Why Big, Blue Varicose Veins Raise a Red Flag

And you thought they were just an issue for Grandma. Big, blue, bulging veins — called varicose veins — can appear on your legs, too.

Sometimes varicose veins run in the family. Sometimes they’re because you stand a lot. Overweight people are more likely to have varicose veins. So are women, mostly due to pregnancy.

Increased pressure, from carrying more weight over time, can weaken the walls of your blood vessels. Rather than efficiently shooting blood back to your heart, weak-walled veins swell as they allow blood to pool.

That’s what makes varicose veins so visible, especially when they’re close to your skin. But they’re not merely a cosmetic concern, says Cleveland Clinic vascular surgeon George Anton, MD. Big, blue varicose veins can raise a red flag about your vascular health.

“When veins are big enough, the blood that pools in them can clot,” he says. “Clots can travel through your body, putting you at risk for a pulmonary embolism, which could be life threatening.”

When to see a doctor

Because of the clotting risk, all large varicose veins should be evaluated by a physician, says Dr. Anton. So should veins that cause one or more of these symptoms:

• Sore, achy or throbbing legs. Sometimes varicose veins can make legs feel heavy or weak.
• Phlebitis. This vein inflammation is usually due to a blood clot.
• Skin ulcers. Open sores can form when blood and other fluid build up due to poor circulation. Sometimes the sores bleed and can become infected.
• Swollen legs, ankles or feet. If an area of your skin looks darker or hardened, blood may be pooling there.

Treatment options

Treatment depends on the size of the vein, the complexity of its branches and evidence of a clot, says Dr. Anton. Usually evaluation involves a physical exam and ultrasound imaging.

“Most of the time, the first line of treatment is wearing compression stockings,” says Dr. Anton. “If veins are very large and complicated, however, stockings usually aren’t enough.”

Other treatment options include:

• Sclerotherapy. A chemical solution is injected into the vein to make it collapse and eventually disappear. Veins usually require several sclerotherapy sessions, several weeks apart. This technique is better for small to medium varicose veins.
• Endovenous ablation. This procedure is typically done in a procedure room with local anesthesia. Laser or radio-frequency technology is used to close off the vein.
• Surgery. Larger veins under pressure are best removed surgically, either as an office procedure or an outpatient hospital procedure, says Dr. Anton. The veins are removed through small incisions in the skin.

“It’s common to require a combination of treatments,” says Dr. Anton. “In each case, we try to minimize complication from bleeding and clotting. For example, if we suspect there’s a clot, we may stay away from ablation and sclerotherapy. Surgery may be the safest option.”

How to reduce varicose veins

If you have varicose veins or just want to reduce your risk of developing them, try these tips:

1. Wear knee-high compression socks. These socks may improve circulation in your legs and prevent blood from pooling there. This is especially important if you stand for long hours each day.
2. Pump your calf muscles. When you’re seated for long stretches of time, like while traveling, exercise your legs to keep the blood moving. Pumping your calf muscles while seated does this just as well as getting up and walking around.
3. Don’t wait to see a doctor. “Women often are told not to have their varicose veins treated until after they’re done having children, but that’s not always the case,” says Dr. Anton. “They should be evaluated for treatment. Varicose veins can become more difficult to treat if future pregnancies make them worse.”

Preventing or reducing varicose veins not only will keep your legs looking younger, but also will improve your vascular health.