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Varicose veins
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In one pass The veins in your legs have to carry blood from your feet all the way back to your heart, against gravity the whole way.
Educational content, not medical advice — consult a clinician.
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Chapter 1
Why leg veins bulge
The veins in your legs have to carry blood from your feet all the way back to your heart, against gravity the whole way. What helps them is a series of one-way valves inside the veins: two thin flaps that let blood move only upward and close to hold it up the moment it starts to fall back.
When the valves don't close properly, blood flows back down and pools in the superficial veins of the lower leg. Pressure inside these veins stays high, and the walls are slowly stretched wider and longer, until they become the bulging, twisting varicose veins under the skin. The fine red or purple threads that look like a spider's web are a different thing and are usually harmless.
Varicose veins are common and mostly not dangerous. They can make your legs feel heavy and achy and your ankles swell, more so after standing a long time, and better when you rest with your legs up.
Some situations can't wait. If one leg suddenly swells and has a throbbing pain, with red or bluish skin, it may be a deep vein thrombosis (a blood clot in a deep vein): seek medical help as soon as possible, ideally the same day. If you are also short of breath or have chest pain, call emergency services now. If a varicose vein bursts and bleeds, lie down, raise the leg, press firmly on the bleeding spot with your hand, then get medical care; if it won't stop, call emergency services now.
When the valves don't close properly, blood flows back down and pools in the superficial veins of the lower leg. Pressure inside these veins stays high, and the walls are slowly stretched wider and longer, until they become the bulging, twisting varicose veins under the skin. The fine red or purple threads that look like a spider's web are a different thing and are usually harmless.
Varicose veins are common and mostly not dangerous. They can make your legs feel heavy and achy and your ankles swell, more so after standing a long time, and better when you rest with your legs up.
Some situations can't wait. If one leg suddenly swells and has a throbbing pain, with red or bluish skin, it may be a deep vein thrombosis (a blood clot in a deep vein): seek medical help as soon as possible, ideally the same day. If you are also short of breath or have chest pain, call emergency services now. If a varicose vein bursts and bleeds, lie down, raise the leg, press firmly on the bleeding spot with your hand, then get medical care; if it won't stop, call emergency services now.
Mechanism · How valves hold the blood up
The leg has two sets of veins: deep veins, buried between the muscles, and superficial veins just under the skin, the bluish ones you can see. Many short connecting branches link the two, and they have valves too, letting blood flow only from the surface inward.The valves are usually two thin flaps, and they get more numerous toward the lower leg; the longest superficial vein, running from the inside of the ankle up to the groin, has at least 6 of them. When you stand, blood has to overcome gravity and the pressure inside the abdomen to get back to the heart, and every valve carries part of the weight of that column of blood.
What doctors call a varicose vein is usually a superficial vein at least 3 mm across that bulges and becomes more and more twisted. Among people who see a doctor for long-standing poor return of blood from the legs, about 90% have their backflow in the superficial veins. So most varicose veins are a superficial-vein problem, not the same thing as a deep vein thrombosis; the two do overlap, though, because people with varicose veins are more likely to get a deep vein thrombosis.
Clinical · What varicose veins feel like
Many people have varicose veins with no discomfort at all and are only bothered by how they look. When there are symptoms, the common ones are:Pain, aching or heaviness, as if the legs were filled with lead.Itching, color changes, or dry, scaly skin.Swelling of the ankles or calves, usually starting around the ankle and getting worse as the day goes on and you spend more time on your feet.
These complaints share one feature: anything that lowers the pressure in the leg veins, such as raising the legs, wearing compression stockings or going for a walk, eases them. That in itself is a clue to the mechanism.
Left untreated, varicose veins can slowly get worse, usually over many years. In a population study in the UK that followed people for 13 years (the Edinburgh Vein Study), about 31.9% of those who started with varicose veins progressed to chronic venous insufficiency, meaning the swelling and skin changes that long-term high pressure in the leg veins brings; family history, a previous deep vein thrombosis and obesity were linked to progression.
Chapter 2
How walking pumps blood upward
When you stand still, the pressure in the veins of your foot comes from the whole column of blood between your foot and your heart, and it can be as high as 80 to 90 mmHg (millimeters of mercury).
