Varicose veins are among the most common vascular conditions I see in practice. Research has shown that approximately 23 percent of adults in the United States have varicose veins, and chronic venous disease in its broader forms affects up to 40 percent of the population. Despite how common they are, patients frequently tell me the same thing: they were told for years that it was just a cosmetic problem and not worth treating.
That is not always accurate, and in some cases it leads to patients presenting with advanced disease that could have been managed much earlier.
This article explains what varicose veins are, why they develop, who is most at risk, and what can happen when they are left untreated over time. My goal is not to alarm anyone, but to give you accurate information so you can make an informed decision about your own vein health.
What Are Varicose Veins, and Why Do They Develop?
Varicose veins are enlarged, twisted veins that typically appear blue or purple beneath the skin of the legs. They form when the one-way valves inside the veins weaken or fail. Under normal circumstances, these valves open to allow blood to flow upward toward the heart, then close to prevent it from falling back down under gravity. When a valve fails, blood does not move efficiently upward. Instead, it flows backward and collects in the vein below, a process called reflux.
This is the central mechanism behind a condition where the venous system of the legs can no longer adequately return blood to the heart. As reflux progresses, pressure builds inside the affected veins. That elevated pressure is what drives the downstream complications described in this article.
It is worth noting that varicose veins visible at the surface are often a sign of deeper venous reflux that cannot be seen without imaging. This is why I perform a duplex ultrasound on every patient I evaluate for vein disease. What you see bulging at the skin may be only part of the picture.
Who Is Most at Risk?
Certain factors significantly increase the likelihood of developing varicose veins and venous insufficiency. These include:
- Age — Valve function naturally diminishes over time, and the prevalence of varicose veins increases with age.
- Female sex — Women develop varicose veins at higher rates than men, in part due to hormonal influences on vein wall elasticity.
- Family history — Venous insufficiency has a strong hereditary component. If one parent has varicose veins, your risk is elevated. If both parents are affected, the risk is substantially higher.
- Pregnancy — Increased blood volume and uterine pressure on the pelvic veins contribute to reflux. The condition often improves after delivery but may not resolve completely, and subsequent pregnancies can worsen it.
- Obesity — Elevated intra-abdominal pressure impairs venous return and accelerates valve damage.
- Prolonged standing or sitting — Occupations that require long periods on your feet or at a desk reduce the effectiveness of the calf muscle pump, which normally assists in moving blood back toward the heart.
Understanding your risk profile is relevant not only to whether you may develop varicose veins, but to how aggressively they are likely to progress.
How Varicose Veins Progress Over Time
This is one of the most important concepts I discuss with patients. Venous disease does not usually worsen dramatically overnight. It tends to progress gradually, often over years, and the changes can be subtle enough that patients adapt to them without realizing the disease is advancing.
The typical trajectory begins with mild aching or leg heaviness that a patient attributes to being tired or aging. Over time, swelling develops, often around the ankles by the end of the day. Skin changes follow. What starts as itching or mild discoloration can slowly transition to skin thickening, chronic inflammation, and ultimately tissue breakdown. At each stage along that path, there are treatment options available. The further along the progression, the more complex the management becomes.
The reason I raise this is not to create urgency where none exists. Some patients have varicose veins that remain relatively stable for many years. But in patients who already have symptoms — particularly swelling, skin changes, or significant aching — waiting carries real clinical risk. Asymptomatic varicose veins are not the same as symptomatic ones, and that distinction matters in how I approach evaluation and treatment recommendations.
Common Symptoms
Many patients have visible veins with minimal discomfort. Others experience symptoms that affect how they function throughout the day. Common symptoms of varicose veins include:
- Leg heaviness or aching, typically worsening as the day progresses
- Throbbing or burning sensations in the legs
- Swelling in the lower legs and ankles
- Itching or a rash-like irritation near the affected veins
- Nighttime cramps or restless legs
- Fatigue in the legs after prolonged standing
These symptoms typically improve with walking, leg elevation, or compression stockings, and worsen with prolonged standing or sitting. That pattern — relief with movement and elevation, worsening with dependency — is characteristic of venous disease.
What Can Happen If Varicose Veins Are Left Untreated
1. Skin Discoloration (Hyperpigmentation)
As venous pressure increases over time, fluid and red blood cells begin to leak out of the veins into the surrounding tissue. When red blood cells break down outside the vascular system, they leave behind hemosiderin, an iron-containing compound that produces a characteristic brownish discoloration of the skin, most often appearing around the inner ankle or lower calf.
This change is not cosmetic. It indicates that the underlying venous pressure has been elevated long enough to cause tissue-level changes. Once hyperpigmentation is present, the skin in that area is more vulnerable to injury and heals more slowly.
2. Lipodermatosclerosis
Lipodermatosclerosis refers to chronic inflammation and fibrosis of the skin and subcutaneous fat of the lower leg. Patients typically describe the affected skin as feeling tight, firm, tender, or indurated — sometimes referred to as a “woody” texture. The lower leg may take on an inverted bottle shape, with significant swelling above a zone of fibrotic, thickened tissue.
