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Varicose veins are abnormally stretched veins measuring over 3 mm in diameter. Over time, veins in the body stretch so they become larger in diameter and some elongate as well. This stretching of veins occurs over a period of years and is caused by pressure of blood inside the veins. Much of the problem is genetic and at least 19 different genes are implicated in this process. The vein walls stretch more in some people than in others. Many other factors are associated with development of varicose veins including obesity, pregnancy, prolonged sitting or standing, or obstruction of veins in the abdomen or pelvis.

As veins stretch, the one-way valves in the veins fail allowing blood to run away from the heart due to the effects of gravity. This valve failure results in increasingly high pressure in the veins and worsening stretching of the veins. This process is called venous insufficiency and the abnormal downward flow of blood in the veins is called reflux.

Varicose veins may cause no symptoms at all. More often, varicose veins are associated with pain, tenderness, swelling at the ankle or calf, or brown-pigmented skin or a rash at the ankles or calves.

Evaluation of varicose veins is important since they usually are a sign of progressive valve failure

and changes which place the patient at risk for clotting in the veins (thrombosis), infection in the feet or legs, or skin ulcers.

Patients with varicose veins and any sign of swelling of the ankle, soft tissue pain or tenderness, or abnormal skin changes in the ankle or calf should be evaluated clinically and should be studied with color duplex ultrasound to map the major veins of the legs and to evaluate the veins for venous insufficiency (valve failure).

Varicose veins may be treated a number of different ways depending on the location, size, and shape of the abnormal veins. Elastic compression stockings are helpful in management of varicose veins and may slow down progression, but patients with varicose veins often need other procedures which may include foam sclerotherapy, endovenous thermal ablation, or microphlebectomy.

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