[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Conditions](https://durgical.com/en/conditions/) › Varicose veins [Conditions](https://durgical.com/en/conditions/) · [Lower limb](https://durgical.com/en/anatomy/region/lower-limb/) # Varicose veins Varicose veins are swollen, twisted surface veins of the leg, caused by weak valves that let blood flow backward and pool. Updated 2026-10-29 ## Structures involved Tap one to see what it is and open it in 3D. - [Great saphenous vein](https://durgical.com/en/anatomy/great-saphenous-vein/) - [Small saphenous vein](https://durgical.com/en/anatomy/small-saphenous-vein/) - [Perforating veins](https://durgical.com/en/anatomy/perforating-veins/) - [Leg veins](https://durgical.com/en/anatomy/anterior-tibial-veins/) - [Femoral vein](https://durgical.com/en/anatomy/femoral-vein/) - [Popliteal vein](https://durgical.com/en/anatomy/popliteal-vein/) - [Saphenous nerve](https://durgical.com/en/anatomy/saphenous-nerve/) - [Sural nerves](https://durgical.com/en/anatomy/sural-nerve/) ## In histology - [Blood vessels: artery, vein and capillary layers](https://durgical.com/en/histology/blood-vessels-artery-vein-and-capillary-layers/) ## In the clinical exam - [Varicose veins: the Trendelenburg (Brodie–Trendelenburg) test](https://durgical.com/en/clinical-exam/varicose-veins-the-trendelenburg-test/) ## In physiology - [Vascular compliance and capacitance](https://durgical.com/en/physiology/vascular-compliance-and-capacitance/) ## Why it happens - [Edema and effusions: the four mechanisms](https://durgical.com/en/general-pathology/edema-and-effusions-the-four-mechanisms/) ## What it is Dilated, twisted superficial [leg veins](https://durgical.com/en/anatomy/anterior-tibial-veins/), usually of the great or small saphenous system, caused by failure of the venous valves and reflux of blood. ## Who gets it Very common in adults, more often in women and with age. A frequent reason for consultation in Latin America, especially in people who stand for long periods at work. ## Causes - Primary weakness of the vein wall and valves - Secondary to previous deep vein thrombosis - Rarely congenital venous malformations ## Risk factors - Family history - Female sex and pregnancy - Older age - Long periods of standing - Obesity - Previous deep vein thrombosis ## Pathophysiology Leaky valves at the saphenofemoral or saphenopopliteal junction, or in perforating veins, let blood flow backwards. Pressure in the superficial veins rises, so they stretch and become tortuous. Long-standing venous hypertension damages the skin, leading to oedema, pigmentation and ulcers. ## Classification - CEAP classification: Clinical (C0–C6), Etiology, Anatomy and Pathophysiology - C2 varicose veins, C3 oedema, C4 skin changes, C5 healed ulcer, C6 active ulcer ## Symptoms and signs - Visible bulging, twisted veins - Heaviness, aching and tiredness of the legs, worse at the end of the day - Ankle swelling - Itching and night cramps - Brown skin pigmentation, eczema or hardened skin around the ankle ## Red flags - Painful, hard, red cord along a vein (superficial thrombophlebitis) - Sudden swelling of the whole leg (possible deep vein thrombosis) - Bleeding from a varix - Ulcer that does not heal ## Diagnosis **Clinical** Inspection standing up, palpation along the saphenous veins and description of [skin](https://durgical.com/en/anatomy/skin/) changes using the CEAP scale. **Tests** Usually none; coagulation tests only if thrombosis is suspected. **Imaging** Venous duplex ultrasound maps reflux in the saphenous and [perforating veins](https://durgical.com/en/anatomy/perforating-veins/) and checks the deep veins before treatment. ## Differential diagnosis - Deep vein thrombosis - Lymphoedema - Post-thrombotic syndrome - Heart, [kidney](https://durgical.com/en/anatomy/kidney/) or [liver](https://durgical.com/en/anatomy/liver/) causes of leg swelling - Telangiectasias and reticular veins ## Goal of treatment Relieve symptoms, prevent skin damage and ulcers, and remove reflux in veins that cause problems. ## Treatment **Conservative** Graduated compression stockings, leg elevation and exercise. **Lifestyle** Weight control and avoiding long periods standing still. **Procedure** Endovenous thermal ablation (laser or radiofrequency) or foam sclerotherapy of refluxing veins. **Surgical** Ligation and stripping of the saphenous vein or ambulatory phlebectomy. ## Complications - Superficial thrombophlebitis - Bleeding - Venous eczema and lipodermatosclerosis - Venous ulcer - Recurrence after treatment ## Prognosis A chronic condition that tends to progress slowly. Treatment relieves symptoms well, but new varicose veins can appear over the years. ## Prevention - Regular walking and calf muscle exercise - Healthy weight - Compression in high-risk occupations, as advised by a clinician ## Test yourself Think of the answer, then tap the question to see it. ## What is the basic mechanism behind primary varicose veins? Venous valve failure causing reflux and high pressure in the superficial veins. ## Which classification is used to describe chronic venous disease? CEAP: Clinical, Etiology, Anatomy and Pathophysiology; clinical classes run from C0 to C6. ## Which imaging test is the standard for assessing varicose veins before treatment? Venous duplex ultrasound, which shows reflux and confirms the deep veins are patent. ## In CEAP, what does C6 mean? An active venous ulcer; C5 is a healed ulcer. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/conditions/varicose-veins/) ## Related conditions - [Cellulitis of the leg](https://durgical.com/en/conditions/cellulitis-of-the-leg/) - [Deep vein thrombosis](https://durgical.com/en/conditions/deep-vein-thrombosis/) - [Lymphoedema](https://durgical.com/en/conditions/lymphoedema/) - [Chronic venous insufficiency](https://durgical.com/en/conditions/chronic-venous-insufficiency/) - [Venous leg ulcer](https://durgical.com/en/conditions/venous-leg-ulcer/) Educational information, not medical advice. For any symptom, see a health professional. Sources: [Varicose Veins](https://www.ncbi.nlm.nih.gov/books/NBK470194/) (StatPearls (NCBI Bookshelf), 2023). [← All conditions](https://durgical.com/en/conditions/) ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. 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