Take a step and that changes. The calf muscles contract and squeeze flat the deep veins that run between them, and the blood can only go up, because the valves below have closed; the muscles relax, the veins fill again, and the next squeeze follows. This is called the calf muscle pump. In someone whose valves work, the pressure in the foot veins falls to below 30 mmHg while walking.
When the valves leak, that drop is blunted: with every squeeze, part of the blood flows back through the leaking valves, and walking brings the pressure down much less.
That is why your legs feel worst after standing still for a long time, and better after a walk or with your legs up. It is also why some people call the calf a second heart, but it only works while the muscle contracts and relaxes. Standing still or sitting still, it is switched off.
Take a step and that changes. The calf muscles contract and squeeze flat the deep veins that run between them, and the blood can only go up, because the valves below have closed; the muscles relax, the veins fill again, and the next squeeze follows. This is called the calf muscle pump. In someone whose valves work, the pressure in the foot veins falls to below 30 mmHg while walking.
When the valves leak, that drop is blunted: with every squeeze, part of the blood flows back through the leaking valves, and walking brings the pressure down much less.
That is why your legs feel worst after standing still for a long time, and better after a walk or with your legs up. It is also why some people call the calf a second heart, but it only works while the muscle contracts and relaxes. Standing still or sitting still, it is switched off.
Mechanism · How the high pressure reaches skin
If the valves in the short branches linking deep and superficial veins also fail, the high pressure the calf muscles squeeze into the deep veins rushes straight into the superficial veins and on into the smallest vessels of the skin.Over time, the skin around the ankle is often the first to suffer: it itches, turns dry and scaly, changes color, or feels hard. According to the UK's National Health Service (NHS), persistently high pressure in the leg veins weakens the skin, and then a minor injury can turn into a venous leg ulcer, a sore that takes a long time to heal, usually on the inside of the leg between the knee and the ankle. People with varicose veins are at higher risk.
Skin that is changing means the vein pressure in that leg has been high for a long time, and it is worth having a doctor look at it.
nhs-leg-ulcer
Chapter 3
Why some people get them more
Varicose veins don't have a single cause. The basic risk factors that guidelines list are older age, being female, having been pregnant, and having family members with them. Others often mentioned are being overweight, standing or sitting for long periods, and a previous deep vein thrombosis.
The current view is that the vein wall and the valves both go wrong. On the wall side: with age, the vein wall loses its elasticity; female hormones can make it easier to stretch; and genes are thought to affect the wall's structure. On the valve side: when valves fail and blood flows back down, the flow slows and pools, the wall becomes short of oxygen and inflamed, and it is remodeled and stretched further.
During long standing the calf muscle pump stays switched off, so the pressure in the leg veins stays high. Pregnancy concentrates all of this: hormones and body structure are changing, up to about 40% of pregnant women develop new varicose veins or see existing ones get worse, and many improve or disappear after the baby is born.
Standing for long hours at work has been followed over time too, and people who stood more were hospitalized for varicose veins more often. That is an observed association, but it points the same way as the calf-pump mechanism.
The current view is that the vein wall and the valves both go wrong. On the wall side: with age, the vein wall loses its elasticity; female hormones can make it easier to stretch; and genes are thought to affect the wall's structure. On the valve side: when valves fail and blood flows back down, the flow slows and pools, the wall becomes short of oxygen and inflamed, and it is remodeled and stretched further.
During long standing the calf muscle pump stays switched off, so the pressure in the leg veins stays high. Pregnancy concentrates all of this: hormones and body structure are changing, up to about 40% of pregnant women develop new varicose veins or see existing ones get worse, and many improve or disappear after the baby is born.
Standing for long hours at work has been followed over time too, and people who stood more were hospitalized for varicose veins more often. That is an observed association, but it points the same way as the calf-pump mechanism.
Evidence · A study that followed standing work
Danish researchers drew a random sample from the national population register and in 1991 interviewed 2,939 men and 2,708 women who were employed (aged 20 to 59), then followed them for 12 years to see who was hospitalized for varicose veins of the legs.Over 12 years, 40 men and 71 women were hospitalized for varicose veins.People whose jobs had them standing or walking at least 75% of the time, compared with everyone else, had about 1.75 times the risk of hospitalization among men (the included 1, so not significant) and about 1.82 times among women; about 1.78 times combined.The analysis adjusted for smoking, body mass index and heavy lifting, and, for women, the number of children.
