---
title: Varicose veins of the legs
description: What varicose veins of the legs are, why they develop, how they are recognised, which treatment approaches clinical guidelines describe and when to call an ambulance.
type: disease
aliases:
  - varicose veins
  - varicose vein disease
  - varicose veins of the lower limbs
  - varicosities
sources:
  - tier: guideline
    org: minzdrav-rf
    title: Варикозное расширение вен нижних конечностей
    year: 2024
    url: https://cr.minzdrav.gov.ru/view-cr/680_2
  - tier: guideline
    org: minzdrav-rf
    title: Флебит и тромбофлебит поверхностных сосудов
    year: 2024
    url: https://cr.minzdrav.gov.ru/view-cr/668_2
  - tier: guideline
    org: nice
    title: 'Varicose veins: diagnosis and management (CG168)'
    year: 2013
    url: https://www.nice.org.uk/guidance/cg168
  - tier: reference
    org: msd-manuals
    title: Varicose Veins (MSD Manual Professional Version)
    year: 2026
    url: https://www.msdmanuals.com/professional/cardiovascular-disorders/peripheral-venous-disorders/varicose-veins
  - tier: reference
    org: msd-manuals
    title: Varicose Veins (MSD Manual Consumer Version)
    year: 2026
    url: https://www.msdmanuals.com/home/heart-and-blood-vessel-disorders/venous-disorders/varicose-veins
  - tier: reference
    org: msd-manuals
    title: Overview of the Venous System (MSD Manual Consumer Version)
    year: 2026
    url: https://www.msdmanuals.com/home/heart-and-blood-vessel-disorders/venous-disorders/overview-of-the-venous-system
sources_checked: 2026-10-13
review: null
---

Varicose veins of the legs are a chronic condition in which the veins under the skin of the legs become dilated. Over time it can lead to chronic venous insufficiency: swelling, darkening of the skin, eczema, hardening of the skin and venous (trophic) ulcers.<Cite n={1} /> In varicose veins, blood flows in the reverse direction.<Cite n={3} /> The condition is common: NICE estimates that visible varicose veins in the legs affect at least a third of people.<Cite n={3} /> Varicose veins are more common in women than in men.<Cite n={4} />

<Diagram name="varicose-veins">
  <p slot="normal">
    A superficial vein lies under the skin and a deep vein within the muscles; short connecting
    veins link them.<Cite n={6} /> The leg veins have valves made of two flaps (cusps): blood
    flowing towards the heart pushes them open, and if blood tries to flow backward, the cusps
    close.<Cite n={6} /> Valves in the connecting veins let blood flow only from the superficial
    veins into the deep veins.<Cite n={6} />
  </p>
  <p slot="disease">
    The superficial vein is widened, the cusps of its valves have separated, and when the person
    stands, blood flows backward, downwards; this backward flow is called reflux.<Cite
      n={[1, 5]}
    /> Blood pools in the vein and stretches it even more; the weakened wall lengthens, and the vein
    becomes twisted.<Cite n={[1, 5]} /> The disease begins in the veins under the skin, so the deep
    vein in the diagram is unchanged.<Cite n={1} />
  </p>
</Diagram>

## Why it happens

<Patient>

The disease is based on an inherited weakness of the vein wall. Yet varicose vein disease is not a genetic disease: for it to appear, outside factors are needed, above all lifestyle.<Cite n={1} /> The weakened wall loses its elasticity, the vein becomes longer and wider and, to fit in the same space as before, becomes twisted.<Cite n={5} /> The valve cusps separate, and when the person stands, gravity pulls the blood back down, stretching the vein even more.<Cite n={5} />

The main risk factors are female sex, age, excess weight, standing for long periods, varicose veins in relatives and the number of pregnancies.<Cite n={1} /> The disease becomes more common with age, but many cases occur in people under 30.<Cite n={1} /> Varicose veins often first appear during pregnancy.<Cite n={[3, 5]} />

</Patient>

<Student>

Varicose veins of the lower limbs are one form of chronic venous disease, which also includes post-thrombotic syndrome, telangiectasias and reticular veins.<Cite n={1} /> Venous reflux is retrograde flow of blood caused by valve dysfunction in the superficial, deep or perforator veins.<Cite n={1} /> Reflux from the deep veins into varicose superficial veins leads to pooling (stasis) of blood in them and to volume overload of the superficial and deep veins.<Cite n={1} />

MSD explains the higher frequency of varicose veins in women by the effect of oestrogen on venous structure and by the rise in pelvic and leg venous pressures in pregnancy.<Cite n={4} /> Varicose veins can also develop after [deep vein thrombosis](../deep-vein-thrombosis/).<Cite n={4} />

