Why do they happen? Partly it’s because our veins act like ladders: They have rungs (valves) that help blood make its way back toward the heart, step by step, without slipping back down. When those valves weaken or collapse, blood and fluid can start to pool in the lower legs, leading to larger, ropier, more visible veins. This process can worsen with age, gravity, prolonged standing or immobility, genetics, blood vessel disease, water retention, or pregnancy. Sometimes, poorly-functioning veins can lead to lower leg swelling, throbbing, aching, muscle fatigue, discolored rashes, or even skin ulcers.
If you’re noticing prominent veins on your legs, it’s a good idea to discuss it with your primary doctor, dermatologist, or a vascular surgeon - especially if you’re feeling uncomfortable. Lower leg symptoms could be due to a blood vessel disease or a medical condition. A clot in the lower legs (deep vein thrombosis, or DVT) can be dangerous, even life-threatening. DVTs can appear as pinkness, swelling, or pain in the lower leg, sometimes with a firm cord or lump that can be felt in the calf. This is most common in people with a blood clotting disorder, women who are pregnant or take certain birth control pills, those who’ve been traveling or immobile for a prolonged time, or people who’ve recently had orthopedic surgery, such as a hip replacement. An ultrasound can quickly evaluate for a clot.
For those with normal but enlarged leg veins, simple steps can help: regular exercise, watching salt intake, elevating the legs periodically, and compression socks or stockings that squeeze the lower legs in a graded fashion to help funnel blood up toward the heart. Compression socks or devices are very effective when they are labeled with a “squeeze rating” of 20-30 mmHg, but they should not be used by those with certain medical or vascular conditions, which is why it’s important to check with your doctor first.
Cosmetic and medical treatments can also help to reduce visible veins. A vascular surgeon may perform vein stripping (phlebectomy) or endovenous ablation using laser or radiofrequency energy to reduce enlarged varicose veins. Small vessels - called telangiectases, matted veins, spider veins, or reticular veins - can often be reduced or erased cosmetically with a pulsed dye laser, intense pulsed light (IPL), or injections of medicine directly into tiny veins (called sclerotherapy). When performed safely by a well-trained provider, these minimally-invasive treatments may cause temporary redness, bruising, or skin color changes, but they typically don't disrupt the skin’s surface, cause scarring, or contribute to circulation problems. These therapies should not be performed on anyone who is pregnant or breastfeeding or has a history of blood clots or vascular disease.
And if your varicose veins aren’t bothersome and your body feels healthy, you might choose to do nothing at all - a reasonable decision given that surgical and cosmetic treatments are not risk-free.
BY LAUREL NAVERSEN GERAGHTY, MD