How to read it: this is a cohort study, so it shows an association and cannot prove that standing causes varicose veins; and it counted hospital stays, not all varicose veins. The authors estimate that more than one fifth of working-age hospitalizations for varicose veins can be attributed to prolonged standing at work. Guidelines point the same way: avoiding prolonged standing may be beneficial.
Background · Varicose veins in pregnancy
Pregnancy changes the leg veins in several ways at once, through function, body structure and hormones, so it is the time when varicose veins most often appear or get worse; up to about 40% of pregnant women are affected.Many varicose veins that appear in pregnancy improve or disappear after the baby is born.Compression stockings can be used in pregnancy. A German guideline says they can improve symptoms, but there is no evidence yet that they prevent varicose veins from appearing; in one study, pregnant women increasingly rejected compression tights as their pregnancy went on.Treatments such as closing or removing veins are not usually recommended during pregnancy, and only a doctor decides on them in exceptional cases.
The risk of deep vein thrombosis is also higher in pregnancy and in the 6 weeks after birth. If one leg suddenly swells and hurts during pregnancy, seek medical help as soon as possible, ideally the same day.
Chapter 4
What you can do yourself
Most varicose veins don't need treatment in themselves. The things you can do yourself all help the calf muscle pump or lower the pressure in your leg veins:
Keep moving: walking and running make the calf contract and relax, pushing blood upward.Don't stand or sit for long stretches: get up and walk a few steps every so often, and raise your feet when you sit if you can.Put your legs up when you can: lie down with your legs on cushions and let gravity help the blood back.Keep to a healthy weight, and don't smoke.Look after your skin: use a moisturizer if it is dry or itchy, and try not to knock your shins, which lowers the chance of bleeding.
These steps have a clear mechanism and guideline support behind them, but the trials that test them directly are few and small, and the same goes for compression stockings. Stockings don't suit everyone: people with poor blood supply through the leg arteries shouldn't wear them, and whether to wear them, and which kind, is something to decide with a doctor or pharmacist.
If you have symptoms, they are getting worse, or a sore on your leg hasn't healed after 2 weeks, see a doctor. For what else a desk-bound day does to the body, see The Sedentary Office Body.
Keep moving: walking and running make the calf contract and relax, pushing blood upward.Don't stand or sit for long stretches: get up and walk a few steps every so often, and raise your feet when you sit if you can.Put your legs up when you can: lie down with your legs on cushions and let gravity help the blood back.Keep to a healthy weight, and don't smoke.Look after your skin: use a moisturizer if it is dry or itchy, and try not to knock your shins, which lowers the chance of bleeding.
These steps have a clear mechanism and guideline support behind them, but the trials that test them directly are few and small, and the same goes for compression stockings. Stockings don't suit everyone: people with poor blood supply through the leg arteries shouldn't wear them, and whether to wear them, and which kind, is something to decide with a doctor or pharmacist.
If you have symptoms, they are getting worse, or a sore on your leg hasn't healed after 2 weeks, see a doctor. For what else a desk-bound day does to the body, see The Sedentary Office Body.
Evidence · Exercise and stockings, by numbers
Exercise: a Cochrane systematic review found 5 randomized trials with 146 people who had long-standing poor return of blood from the legs (but no ulcer), comparing regular exercise with no structured exercise. The studies differed too much to pool; at six months there was no clear difference in symptoms, and whether venous refilling time, quality of life or calf strength improved was uncertain, with all evidence of very low certainty. The authors conclude that the current evidence is insufficient to assess the benefits and harms of exercise. That means it hasn't been measured well, not that it was measured and failed.Compression stockings: another Cochrane review included 13 studies with 1,021 people with varicose veins and no ulcer, with evidence of low to very low certainty. Compared with no stockings or placebo stockings, all 4 studies that reported symptoms found a subjective improvement, but the way they were analyzed carried a risk of bias; the main side effects were itching and irritation, none severe; in some studies many people stopped because of discomfort, difficulty putting them on, or how they looked. The authors conclude that there is not enough high-certainty evidence to tell whether stockings alone are effective, or whether any type is better than another. One review notes that about half of patients cannot keep up compression therapy, commonly because of tightness and warmth.
How guidelines use them: guidelines from the US Society for Vascular Surgery and partner societies suggest compression as the main treatment when a person's health makes a conservative approach more suitable or they prefer it; for people who are candidates for a procedure, they recommend the procedure over long-term stockings. A German guideline lists raising the legs, working the muscle pump around the ankle, and compression as basic treatment.