When I see lipodermatosclerosis in a patient, it tells me the venous disease has been ongoing for some time and that the inflammatory burden on the surrounding tissue is substantial. These patients are at elevated risk for ulceration, and treating the underlying reflux is important both to prevent further progression and to reduce ongoing inflammation.
3. Venous Leg Ulcers
Venous leg ulcers represent one of the most serious complications of untreated chronic venous insufficiency. Clinical data indicates that venous insufficiency accounts for approximately 70 to 80 percent of all chronic leg ulcers, and studies suggest that up to 1 percent of Western populations will develop a venous ulcer at some point in their lifetime.
These ulcers typically appear near the medial ankle and present as shallow, irregular wounds that are slow to heal, frequently recur, and are at risk for secondary bacterial infection. The challenge with venous ulcers is that treating the wound alone is insufficient. Without addressing the underlying venous reflux, the elevated venous pressure continues to impair healing and drive recurrence. Research has demonstrated recurrence rates as high as 70 percent in patients whose ulcers are managed with wound care alone, without correction of the underlying venous problem.
When I evaluate a patient with a venous ulcer, the treatment plan must address both the wound itself and the vein disease driving it. The two cannot be separated if the goal is durable healing.
4. Superficial Thrombophlebitis
Superficial thrombophlebitis is inflammation of a surface vein, often accompanied by a clot within that vein. Patients typically notice a firm, tender, cord-like area along the course of a varicose vein, with overlying redness and warmth.
Clinical evidence indicates that patients with varicose veins have approximately five times the risk of developing superficial thrombophlebitis compared to those without venous disease. While superficial clots are generally less immediately dangerous than deep vein thrombosis, they are not benign. Clots in large surface veins close to the junction with the deep venous system require careful evaluation, as they can extend into the deep system. I evaluate each case individually to determine appropriate management.
5. Deep Vein Thrombosis and Pulmonary Embolism
Deep Vein Thrombosis is a clot in the deep venous system of the leg. DVT affects approximately 900,000 Americans annually, and its most serious complication — pulmonary embolism — occurs when part of the clot dislodges and travels to the lungs. A pulmonary embolism can be life-threatening.
Not every patient with varicose veins will develop DVT, and it is important not to overstate this risk. However, the association between chronic venous disease and DVT is supported by clinical evidence, and new one-sided leg swelling accompanied by pain, warmth, or redness should always prompt medical evaluation to rule out deep vein involvement.
Seek urgent care the same day if you develop sudden swelling in one leg, new warmth or tenderness along a vein, or significant leg pain that does not improve with rest. Call 911 if you experience chest pain, shortness of breath, or cough up blood — these may indicate a pulmonary embolism.
6. Varicose Vein Bleeding
Varicose veins located close to the skin surface can bleed after minor trauma such as a bump or scratch. Because these veins are under elevated pressure, bleeding can be more significant than the mechanism of injury would suggest. Patients who are on anticoagulant therapy or antiplatelet medications are at particular risk.
If a varicose vein bleeds, apply firm direct pressure and elevate the leg. If bleeding does not stop promptly, seek urgent care. Minimally invasive vein treatment can close off problematic veins and reduce the risk of future bleeding episodes.
Schedule a Consultation at Coastal Vascular Center
You can reach Coastal Vascular Center at 281-949-6020 or schedule a consultation online. We understand that these symptoms are frightening, and we are here to provide clear answers and a path forward.
When to Schedule a Vein Evaluation vs. When to Seek Urgent Care
Schedule a vein evaluation if you have:
- Aching, heaviness, or fatigue in the legs, especially later in the day
- Swelling around the ankles or lower legs
- Itching, dryness, or an eczema-like rash near the ankle
- Skin discoloration — brownish or darkening skin near the lower leg
- Symptoms that are gradually worsening over weeks or months
Seek urgent medical care the same day if you notice:
- Sudden swelling in one leg
- New redness, warmth, or tenderness along a vein
- New, significant leg pain that does not improve with rest
Call 911 if you have:
- Chest pain
- Shortness of breath
- Coughing up blood
These may be signs of a pulmonary embolism.
How I Evaluate Varicose Veins
When I evaluate a patient for varicose veins, the workup is straightforward but important. I review the patient’s symptom history, relevant medical history, and risk factors. I then perform a focused physical examination of the legs.
The most important diagnostic tool is duplex ultrasound, which allows me to directly visualize blood flow patterns within the veins. I use duplex ultrasound to identify reflux — backward blood flow through incompetent valves — and to map the anatomy of the venous system. This tells me which veins are causing symptoms, how severe the reflux is, and which treatment approach is most appropriate. It is non-invasive, takes place in the office, and provides information I cannot obtain from an examination alone.
