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How are varicose veins diagnosed?

Varicose Veins

Images courtesy of
Zachary Rattner, MD

Varicose veins are veins that have been twisted or bulging as a result of improper valve function, which causes blood circulating through the body’s veins to collect and pool instead of properly moving towards the heart. Varicose veins are bulging veins, 3 mm in diameter or larger, near the surface of the legs resulting in large discolored lumps. These larger varicose veins may cause concern about cosmetic appearance and/or may cause symptoms such as leg achiness, heaviness, cramps, itching or fatigue. Varicose veins can also cause leg swelling, skin inflammation, leg ulcers and phlebitis. Varicose veins may also indicate the presence of chronic venous insufficiency (CVI) or venous reflux, a progressive disease characterized by poor blood circulation in the leg veins due to improper valve function.

Varicose veins are extremely common in the United States, being somewhat more common in women than in men. Varicose veins can almost always be treated with minimally invasive techniques, but it is extremely important that a proper medical history, physical exam and duplex ultrasound be performed prior to any varicose vein removal in order to determine the most appropriate options for treatment.

The most common predisposing factor relating to varicose veins is genetic predisposition. Pregnancy is a very common factor as well, which can cause varicose veins as a result of the hormonal effect on the vein wall, increased blood volume and pressure on veins from the enlarged uterus. Other factors that contribute to the likelihood of varicose veins include standing occupations, physical injuries, obesity, a sedentary lifestyle and the natural aging process.

Spider veins are smaller (less than 1 mm in diameter) than varicose veins and are located at the very surface of the skin. Similar to varicose veins, the valves in these spider veins are not working properly so that blood tends to pool in the veins. This pooling causes the spider veins to enlarge and become more visible. Although spider veins will not typically bulge past the surface of the skin, they can appear as purple, blue or red lines that resemble tree branches. Spider veins often occur on the face and hands, but they are common on the legs as well. Spider veins can also clump together and form small vein masses.

Get in touch with a vein specialist if you are unsure of whether you have varicose veins or spider veins, or if you are looking for more information on treatments that are available. Varicose vein removal is available through traditional sclerotherapy, endovenous laser treatment, radiofrequency ablation, ambulatory phlebectomy and vein ligation/stripping. Spider vein removal is available through sclerotherapy, surface laser treatment and intense pulsed light therapy. There are also natural vein treatments available for those who prefer a more conservative approach to varicose vein treatment. Please feel free to ask a doctor any additional medical questions by referring to DoctorQA’s question and answer portal.


Reviewed by Steven E. Zimmet, MD, RVT, FACPh
Editor of Phlebology
President, Zimmet Vein & Dermatology
Past-President, American College of Phlebology

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