- Varicose Vein Endovenous Laser Therapy