What are the Stages of Varicose Veins?

Varicose veins are a common condition that affects many individuals. According to the AHA Journal Circulation, approximately 23 percent of US adults have varicose veins. These swollen and twisted veins, usually appearing in the legs, can cause discomfort and, in some cases, lead to more serious health issues such as venous ulcers and blood clots. Understanding the stages of varicose veins is crucial for early detection and effective management of this painful leg condition.

It is helpful to recognize the stages associated with varicose veins to successfully manage chronic venous insufficiency (the disorder that causes varicose veins). Varicose veins follow a progression through these distinct stages, each characterized by specific symptoms and treatment approaches.

By recognizing and differentiating between these predictable stages, individuals with vein disease are empowered to take control of their vein health by seeking appropriate vein treatment by a qualified vein specialist. This healthcare professional can customize a treatment plan according to the specific stage of vein disease the patient is experiencing.

Varicose veins typically progress through the following stages: spider veins, varicose veins, edema, severe skin changes, thrombophlebitis, and venous ulcers. Read on to learn more about each stage, including symptoms, causes, risk factors, and treatment options.

Center for Vein Restoration (CVR) offers a multidisciplinary approach at every stage of varicose vein disease. Our team of board-certified vein specialists located across the United States is well-equipped to address the underlying cause of venous insufficiency and manage associated symptoms at every stage of vein disease.

Stage 1: Spider Veins

The initial stage of varicose veins often involves the development of spider veins, also known as telangiectasias. Small, dilated blood vessels appear close to the skin's surface and resemble spider webs or tree branches. While spider veins are generally more of a cosmetic concern than a health issue, they can be an early indicator of underlying venous insufficiency.

Per the American Society of Plastic Surgeons, 50 to 55 percent of women and 40 to 45 percent of men have spider veins.

What are the symptoms of Stage 1 spider veins?

• Small, thin veins visible just beneath the skin
• Usually asymptomatic and does not cause discomfort
• It can be red, blue, or purple in color
• May resemble a spider web or tree branch pattern

What causes Stage 1 spider veins?

• Increased blood pressure in the veins near the surface of the skin
• Weakened or damaged valves in the veins allow blood to collect, leading to vein swelling

What are the risk factors of Stage 1 spider veins?

• Contributing factors include genetics, increased pressure in the veins due to factors such as overweight, older age, being female, inactivity, leg injury, pregnancy, smoking, and oral contraceptive use.

How are Stage 1 spider veins treated?

Treatment of Stage 1 spider veins typically involves non-invasive and minimally invasive procedures aimed at improving the appearance of the veins and preventing further progression. It's important to note that while these treatments can effectively reduce the visibility of spider veins, they may not always prevent the development of new ones.

Here are some common treatments for Stage 1 spider veins:

1. Compression Stockings: These specially designed stockings apply gentle pressure to the legs, helping to improve blood circulation and reduce the appearance of spider veins.
2. Lifestyle Modifications: Maintaining a healthy weight, avoiding prolonged periods of standing or sitting, and engaging in regular physical activity. Exercise, in particular, helps improve blood circulation and overall vascular health.
3. Visual Sclerotherapy: During this procedure, a solution is injected directly into the affected veins, causing them to collapse and eventually fade from view. Sclerotherapy is an outpatient procedure and is well-tolerated with minimal discomfort.

Stage 2: Varicose Veins

As the condition progresses, individuals may develop varicose veins. These are larger, bulging veins that often appear twisted and maybe blue or purple in color. Varicose veins can cause aching, throbbing, or a heavy feeling in the legs. Genetics, age, and prolonged standing or sitting may contribute to the development of varicose veins.

What are the symptoms of Stage 2 varicose veins?

• Enlarged veins that are blue or purple and may appear bulging or twisted
• Can cause discomfort, such as aching, throbbing, or a heavy sensation in the legs
• Legs may feel swollen, especially after prolonged sitting or standing
• Skin changes such as darkening or thickening of the skin around the affected area may occur

What causes Stage 2 varicose veins?

As the condition progresses, individuals may develop varicose veins. These are larger, bulging veins that often appear twisted and may be blue or purple in color. Varicose veins can cause aching, throbbing, or a heavy feeling in the legs. Genetics, age, and prolonged standing or sitting may contribute to the development of varicose veins.

What are the symptoms of Stage 2 varicose veins?

