Varicose veins, the most common vein disorder, are enlarged, twisted veins, usually in the legs and feet, that are not transporting blood effectively. They appear as bulging, bluish cords beneath the surface of your skin. They affect about 60% of Americans. Women are more likely to have varicose veins than men are. In many cases, varicose veins are simply a cosmetic problem. But varicose veins can also cause pain and discomfort, and in some cases serious complications, such as phlebitis (inflammation of the veins), skin ulcers, and blood clots, can occur.

Varicose veins are accompanied by the following signs and symptoms:

• Prominent dark-blue blood vessels, especially in the legs and feet (not "spidery"-looking veins, which are similar to varicose veins but smaller and less troublesome)
• Aching, tender, heavy, or sore legs
• A burning feeling in your lower legs
• Swelling in the ankles or feet, especially after standing
• Breaks in the skin
• Superficial blood clots
• Skin ulcers near your ankle

Varicose veins develop when your veins stretch and their valves, which prevent backflow of blood, fail. Primary varicose veins result from weakness in the walls of the veins. They occur commonly as we age, and also in women during pregnancy. Secondary varicose veins are most often caused by problems with veins lying deep among the muscles, which carry about 90% of the blood returning to your heart. These problems include blood clots and the resulting diversion of blood flow, and can be serious.

People with the following conditions or characteristics are at risk for developing varicose veins:

• Family history (accounts for 50% of cases)
• Female (three times more common)
• Older (veins fail as we age)
• Hormonal changes related to pregnancy, premenstrual period, and menopause
• Standing for long periods
• Obesity
• Tumors
• Certain diseases
• Arteriovenous fistulas (abnormal blood flow between arteries and veins)

If you are experiencing symptoms associated with varicose veins, you should see your health care provider. Your health care provider will conduct a physical exam of your legs while you are standing and also may perform tests to determine how well your veins are functioning and to distinguish between primary and secondary varicose veins. Your doctor may also perform an ultrasound test to look for blood clots.

Conservative treatment may be all you need. This may involve avoiding prolonged sitting, standing, or walking, getting regular exercise, losing weight, elevating your legs periodically, and wearing compression stockings.

Prevention

Regular exercise improves vein functioning, and weight loss and exercise lower the likelihood of blood clots.

Surgical and Other Procedures

• Sclerotherapy -- injection of a solution into a varicose vein, followed by application of a compression dressing, in order to make the vein disappear
• Radiofrequency ablation -- a catheter is threaded into the varicose vein to heat the vein wall in order to obliterate the vein and improve the function of its valve
• Laser surgeries -- new laser technology sends a burst of light onto the vein, which makes it eventually disappear
• Stripping the vein -- removal of the vein via small incisions
• Vein surgery -- generally only used in severe cases involving leg ulcers

Complementary and Alternative Therapies

A comprehensive treatment plan for varicose veins may include a range of complementary and alternative therapies. Generally these therapies are aimed at preventing varicose veins from developing or current varicose veins from worsening, not making existing veins disappear.

Nutrition

• Eat foods rich in dietary fiber in the form of complex carbohydrates (whole grains) and bioflavonoids (dark berries, dark leafy greens, garlic, and onions).
• Potentially beneficial supplements include vitamin C (500 - 1,000 mg three times per day), vitamin E (400 IU per day), and zinc (15 - 30 mg per day).
• Rutin (500 mg two times per day) is a bioflavonoid that may shore up the walls of veins and help them function better.
• Oligomeric proanthocyandin complexes (OPCs) are bioflavonoids found in grape seed and pine bark. They appear to be able to reduce leakage in veins and reduce swelling in the legs. Doses are 720 mg of grape seed extract per day or 100 - 120 mg of pycnogenol (pinus pinaster) three times per day. Taking grape seed extract along with a vitamin C supplement may raise blood pressure, so check with your doctor. Do not take grape seed extract if you take blood-thinning medication.

Herbs

Herbal remedies may offer relief from symptoms. Herbs are generally available as dried extracts (pills, capsules, or tablets), teas, or tinctures (alcohol extraction, unless otherwise noted). People with a history of alcoholism should not take tinctures. Dose for teas is 1 heaping tsp. per cup of water steeped for 10 minutes (roots need 20 minutes).

• Horse chestnut (Aesculus hippocastanum) 250 mg two times per day, standardized to contain 16 - 21% aescin. Use only reputable brands that have been professionally formulated. Crude preparations can contain a toxic compound. Do not use if you have liver or kidney disease or take blood-thinning medication, and do not exceed recommended dosage.
• Butcher's broom (Ruscus aculeatus), 150 mg three times per day, standardized to contain 9 - 11% ruscogenin.
• Gotu kola (Centella asiatica), 200 mg two to four times per day, standardized to contain 10% asiaticosides. Do not take gotu kola if you have liver disease.
• Bilberry (Vaccinium myrtillus), 80 - 160 mg three times per day, standardized to contain 25% anthocyanoside. Do not take bilberry if you take a prescription diuretic (water pills).

Homeopathy

Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual. Some of the most common remedies for varicose veins include Aesculus, Fluoricum acidum, Hamamelis, and Secale.

Physical Medicine

Cold compresses of witch hazel (Hamamelis virginiana) and yarrow (Achillea millefolium) tea may provide temporary relief from pain and burning.

Acupuncture and Massage

Acupuncture and massage may help improve the overall circulatory system.

Varicose vein disease is a chronic condition, and new varicose veins often develop after treatment.

Walking after sclerotherapy is important to help promote healing.

If you've had surgical treatment, contact your health care provider if you develop severe pain, tenderness, swelling, scabs, or blisters.

Bergan JJ, Yao JST. Venous Disorders. Philadelphia, PA: Saunders; 1991: 201–215.

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications; 1998:99, 149, 432.

Brinkhaus B, Lindner M, Schuppan D, Hahn EG. Chemical, pharmacological and clinical profile of the east Asian medical plant Centella asiatica. Phytomedicine. 2000;7:427-48.

Fauci AS. Harrison's Principles of Internal Medicine. 14^th ed. New York, NY: McGraw-Hill; 1998: 1405.

Goldman MP, Weiss RA, Bergan JJ. Varicose Veins and Telangectasias: Diagnosis and Treatment. 2^nd ed. St. Louis, MO: Quality Medical; 1999: 3–41, 110–124, 164–174, 175–264, 414–424, 470–497.

Hoffman D. The New Holistic Herbal. New York, NY: Barnes & Noble Books;1995: 31.

Kiesewetter H, Koscielny J, Kalus U, et al. Efficacy of orally administered extract of red vine leaf AS 195 (folia vitis viniferae) in chronic venous insufficiency (stages I-II). A randomized, double-blind, placebo-controlled trial. Arzneimittelforschung. 2000;50:109-17.

Murray MT, Pizzorno JE. Encyclopedia of Natural Medicine. Rocklin, Calif: Prima Publishing; 1998: 540.

Petrassi C, Mastromarino A, Spartera C. Pycnogenol in chronic venous insufficiency. Phytomedicine. 2000;7:383-8.

Rosen P, et al. Emergency Medicine: Concepts and Clinical Practice. 4^th ed. Vol 2. St. Louis, MO: Mosby; 1998: 1862–1863.

Vanscheidt W, Jost V, Wolna P, et al. Efficacy and safety of a Butcher's broom preparation (Ruscus aculeatus L. extract) compared to placebo in patients suffering from chronic venous insufficiency. Arzneimittelforschung. 2002;52:243-250.