Varicose veins are veins under the skin of the legs, which have become widened, bulging, twisted, gnarled and enlarged veins. They are most common in the legs and ankles. Any vein may become varicose, but the veins most commonly affected are those in your legs and feet. That's because standing and walking upright increases the pressure in the veins of your lower body. There are two main systems of veins in the legs:

• Deep veins: The leg muscles squeeze the deep veins during walking, carrying most of the blood back up the legs to the heart.

• Superficial veins: These occur under the skin which are less important and can form varicose veins.

These veins contain one-way valves to ensure that the blood flows towards the heart. Failure of these valves allows blood to flow backwards down the veins and results in an overload of pressure when standing. This excess pressure leads to widening of the veins so that they do not close properly. Blood then flows back into the leg along these veins and causes varicose veins to develop.

Arteries carry blood from your heart to the rest of your tissues. Veins return blood from the rest of your body to your heart, so the blood can be recirculated. To return blood to your heart, the veins in your legs must work against gravity. Muscle contractions in your lower legs act as pumps, and elastic vein walls help blood return to your heart. Tiny valves in your veins open as blood flows toward your heart then close to stop blood from flowing backward.

• Age-As you get older, your veins can lose elasticity causing them to stretch. The valves in your veins may become weak, allowing blood that should be moving toward your heart to flow backward. Blood pools in your veins, and your veins enlarge and become varicose. The veins appear blue because they contain deoxygenated blood, which is in the process of being recirculated through the lungs.

• Pregnancy-Some pregnant women develop varicose veins. Pregnancy increases the volume of blood in your body, but decreases the flow of blood from your legs to your pelvis. This circulatory change is designed to support the growing fetus, but it can produce an unfortunate side effect — enlarged veins in your legs. Varicose veins may surface for the first time or may worsen during late pregnancy, when your uterus exerts greater pressure on the veins in your legs. Changes in your hormones during pregnancy also may play a role. Varicose veins that develop during pregnancy generally improve without medical treatment within three months after delivery.

Varicose veins usually don't cause any pain.Varicose veins look dark blue, swollen, and twisted under the skin. Signs you may have varicose veins include:

• Veins that are dark purple or blue in color
• Heaviness, burning, aching, tiredness, or pain in your legs. Symptoms may be worse after you stand or sit for long periods of time.
• Swelling in your feet and ankles.
• Itching over the vein.
• Open sores, or you may bleed after a minor injury.
• Skin ulcers near your ankle, which can mean you have a serious form of vascular disease that requires medical attention.

Varicose veins are common and usually aren't a sign of a serious problem. But in some cases, varicose veins can be a sign of a blockage in the deeper veins called deep vein thrombosis

Phlebitis
Phlebitis (sometimes called thrombophlebitis) means inflammation of the veins, and is often accompanied by some thrombosis (clotting of blood) inside the affected veins, which become hard and tender. This is not the same as deep vein thrombosis (DVT) and is not usually dangerous. It does not mean that the varicose veins necessarily have to be treated.

Bleeding
The risk of bleeding as a result of knocking varicose veins worries many people, but this is very rare. It will always stop with firm pressure and the veins can then be treated to remove the risk of further bleeding.

Self-care
Avoid prolonged standing or sitting still. Try to put your feet up frequently (sit or lie down and raise the feet above the level of your hips - for example, use extra pillows under your feet on a bed or footrest). This helps to reduce blood pooling in the veins. Use a moisturising cream or ointment to protect the skin if it is dry, flaky or itchy.

Compression stockings
Wearing compression stockings is often the first approach to try before moving on to other treatments. Compression stockings are worn all day. They steadily squeeze your legs, helping veins and leg muscles move blood more efficiently. The amount of compression varies by type and brand.

• Sclerotherapy is performed by injecting a solution into the diseased veins.A mild chemical solution is injected into the dysfunctional vein, which causes it to shrink and gradually disappear. A single treatment session may involve as few as 1 to as many as 50 injections. After treatment, the leg is wrapped in elastic bandages to ensure that the treated veins remain closed. Sclerotherapy does not require anesthesia, and can be done in the doctor's office. Side effects which may only occur at the site of the injection, such as stinging or painful cramps; red raised patches of skin, small skin ulcers, and bruises. Spots, brown lines, or groups of fine red blood vessels could appear around the vein being treated. These usually disappear. The treated vein could become inflamed. Applying heat and taking aspirin or antibiotics can relieve this. Lumps of coagulated or congested blood may develop which are not dangerous and can be drained.

• Laser surgeriesIn some cases, underlying vein disease may be treated with an advanced ultrasound guided laser technique through a single puncture or an incision that is less than a quarter of an inch. Sometimes referred to as endovenous laser or "endolaser", this approach allows treatment of vein disease that in the past required stripping through large incisions. Our many years of experience with ultrasound guided vein therapy makes us uniquely qualified to offer this advanced ultrasound guided laser method to our patients. This procedure can be performed in the office.

• Vein strippingThis procedure involves removing a long vein through small incisions. This is an outpatient procedure for most people. Removing the vein won't adversely affect circulation in your leg because veins deeper in the leg take care of the larger volumes of blood.

• Foam sclerotherapyThis uses a chemical mixed with air to make foam. The foam is injected into the veins, pushing the blood away and making the veins go into spasm. After treatment, compression stockings are needed, and the veins will be hard and swollen for a while before they shrink down. More than one treatment may be needed.

• Mini-phlebectomy- Mini-phlebectomy is an in-office surgical procedure performed under local anesthesia to remove the faulty area of a vein through minute incisions.
• Ambulatory surgery-Ambulatory surgery is performed in the hospital to remove the long saphenous vein through two small incisions at the groin and at the ankle or knee.

• Wearing compression stockings- They improve circulation and are a mainstay of treatment for varicose veins that are causing symptoms.

• Regularly elevating the legs- Elevating your legs helps keep the blood from pooling in your lower legs and improves blood flow to the rest of your body.

• Avoiding long periods of standing or sitting-Sitting or standing still for long periods of time puts added stress on the veins in your legs.

• Exercising and controlling your weight-Walking, bicycling, and swimming are recommended for varicose veins.