• Enlarged veins that are blue or purple and may appear bulging or twisted
• Can cause discomfort, such as aching, throbbing, or a heavy sensation in the legs
• Legs may feel swollen, especially after prolonged sitting or standing
• Skin changes such as darkening or thickening of the skin around the affected area may occur

What causes Stage 2 varicose veins?

Caused by weakened walls and increased blood pressure in the veins, leading to twisting, bulging, unsightly veins, leg pain, swelling, aching, itching, and feelings of heaviness.

What are the risk factors of Stage 2 varicose veins?

Risk factors include heredity, advanced age, being female, standing or sitting for long periods, and a sedentary lifestyle.

How are Stage 2 varicose veins treated?

In addition to treatment options for spider veins, varicose vein treatment can include the following minimally invasive procedures:

1. Endovenous Thermal Ablation:

• Radiofrequency Ablation (RFA): RFA is a minimally invasive procedure using radiofrequency energy to heat and close the diseased vein. It is often effective for larger varicose veins.
• Endovenous Laser Ablation (EVLA): Like RFA, EVLA utilizes laser energy to seal the affected vein. This procedure is suitable for larger veins and can be performed outpatient.

2. Ultrasound Guided Foam Sclerotherapy:

This specialized approach to treating varicose veins uses ultrasound imaging to guide the injection of a foam sclerosing agent into the affected veins precisely. This targeted procedure enhances the effectiveness of sclerotherapy, leading to the collapse of varicose veins and promoting improved blood flow, ultimately alleviating symptoms associated with the condition.

3. Varithena

A specially formulated foam is injected directly into the affected veins. This innovative procedure effectively collapses and closes off the diseased veins, relieving symptoms and improving the overall appearance of varicose veins.

4. VenaSeal

This advanced, minimally invasive treatment for varicose veins uses a medical adhesive to seal the affected veins. By closing off the diseased veins, VenaSeal offers a precise and efficient solution, reducing symptoms and promoting improved blood circulation in individuals with varicose veins.

4. Ambulatory Phlebectomy:

• Microphlebectomy: In cases where varicose veins are close to the surface, microphlebectomy may be recommended. This outpatient procedure involves removing small sections of the affected vein through tiny incisions that require only a band-aid for healing.
• Combined Approaches: Combination Therapy: In some cases, a combination of treatments may be recommended to address different aspects of the condition and optimize outcomes.

Stage 3: Edema

In more advanced stages of varicose veins, individuals may experience edema (swelling) in the affected leg. Swelling occurs because of increased pressure within the veins, leading to fluid leakage into the surrounding tissues. Edema can cause discomfort and may be accompanied by changes in skin texture, such as dryness or a feeling of tightness.

What are the symptoms of Stage 3 edema?

• Swelling of the legs is due to trapped fluid in the body's tissues.
• Symptoms include pain, itching, numbness, tenderness, and muscle cramps.
• The affected area may feel tight or heavy, and the individual may experience restless legs.

What causes Stage 3 edema?

Per the National Institutes of Health (NIH), pitting and non-pitting edema is a condition often associated with venous insufficiency in the lower extremities resulting from capillary filtration exceeding lymphatic drainage.

• Stage 3 edema is caused by the progression of varicose veins and resulting venous insufficiency, which affects the veins' ability to pump blood to the heart.
• Risk factors include genetics, prolonged edema, and poor circulation.

How is Stage 3 edema treated?

Effective management often involves a combination of interventions tailored to address both the symptoms and the underlying causes of edema. Varicose vein treatments can be employed, as well as the following:

1. Leg Elevation: Elevating the affected leg above heart level can help reduce swelling by allowing fluid to drain away from the affected area. Elevation is particularly effective when combined with compression therapy and can be incorporated into daily routines.
2. Diuretic Medications: In some cases, healthcare providers may prescribe diuretic medications to help the body eliminate excess fluid and reduce edema. A healthcare professional must carefully monitor the use of diuretics.
3. Manual Lymphatic Drainage (MLD): This specialized massage technique is designed to stimulate the lymphatic system and promote the drainage of excess fluid. Trained therapists often perform MLD, which can complement other treatment approaches.

Stage 4: Skin Changes

Long-term venous insufficiency can lead to significant changes in the skin surrounding the affected veins. The skin may become discolored, taking on a reddish or brownish hue. Additionally, individuals may notice the development of open sores or ulcers, particularly near the ankles. These skin changes indicate chronic venous insufficiency and require prompt medical attention.