Clinical · What a specialist may offer
When more is needed, a specialist usually starts with a duplex ultrasound, a scan that shows which way blood is flowing, to find which vein, and which part of it, has backflow, and then works out a plan with you.A common approach is to close off the faulty stretch of superficial vein from the inside, so blood stops flowing through it; methods include sealing it with heat and injecting a foam that blocks it, and there is also surgery to pull the vein out.The UK's NHS says heat sealing is usually the first choice; US guidelines recommend treatment over long-term compression stockings for people who are suitable for it.Here stockings are mostly a supporting act: they become the main treatment only when procedures are unsuitable or not needed, and are sometimes worn for a while after treatment.Treatment just to improve how veins look is not usually provided by the UK public health service.
Which treatment, and when, is decided by the specialist based on the ultrasound and your situation.
Chapter 5
When to see a doctor
Most varicose veins are not dangerous, but don't wait in these situations:
Call emergency services now (120 in mainland China; don't drive yourself to the emergency department):
Leg swelling or pain together with sudden shortness of breath or chest pain: a clot may have traveled to the lungs (pulmonary embolism), which can be life-threatening.A varicose vein that is bleeding and won't stop despite firm pressure and raising the leg.
Get medical help soon:
One leg that suddenly swells and has a throbbing pain (usually in the calf or thigh), with red, bluish or darkened skin, may be a deep vein thrombosis: ideally be seen the same day.A varicose vein that has bled, even if the bleeding has stopped: be seen the same day.A stretch of varicose vein that suddenly turns hard and painful may be a clot in a superficial vein, which can spread into the deep veins.
Book an appointment:
Skin around the ankle that itches, turns dry and scaly, changes color or hardens.A sore on your leg that hasn't healed after 2 weeks.Leg pain, swelling or itching, or varicose veins that are getting worse.
This list is not a diagnosis. It tells you when to stop handling things yourself and have a doctor look in person.
Call emergency services now (120 in mainland China; don't drive yourself to the emergency department):
Leg swelling or pain together with sudden shortness of breath or chest pain: a clot may have traveled to the lungs (pulmonary embolism), which can be life-threatening.A varicose vein that is bleeding and won't stop despite firm pressure and raising the leg.
Get medical help soon:
One leg that suddenly swells and has a throbbing pain (usually in the calf or thigh), with red, bluish or darkened skin, may be a deep vein thrombosis: ideally be seen the same day.A varicose vein that has bled, even if the bleeding has stopped: be seen the same day.A stretch of varicose vein that suddenly turns hard and painful may be a clot in a superficial vein, which can spread into the deep veins.
Book an appointment:
Skin around the ankle that itches, turns dry and scaly, changes color or hardens.A sore on your leg that hasn't healed after 2 weeks.Leg pain, swelling or itching, or varicose veins that are getting worse.
This list is not a diagnosis. It tells you when to stop handling things yourself and have a doctor look in person.
Safety · Stopping a bleeding varicose vein
Pressure inside a varicose vein is high and its wall is thin, so if it bursts, it can bleed a lot. About 4% of people seen for varicose veins have had a bleed, often from small veins near the ankle where the skin has already darkened and hardened, or from an ulcer; a hot shower or bath that widens the veins, or a minor knock, can set it off. Fatal bleeding is uncommon but not unheard of, and mostly affects older people who live alone, have trouble moving, have fragile skin or an ulcer near the ankle, or take blood thinners or antiplatelet drugs.The first-aid steps from the International Union of Phlebology:
1. Lie or sit down at once and raise the leg, resting it on something or having someone hold it up.
2. Press firmly on the bleeding spot with your hand; if you have gauze or a clean cloth, put it on and bind it tightly with a bandage, and leave it on until a doctor has seen it.
3. Then get medical care; if there is a lot of blood or it won't stop, call an ambulance.
Don't put a tourniquet on the leg: it raises the pressure in the veins below it.
Get seen even after the bleeding stops: if the vein problem underneath isn't treated, it can bleed again. If an older relative has varicose veins, it is worth the family learning these two steps too: raise the leg, press directly.