</Student>

## Symptoms

<Patient>

The main sign is knotted or twisted veins under the skin that are most visible when standing.<Cite n={[1, 4]} /> Varicose veins can cause pain or discomfort along the veins, heaviness and quick tiring of the legs, a feeling of swelling, cramps, itching, burning and a feeling of restlessness in the legs.<Cite n={1} /> The symptoms get worse towards the end of the day and with long standing or sitting, and ease after walking or resting lying down.<Cite n={1} /> But many people, even some with very large varicose veins, have no pain.<Cite n={5} />

Small "spider veins" and "thread veins" are also common in healthy people; they are a cosmetic issue.<Cite n={1} /> Veins visible through fair skin are not a disease either.<Cite n={1} />

Varicose veins may become more severe over time and lead to complications: changes in skin colour, bleeding, venous ulcers.<Cite n={3} /> NICE estimates that 3% to 6% of people with varicose veins develop a venous ulcer in their lifetime.<Cite n={3} />

</Patient>

<Student>

Varicose veins are subcutaneous veins more than 3 mm in diameter in the standing position, usually knotted (saccular) and/or tortuous (serpentine); telangiectasias are intradermal veins less than 1 mm in diameter, reticular veins 1–3 mm.<Cite n={1} />

Chronic venous disease is described with the CEAP classification: C0, no visible or palpable signs; C1, telangiectasias or reticular veins; C2, varicose veins; C3, oedema; C4, trophic changes of the skin and subcutaneous tissue; C5, healed and C6, open (active) venous ulcer.<Cite n={1} /> The classes are not stages: the disease can present straight away with oedema and even trophic changes.<Cite n={1} /> Chronic venous insufficiency (CVI) corresponds to classes C3–C6; the hyperpigmentation it causes is most often on the medial side of the lower third of the leg.<Cite n={1} />

</Student>

According to MSD, only a small percentage of people with varicose veins have complications.<Cite n={5} /> One of them is thrombophlebitis (superficial vein thrombosis): a clot forms in the vein, and the vein wall, the subcutaneous tissue and the skin around it become inflamed.<Cite n={2} /> Varicose veins are the most common risk factor for thrombophlebitis.<Cite n={2} /> It shows itself as a painful lump with redness and local warmth of the skin over varicose nodes or a large vein under the skin; sometimes a firm, painful cord can be felt.<Cite n={2} /> The greatest danger is that the clot spreads into the deep veins ([deep vein thrombosis](../deep-vein-thrombosis/)) and causes [pulmonary embolism (PE)](../pulmonary-embolism/).<Cite n={2} /> Another complication is bleeding: the thin skin over a dilated vein can break even after a minor injury; very rarely, such bleeding, if unnoticed during sleep, is fatal.<Cite n={4} />

## How it is diagnosed

<Patient>

The doctor asks about symptoms and examines the legs while the person stands; the diagnosis is usually obvious from the examination.<Cite n={[1, 4]} /> The main test is a duplex ultrasound scan of the leg veins: it shows where the valves fail and where blood flows backward.<Cite n={[3, 4]} /> NICE advises an ultrasound scan to confirm the diagnosis and plan treatment; according to the Russian Ministry of Health guideline, it is needed when the diagnosis is unclear and before a procedure.<Cite n={[1, 3]} />

</Patient>

<Student>

The diagnostic criterion is the presence of knotted and/or tortuous subcutaneous veins more than 3 mm in diameter that bulge and are visible in the standing position.<Cite n={1} /> The Russian Ministry of Health guideline recommends duplex scanning as the first-line imaging method when invasive treatment is planned, and assessing valve competence of the superficial, deep and perforator veins in the standing position.<Cite n={1} /> NICE recommends duplex ultrasound to confirm the diagnosis of varicose veins and the extent of truncal reflux, and to plan treatment.<Cite n={3} />

The Russian Ministry of Health guideline considers reflux pathological if it lasts more than 0.5 s in the superficial veins, tibial veins, gastrocnemius veins and deep femoral vein, and more than 1 s in the common femoral, femoral and popliteal veins.<Cite n={1} /> It does not recommend functional tests (such as the Trendelenburg test) for diagnosis and treatment planning.<Cite n={1} />

</Student>

## How it is treated

<Patient>

Varicose veins that have already formed do not go away with pills, ointments or stockings. They can only be removed or closed from inside: with heat (thermal ablation), without heat, or by injecting a special substance (sclerotherapy).<Cite n={1} /> Treatment without a procedure only relieves symptoms.<Cite n={1} /> The disease cannot be cured completely: new varicose veins may develop over time, and treatment often has to be repeated.<Cite n={[3, 4, 5]} />

