Varicose Veins: What You Need to Know

Varicose veins (or varices) are not just a cosmetic problem, but a sign of altered venous circulation that deserves medical attention. This is a very common condition: it affects between 10 and 40% of the population, meaning that more than 7 million people are affected in Italy alone. Precisely because it is so common, it is often underestimated.

What varicose veins are

Varicose veins are dilated, tortuous, and permanently altered veins that have lost the ability to efficiently return blood to the heart. They appear mainly in the legs, since that is where blood must overcome gravity to travel upward. Two allies help ensure this upward flow: the system of venous valves, which act as “one-way doors” allowing blood to move upward and preventing it from flowing back down and the calf muscle pump, a true “peripheral heart” that pushes blood upward with every step.

How they form: genetics and lifestyle

The formation of varicose veins depends on a combination of factors. Genetic predisposition plays a key role: if one’s parents suffer from venous insufficiency, the likelihood of developing it is higher, due to a congenital weakness of the vein walls. Lifestyle adds to this: a sedentary lifestyle, excess weight, and standing for many hours (so-called prolonged orthostatic posture) increase pressure on the veins and accelerate their dilation. This is why varicose veins can be described as a “disease of modern life.”

Spider veins, microvarices, and telangiectasias: clearing up the confusion

Patients often confuse the different signs that appear on the legs. Telangiectasias, commonly known as “spider veins,” are thin, red or reddish-blue branching vessels resembling spiderwebs, and represent the first sign of excessive pressure in the more superficial vessels. Microvarices, or reticular veins, are slightly larger veins (1-3 mm), greenish or bluish in color, located deeper beneath the skin. It’s important to remember that these cosmetic signs can be the “tip of the iceberg” of a deeper venous reflux.

The risk of thrombosis

This is the reason varicose veins should not be neglected: when a vein dilates, the blood inside it stagnates, and as a result, thrombosis can occur (varicose vein thrombosis), potentially involving the deep venous circulation (deep vein thrombosis) and pulmonary embolism. A varicose vein can also rupture, either spontaneously or from trauma, causing significant bleeding, or develop into an ulcer, a later but not-to-be-underestimated complication.

Diagnosis and treatment

Diagnosis is made using venous color Doppler ultrasound, a non-invasive imaging exam that assesses the shape and flow of the vessels and precisely maps the situation. Based on this study, treatment is chosen on a personalized basis: from less invasive techniques such as foam sclerotherapy to endovascular procedures (laser, radiofrequency). All of these are now minimally invasive, outpatient options.

The important message, then, is that varicose veins should not be viewed as simply a cosmetic flaw. Seeking a specialist evaluation with color Doppler ultrasound early on makes it possible to intervene with modern techniques before complications arise and there is no reason to fear a painless, non-invasive exam.