References · 10
- Youn, Y. J., & Lee, J. (2019). Chronic venous insufficiency and varicose veins of the lower extremities. Korean Journal of Internal Medicine, 34(2), 269-283. Advancing age, family history, prolonged standing, obesity, smoking, sedentary lifestyle, lower extremity trauma, prior venous thrombosis, high estrogen states and pregnancy are all considered risk factors. The main pathophysiological cause is ambulatory venous hypertension, caused by venous valve reflux, venous flow obstruction, or both: the venous pressure of the foot vein in the standstill position without skeletal muscle contraction is as high as 80 to 90 mmHg; in a subject with competent venous valves this pressure decreases to less than 30 mmHg during ambulation, but in a patient with CVI the decrease with leg movements is attenuated. If valves in the perforator veins are incompetent, the high pressures generated in the deep veins by calf-muscle contraction can be transmitted to the superficial system and to the microcirculation in skin. In the standing position, blood in the leg veins must overcome gravity and intra-abdominal pressure to return; normal venous valves are typically bicuspid and unidirectional, and their dysfunction causes venous reflux; the number of valves increases from proximal to distal; the great saphenous vein has at least six valves. The calf muscle pump, called the peripheral heart, squeezes the veins on contraction and pumps blood upward in keeping with the one-way valves; during ambulation it empties the venous system and the pressure within the veins decreases. Superficial vein reflux accounts for 90% of patients presenting with CVI; the deep venous system carries approximately 90% of the venous blood flow of the legs. Venous leg discomfort (dull ache, throbbing or heaviness after prolonged standing) is relieved by any measure that lowers venous pressure, such as elevation of the leg, compression stockings, or walking; leg edema begins around the ankle and varies with the time of day. Varicose veins are dilated, bulging, superficial veins at least 3 mm in diameter that become progressively more tortuous and enlarged; patients are often asymptomatic; they cause pain if superficial thrombophlebitis develops and can cause prolonged bleeding. Conservative management includes compression stockings, weight reduction, regular walking exercise and stopping smoking; compression stockings oppose the hydrostatic forces of venous hypertension, but approximately half of patients cannot continue compression therapy, for reasons such as tightness and warmth; coexisting arterial insufficiency limits their use (full text PMC6406103; PMID 30360023). 10.3904/kjim.2018.230
- NHS. (2024). Varicose veins (page last reviewed 1 July 2024). Varicose veins are swollen, twisted veins under the skin, usually on the legs; they are common and not usually serious. They may cause pain, aching or heaviness, skin changes such as itching, colour changes or dry scaly skin, and swollen ankles or legs; symptoms may be worse after standing for a long time and better when resting with the legs up; they may get worse without treatment, usually very slowly over several years. They are different from spider or thread veins, small red, blue or purple veins that are usually harmless. Do: keep to a healthy weight, put your legs up when possible, exercise regularly such as running or walking to improve blood flow, moisturise dry, flaky or itchy skin, try not to injure your legs to help prevent bleeding; don't stand or sit for long periods unless your feet are raised; don't smoke. See a GP if you have pain, itching or swelling, a sore on the leg that has not healed after 2 weeks, or they are getting worse; ask for an urgent GP appointment or NHS 111 if varicose veins are bleeding. Treatment for appearance alone is not usually available on the NHS. A specialist usually confirms with duplex ultrasound; endothermal ablation is usually the first choice; compression stockings are offered only if procedures are not suitable or not needed, are not suitable with problems in the arteries, and the right type should be chosen with a doctor or pharmacist. In pregnancy, compression stockings may be used but procedures are not usually recommended, and varicose veins often get better or go away after the baby is born. Varicose veins happen when the valves that control blood flow in the vein do not work properly, so blood builds up and puts pressure on the vein, which makes it swell and twist; more likely in women, older people, overweight people, in pregnancy, with a lot of time standing or sitting, family members with varicose veins, or previous DVT. Complications include bleeding, varicose eczema, venous leg ulcers, superficial vein thrombosis (hard, painful veins) and DVT. www.nhs.uk/conditions/varicose-veins