The procedures used are laser and radiofrequency ablation, glue and mechanochemical ablation, sclerotherapy and removal of the veins.<Cite n={1} /> According to the Russian Ministry of Health guideline, all these methods are effective, and the choice depends on the doctor's experience and the clinic's equipment.<Cite n={1} /> NICE first offers ablation with heat.<Cite n={3} /> Removing or closing a diseased vein under the skin does not impair the outflow of blood: it has no proper flow towards the heart anyway, and the deep veins do the main work, if they are functioning normally.<Cite n={[1, 5]} />

Sources differ on compression hosiery (medical stockings). The Russian Ministry of Health guideline recommends it to relieve symptoms and swelling.<Cite n={1} /> NICE advises not to offer compression hosiery to treat varicose veins unless a procedure is unsuitable.<Cite n={3} /> Compression has contraindications, for example severe disease of the leg arteries, so whether stockings are needed, and which ones, is for the doctor to decide.<Cite n={1} />

The Russian Ministry of Health guideline recommends phlebotropic (venoactive) drugs to relieve venous symptoms but notes that their effect is limited; they cannot remove varicose veins.<Cite n={1} />

Doctors advise walking every day, resting with the legs raised, losing excess weight and not standing or sitting still for long periods.<Cite n={[1, 3]} /> There are no methods with proven benefit for preventing varicose veins from appearing.<Cite n={1} />

During pregnancy, procedures on the veins are not done except in exceptional circumstances; compression hosiery can relieve symptoms and swelling.<Cite n={[1, 3]} /> Varicose veins that appear during pregnancy usually largely subside in the first 2–3 weeks after delivery.<Cite n={5} />

</Patient>

<Student>

For patients with varicose veins (C2–C6), the Russian Ministry of Health guideline recommends surgical treatment (level of evidence 2, grade of recommendation B): compared with conservative treatment in uncomplicated varicose vein disease, it gives better symptom relief, cosmetic results and quality of life.<Cite n={1} /> To eliminate vertical reflux, the Russian Ministry of Health guideline recommends thermal ablation as preferable to open surgery (level of evidence 1, grade of recommendation B).<Cite n={1} /> For confirmed truncal reflux, NICE offers endothermal ablation; if it is unsuitable, ultrasound-guided foam sclerotherapy; if that is unsuitable too, surgery.<Cite n={3} />

The Russian Ministry of Health guideline recommends elastic compression in chronic venous disease of classes C2–C6 to relieve symptoms (level of evidence 2, grade of recommendation B) and in chronic venous disease to relieve oedema (level of evidence 2, grade of recommendation A).<Cite n={1} /> It recommends phlebotropic drugs to reduce venous symptoms (level of evidence 1, grade of recommendation A); according to a 2020 Cochrane review, their activity against some symptoms and oedema is limited, and they are not recommended in asymptomatic chronic venous disease without venous insufficiency.<Cite n={1} />

According to the Russian Ministry of Health guideline, after a procedure the rate of new varicose veins reaches 30% at 3 years and 50% at 5 years; varicose veins can be treated again an unlimited number of times.<Cite n={1} />

When thrombophlebitis is suspected, the Russian Ministry of Health guideline recommends duplex scanning of the veins of both limbs, assessing the superficial and deep veins.<Cite n={2} /> Treatment uses non-steroidal anti-inflammatory drugs, compression and, in some situations, anticoagulants; the choice is made by the doctor.<Cite n={2} />

</Student>

## When to call an ambulance

Call your local emergency number (112 in the EU, 911 in the US and Canada, 999 in the UK) if a varicose vein is bleeding: the Russian Ministry of Health guideline classes this as a life-threatening condition that requires emergency medical care.<Cite n={1} /> NICE recommends referring people with bleeding varicose veins to a vascular service immediately.<Cite n={3} /> The Russian Ministry of Health guideline also counts superficial vein thrombosis among these conditions: if a painful, red lump or a firm cord appears along a vein, seek medical help urgently or call an ambulance; an ultrasound scan of the superficial and deep veins of both legs is needed.<Cite n={[1, 2]} />

A clot from a superficial vein can spread into the deep veins and cause PE.<Cite n={2} /> The signs of these conditions are described in the articles on [deep vein thrombosis](../deep-vein-thrombosis/) and [pulmonary embolism](../pulmonary-embolism/). After vein surgery, if there is bleeding, a fever or redness around the wounds, calf pain, leg swelling, chest pain or shortness of breath, the Russian Ministry of Health guideline advises contacting the surgeon who did the operation or the emergency services.<Cite n={1} /> As everywhere on the site: call an ambulance for fainting, chest pain or severe shortness of breath; this is the general safety rule, repeated at the bottom of every page.

<Quiz />