What are the symptoms and risks of Stage 4 severe skin changes?

• Significant skin changes may lead to complications such as skin ulcers.
• Sensations of heaviness, tenderness, and pain are worse by the end of the day.
• Significant leg or ankle swelling and heavy sensations that may include pain.

What causes Stage 4 severe skin changes?

• Caused by prolonged edema and poor circulation, leading to significant skin changes, ulcers, and slow-healing sores.
• Risk factors include genetics, prolonged edema, and poor circulation.

How are Stage 4 severe skin changes treated?

Minimally invasive procedures such as endovenous laser ablation (EVLA) or radiofrequency ablation (RFA) are commonly used to treat the underlying venous insufficiency. These procedures close off malfunctioning veins, improving blood circulation and reducing pressure on the affected skin. The following additional methods are employed:

• Wound care and dressings
• Compression therapy
• Topical medications
• Leg elevation and exercise
• Regular follow-up for wound healing treatment plan adjustment

Stage 5: Thrombophlebitis

In some cases, varicose veins can lead to a condition called thrombophlebitis, which involves the formation of blood clots within the affected veins. This can cause localized pain, redness, and swelling. Deep vein thrombosis (DVT) is a more serious form of this condition and requires immediate medical attention.

Symptoms of Stage 5 thrombophlebitis

It's important to note that thrombophlebitis refers to inflammation and blood clot formation within a vein. Signs to look for are:

• Pain and tenderness
• Swelling
• Redness and warmth
• Vein hardening
• Fever and chills
• Limited range of motion
• Skin changes

Causes of Stage 5 thrombophlebitis

Typically associated with underlying venous conditions and the formation of blood clots within veins. Several factors can contribute to the development of thrombophlebitis, including:

• Venous insufficiency
• Varicose veins
• Trauma or injury
• Prolonged immobility
• Pregnancy
• Obesity
• Smoking
• Inherited conditions
• Infection in a vein

Treatment of Stage 5 thrombophlebitis

• Treatment of underlying venous conditions (see varicose vein treatment)
• Blood thinners (Anticoagulants)
• Compression stockings:
• Leg elevation
• Pain relievers
• Heat and warm compresses
• Lifestyle modifications (e.g., exercise, healthy weight)

Center for Vein Restoration provides state-of-the-art vascular care in a comfortable outpatient setting. Call 240-965-3915 to speak to a Patient Services Representative or schedule your consultation online at a CVR near you.

Stage 6: Venous Ulcers

The most severe stage of varicose veins involves the development of venous ulcers. Open sores form on the skin, usually near the ankles. Venous ulcers are challenging to heal and can be recurrent. Effective managing varicose veins, particularly in the earlier stages, is crucial to prevent the progression to venous ulcers.

Symptoms of Stage 6 venous ulcers

Stage 6 venous ulcers are characterized by severe skin changes and chronic wounds that result from prolonged venous insufficiency. Signs include:

1. Open Sores:

The hallmark symptom of Stage 6 venous ulcers is the presence of open, non-healing sores on the skin. These ulcers may be shallow or deep and are typically located near the ankles.

2. Persistent Pain:

Individuals with Stage 6 venous ulcers often experience persistent pain and discomfort in the affected area. The pain may range from aching to sharp, affecting the overall quality of life.

3. Swelling (Edema):

Edema, or swelling, is a common symptom around the site of the venous ulcer. This swelling is often due to impaired circulation and fluid retention in the affected tissues.

4. Skin Changes:

The skin surrounding the ulcer is characterized by significant changes, including discoloration (reddish or brownish hue), thickening, and texture alterations. The skin may become dry, scaly, or exhibit signs of inflammation.

5. Weeping or Drainage:

Venous ulcers may produce exudate, a fluid that can range from clear to yellowish. This drainage may contribute to moisture around the ulcer and require appropriate wound care.

6. Odor:

In some cases, venous ulcers may emit an unpleasant odor. This odor is often associated with the breakdown of tissue and the presence of bacteria in the wound.

7. Infection Risk:

Due to the open nature of the ulcers, there is an increased risk of infection. Signs of infection may include increased redness, warmth, and the presence of pus.