- NHS. (2026). DVT (deep vein thrombosis) (page last reviewed 30 April 2026). DVT is a blood clot in a vein, usually in the leg, and can be dangerous; get medical help as soon as possible. Symptoms: throbbing pain in 1 leg (rarely both), usually in the calf or thigh; swelling in 1 leg; red, blue or darkened skin around the painful area; swollen veins. Ask for an urgent GP appointment or NHS 111 if you think you have DVT. Call 999 or go to A&E if you have DVT symptoms such as pain and swelling and feel short of breath or have chest pain: clots can travel to the lungs (pulmonary embolism), which can be life-threatening; do not drive yourself to A&E. DVT is more likely with varicose veins, age over 60, overweight, smoking, previous DVT, oestrogen-containing contraception or HRT, cancer, pregnancy or a baby in the previous 6 weeks, surgery or hospital stay, and long journeys of more than 4 hours. If a doctor thinks you have DVT you should be referred to hospital within 24 hours for an ultrasound scan. Prevention: stay active, take regular walks, drink plenty of fluids, and do not sit still for long periods. www.nhs.uk/conditions/deep-vein-thrombosis-dvt
- Gwozdzinski, L., Pieniazek, A., & Gwozdzinski, K. (2024). Factors influencing venous remodeling in the development of varicose veins of the lower limbs. International Journal of Molecular Sciences, 25(3), 1560. Varicose veins are more common in women than men; contributing factors include age over 50, related to ageing of the vein walls (the veins lose elasticity and stiffen) and valves, a sedentary lifestyle, obesity and smoking, and familial predisposition; in women, female hormones can lead to stretching of the walls of the veins. Genetic influence on the remodelling of vessel walls has been demonstrated. Chronic venous insufficiency is caused by abnormalities in the wall structure and dysfunction of the venous valves; primary varicose veins are a consequence of venous dilatation and valvular failure without previous deep vein thrombosis. With properly functioning valves, contraction of the calf muscle compresses the vein and pumps blood upwards; during walking the calf muscle pump lowers the pressure in the veins, and valve dysfunction leads to reverse flow (venous reflux). Damage to the valves leads to slow flow or stagnation of blood in varicose veins, leading to hypoxia and inflammation in the vessel wall, with remodelling of the wall (altered collagen I to collagen III ratio, matrix metalloproteinases) (full text PMC10855638; PMID 38338837). 10.3390/ijms25031560
- Pannier, F., Noppeney, T., Alm, J., Breu, F. X., Bruning, G., Flessenkämper, I., et al. (2022). S2k guidelines: diagnosis and treatment of varicose veins. Der Hautarzt, 73(Suppl 1), 1-44. German consensus (S2k) guideline. Varicose vein disease is a degenerative disease of the vein wall in the superficial veins of the legs in which, under the influence of a range of factors (e.g., pregnancy, orthostatic stress), varicose veins develop over the course of life; a primary varicose vein is not in itself a life-changing disease. Basic risk factors are advanced age, female sex, pregnancies and positive family history; a genetic disposition is assumed. Complications include superficial vein thrombosis and variceal bleeding, for which prompt treatment shall be sought. The most common symptoms are heaviness, swelling, itching and occasional pain after standing or sitting for long periods. Basic treatment includes putting the leg up and activating the muscle pump in the ankle region by adequate exercise, plus compression; compression reduces venous symptoms such as heaviness and swelling. Pregnancy affects the leg veins through functional, structural and hormonal changes; up to 40% of all pregnant women present a new or progressing varicose vein; a prophylactic effect of compression to prevent varicose veins in pregnancy has not been proved, but compression can improve the symptoms; invasive treatment during pregnancy should be indicated only in exceptional cases (full text PMC9358954; PMID 35438355). 10.1007/s00105-022-04977-8
- Tüchsen, F., Hannerz, H., Burr, H., & Krause, N. (2005). Prolonged standing at work and hospitalisation due to varicose veins: a 12 year prospective study of the Danish population. Occupational and Environmental Medicine, 62(12), 847-850. A random sample of 2939 men and 2708 women aged 20-59 employed in Denmark were followed for 12 years (40 hospitalisations for varicose veins among men, 71 among women), adjusting for smoking, BMI, heavy lifting and, for women, number of children. For jobs requiring standing or walking at least 75% of working time, the relative risk was 1.75 (95% CI 0.92 to 3.34) for men and 1.82 (1.12 to 2.95) for women; pooled 1.78 (1.19 to 2.68). Conclusion: prolonged standing at work constitutes an excess risk of hospital treatment due to varicose veins and accounts for more than one fifth of all cases of working age (abstract, PMID 16299093). 10.1136/oem.2005.020537