Treatment Options
Treatment depends on the severity of symptoms, ultrasound findings, and the patient’s goals. Options available at Coastal Vascular Center include:
- Conservative management — Compression stockings, regular walking, leg elevation, and weight management can reduce symptoms and slow progression, but do not eliminate reflux. For many patients, compression is an appropriate starting point and, for insurance purposes, is typically required before procedural intervention is covered.
- Sclerotherapy — A solution is injected into the vein, causing it to close and be reabsorbed by the body. Sclerotherapy is commonly used for smaller varicose veins and spider veins.
- Ultrasound-guided sclerotherapy — Used when the vein requires imaging guidance for accurate injection.
- Microphlebectomy — Bulging surface veins are removed through very small incisions under local anesthesia. This is typically performed in the office with minimal downtime.
- Ablation procedures — Radiofrequency Ablation and similar techniques use thermal energy delivered through a small catheter to close the incompetent vein from the inside. These are minimally invasive, performed under local anesthesia, and address the root cause of venous reflux rather than just the surface manifestation.
The right treatment plan depends on your specific anatomy and symptoms. I discuss the options with each patient individually after reviewing the ultrasound findings.
Why Call Coastal Vascular Center
If you have varicose veins and any of the symptoms described in this article — or if you have been told to “just watch it” for years and things have not improved — a vein evaluation is a reasonable and often straightforward next step. I have treated patients across a wide range of venous disease severity, and I consistently find that early evaluation leads to simpler treatment and better outcomes than waiting until complications develop.
At Coastal Vascular Center, we serve patients in the Greater South Houston Area with offices in Pearland and Lake Jackson. A vein evaluation includes an examination and duplex ultrasound imaging so we can give you a clear picture of what is happening and what, if anything, should be done about it.
To schedule an evaluation, call us at 281-949-6020 or request an appointment online.
Key Insights
- Varicose veins are caused by damaged or weakened one-way valves that allow blood to flow backward and pool in the vein under increased pressure.
- Symptoms such as leg heaviness, swelling, and skin changes are signs that underlying venous insufficiency may be worsening, not just cosmetic findings.
- Untreated varicose veins can progress over years to serious complications including skin hardening, open venous ulcers, superficial blood clots, and, less commonly, deep vein thrombosis.
- Venous leg ulcers are notoriously difficult to heal and carry recurrence rates as high as 70 percent when the underlying vein problem is not addressed.
- DVT affects approximately 900,000 Americans annually, and patients with varicose veins carry a measurably elevated risk for superficial thrombophlebitis.
- Most patients have effective minimally invasive treatment options available, and early evaluation leads to better outcomes than waiting for complications to develop.
- A duplex ultrasound is the standard diagnostic tool to assess venous reflux and guide treatment decisions.
Frequently Asked Questions
Do varicose veins always get worse if left untreated?
Not always, but clinical data indicates they often progress over time, particularly when symptoms such as swelling, aching, or skin changes are already present. Asymptomatic varicose veins may remain stable for years, while symptomatic ones carry a greater risk of advancement.
Can compression stockings cure varicose veins?
Compression can effectively manage symptoms and reduce swelling, but it does not close or eliminate the incompetent vein responsible for reflux. It is an important tool for symptom control and is typically required before insurance will authorize procedural treatment.
Can a varicose vein burst and bleed?
Yes. A varicose vein near the skin’s surface can bleed after minor trauma. Because these veins are under elevated pressure, bleeding can be disproportionate to the injury. Apply firm pressure, elevate the leg, and if bleeding does not stop, seek urgent care.
What kind of doctor treats varicose veins?
Vascular specialists and dedicated vein specialists are the appropriate providers for varicose vein evaluation and treatment. A thorough evaluation requires duplex ultrasound imaging, which should be performed and interpreted by a specialist familiar with venous anatomy and reflux patterns.
How do I know if my leg pain is a blood clot?
Sudden one-sided leg swelling, warmth, redness, or significant pain that comes on relatively quickly should be evaluated promptly to rule out DVT. These symptoms are distinct from the gradual, daily-pattern heaviness and aching typical of chronic venous insufficiency.
Are varicose veins more dangerous during pregnancy?
Pregnancy increases venous pressure due to elevated blood volume and uterine compression of pelvic veins, which can accelerate the development of varicose veins and worsen existing ones. The risk of superficial thrombophlebitis and DVT is also elevated during pregnancy and the postpartum period. Women with known venous disease who are pregnant or planning pregnancy should discuss their situation with a vascular specialist.
What is the link between varicose veins and chronic venous insufficiency?
Varicose veins are frequently a visible manifestation of the broader condition known as chronic venous insufficiency, which refers to the failure of the leg veins to adequately return blood to the heart. Not every patient with varicose veins has clinically significant venous insufficiency, but the presence of symptoms — swelling, skin changes, heaviness — suggests the underlying pressure problem is meaningful. Duplex ultrasound is the definitive way to assess whether significant reflux is present.