8. Delayed Healing:

Venous ulcers at Stage 6 are characterized by a prolonged and challenging healing process. Despite appropriate care, these wounds may persist, leading to chronic issues.

9. Complications:

Complications associated with Stage 6 venous ulcers may include cellulitis (skin infection), deep vein thrombosis (DVT), or the development of more extensive skin and tissue damage.

10. Impact on Quality of Life:

It's essential for individuals experiencing symptoms of Stage 6 venous ulcers to seek immediate medical attention. Managing these ulcers involves a multidisciplinary approach, including wound care, compression therapy, and addressing the underlying venous insufficiency through interventions such as endovenous procedures. Early intervention is crucial to prevent complications, promote healing, and improve the prognosis for individuals with Stage 6 venous ulcers.

Whether alleviating pain, promoting wound healing, or preventing recurrence, Center for Vein Restoration (CVR) stands out as a caring solution for individuals dealing with the complexities of varicose vein disease. Our board-certified vascular surgeons and wound care specialists are well-equipped to address underlying venous insufficiency and manage associated symptoms at every stage.

Causes of Stage 6 venous ulcers

1. Chronic Venous Insufficiency (CVI):

The primary cause of Stage 6 venous ulcers is chronic venous insufficiency. In CVI, the valves in the veins fail to function properly, leading to a backward flow of blood and increased pressure in the veins.

2. Venous Hypertension:

Venous hypertension, or high blood pressure in the veins, results from an accumulation of blood due to valve dysfunction. This increased pressure contributes to the formation of venous ulcers.

3. Varicose Veins:

Varicose veins, characterized by enlarged and twisted veins, contribute to venous stasis and increase the risk of ulcers.

4. Deep Vein Thrombosis (DVT):

Previous episodes of deep vein thrombosis, where blood clots form in the deep veins, can cause damage to the venous valves and contribute to chronic venous insufficiency.

5. Obesity:

Excess body weight places additional pressure on the veins, contributing to venous insufficiency.

6. Prolonged Immobility:

Extended periods of immobility, such as prolonged bed rest or a sedentary lifestyle, can disrupt blood flow.

7. Aging:

Aging is associated with natural wear and tear on the venous valves. As individuals age, the risk of developing chronic venous insufficiency and associated ulcers increases.

8. Genetic Predisposition:

Some individuals may have a genetic predisposition to venous disorders, making them more susceptible to chronic venous insufficiency and venous ulcers.

9. Pregnancy:

Pregnancy can lead to increased pressure on the veins in the pelvic area.

10. Trauma or Injury:

Previous trauma or injury to the veins can disrupt normal blood flow.

11. Inflammatory Conditions:

Certain inflammatory conditions of the veins or surrounding tissues, such as vasculitis, chronic thrombophlebitis, rheumatoid arthritis, and inflammatory bowel disease (IBD), can contribute to chronic venous insufficiency and increase the risk of ulcers.

12. Smoking:

The chemicals in tobacco can damage blood vessels and contribute to inflammation.

Treatment of Stage 6 venous ulcers

Treating Stage 6 venous ulcers involves a multidisciplinary approach to address the underlying venous insufficiency, promote wound healing, and manage associated symptoms. Management strategies are aimed at improving blood circulation, reducing swelling, and preventing infection and include:

• Compression therapy
• Wound care
• Leg elevation
• Pain management
• Treatment of underlying venous conditions
• Nutritional support
• Lifestyle modifications
• Regular follow-up and education

Individuals with Stage 6 venous ulcers should work closely with their healthcare providers to develop a personalized treatment plan. Successful management often requires ongoing care and collaboration with a specialized care team to address both the wound and the underlying venous insufficiency. Early intervention and consistent adherence to treatment recommendations are crucial for achieving positive outcomes and preventing complications.

Center for Vein Restoration is Your Vein Health Partner

Center for Vein Restoration (CVR) is America's largest physician-led vein center, offering comprehensive treatment for chronic venous insufficiency in every state of the vein disease process. With 110+ centers in 22 states and 70+ active physicians, CVR impacts the lives of 200,000+ individuals annually and boasts a 98 percent patient satisfaction rating.

CVR accepts various insurances, including Aetna, Blue Cross/Blue Shield, and Medicare; CVR provides accessible, compassionate, and effective vein care during Stages 1-6.

Call 240-965-3915 to speak to a CVR Patient Services Representative or schedule your consultation online at a CVR near you today.