- Araujo, D. N., Ribeiro, C. T., Maciel, A. C., Bruno, S. S., Fregonezi, G. A., & Dias, F. A. (2023). Physical exercise for the treatment of non-ulcerated chronic venous insufficiency. Cochrane Database of Systematic Reviews, 6, CD010637. Five RCTs with 146 participants compared an exercise programme with no structured exercise; data could not be combined and all evidence was very low certainty; there was no clear difference in signs and symptoms at six months, and the review was uncertain whether exercise improves venous refilling time, quality of life or calf strength. Authors' conclusions: there is currently insufficient evidence to assess the benefits and harms of physical exercise in people with chronic venous disease (abstract, PMID 37314059). 10.1002/14651858.CD010637.pub3
- Knight Nee Shingler, S. L., Robertson, L., & Stewart, M. (2021). Graduated compression stockings for the initial treatment of varicose veins in people without venous ulceration. Cochrane Database of Systematic Reviews, 7, CD008819. 13 studies with 1021 participants; studies were small, could not be pooled, and the certainty of the evidence was low to very low. All four studies comparing stockings with no or placebo stockings that reported symptoms found a subjective improvement, but not always analysed between randomised arms and so subject to bias; itching and irritation were the main side effects, none severe; one study reported low compliance due to discomfort, application and appearance; compression tights were increasingly rejected by pregnant women as their pregnancy progressed. Authors' conclusions: there is insufficient high-certainty evidence to determine whether or not compression stockings are effective as the sole and initial treatment of varicose veins in people without healed or active venous ulceration, or whether any type of stocking is superior to any other type (abstract, PMID 34271595). 10.1002/14651858.CD008819.pub4
- Tan, M., Campbell, B., Parsi, K., & Davies, A. H. (2024). Management of bleeding varicose veins. Phlebology, 39(4), 273-275. International Union of Phlebology one-page guideline. Bleeding from varicose veins is a potentially life-threatening complication that is not uncommon; risk is increased with atrophic skin over the veins or veins under an ulcer; risk factors for death include anticoagulation and frailty, and elderly patients who live alone are at high risk. First aid: lie or sit down with the leg elevated; apply pressure to the bleeding site with the hands, then a pad and compressive bandage if available, not removed until medical review; then seek help via a general practitioner or an emergency ambulance. Bleeding varicose veins need urgent referral to a vascular specialist and treatment of the underlying venous disease, because bleeding can recur (full text PMC10993626; PMID 38053359). 10.1177/02683555231219548
- Gloviczki, P., Lawrence, P. F., Wasan, S. M., Meissner, M. H., Almeida, J., Brown, K. R., et al. (2024). The 2023 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society clinical practice guidelines for the management of varicose veins of the lower extremities. Part II. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 12(1), 101670. For symptomatic varicose veins with superficial truncal reflux, compression therapy is suggested for primary treatment if ambulatory status or medical conditions warrant a conservative approach or the patient prefers it; for candidates for intervention, superficial venous intervention is recommended over long-term compression stockings. Graduated stockings can narrow the superficial veins and decrease reflux and venous hypertension; the 13-trial Cochrane review found improvement in symptoms but subject to bias. In asymptomatic C2 disease, weight control, compression stockings and avoiding prolonged standing may be beneficial (consensus); in the Edinburgh Vein Study 31.9% of people with varicose veins progressed to chronic venous insufficiency over 13 years, with family history, previous DVT and obesity as risk factors for progression. Superficial vein thrombosis, while traditionally thought benign, may progress to DVT in 6% to 44% of patients, and anticoagulation is recommended. Bleeding from varicose veins appears in about 4% of patients presenting with varicose veins, often from small veins at the ankle with surrounding skin pigmentation and induration or from an ulcer, sometimes on exposure to warm water or after minor trauma; fatal haemorrhage is uncommon but not entirely rare, mostly in older people living alone, with mobility impairment, fragile skin or an ulcer near the ankle, or on anticoagulant or antiplatelet drugs. For acute bleeding, leg elevation and direct compression should be attempted first; prompt referral to a venous specialist; patients and families should be taught leg elevation and simple compression; the danger of applying venous tourniquets, which increase venous pressure, has often been emphasized (full text PMC11523430; PMID 37652254). 10.1016/j.jvsv.2023.08.011