A short story: what would you do?
Follow Aling Rosa to learn the warning signs and what to do. Turn on your sound for the narration.
What happens in chronic venous disease
Veins carry blood from your legs back up to your heart, against gravity. When you walk, your calf muscles squeeze the veins and push the blood upward. Tiny one-way valves inside the veins stop it from falling back down. [Ref: ESVS 2022 Chronic Venous Disease]
In chronic venous disease, these valves become weak or leaky, and the vein walls stretch. Blood falls back down and pools in the lower legs, so the pressure in the leg veins stays high even when you walk. Over time this causes swelling, varicose veins and changes in the skin. [Ref: ESVS 2022 Chronic Venous Disease]
Less often, the problem is in the deep veins. A past blood clot (DVT) can damage the valves or leave a vein narrowed, which is called post-thrombotic syndrome. A narrowed vein in the pelvis can also block blood from leaving the leg. [Ref: ESVS 2022 Chronic Venous Disease]
Two names you may hear
Chronic venous disease covers everything from spider veins to leg ulcers. Chronic venous insufficiency means the more advanced stages: swelling, skin changes or ulcers. [Ref: ESVS 2022 Chronic Venous Disease]
How common is it?
In a national survey, about 1 in 2 Filipino adults had signs or symptoms of vein disease, more often women and older adults. Fewer than 2 in 100 had advanced changes such as swelling, skin darkening or a healed ulcer. [Data: Maravilla 2019]
Worldwide, about 1 in 5 adults has varicose veins. In a large study, more than half of people with vein disease got worse over about 13 years. About 1 in 3 people with varicose veins went on to get skin changes, which raise the risk of leg sores. [Ref: ESVS 2022 Chronic Venous Disease]
Stages of vein disease
Doctors describe vein disease in stages, from C0 to C6, using a system called CEAP. The stage tells you what can be seen on the leg, not how much it bothers you. [Ref: ESVS 2022 Chronic Venous Disease]
| Stage | What it means |
|---|---|
| C0 | No visible signs, but you may have symptoms such as heavy or aching legs. |
| C1 | Spider veins (tiny red or purple veins) or small blue veins under the skin. |
| C2 | Varicose veins: bulging, twisted veins, usually on the calf or thigh. |
| C3 | Swelling of the ankle or lower leg. |
| C4 | Skin changes: darkening, itchy rash (eczema), or hard, tight skin near the ankle. |
| C5 | A healed leg ulcer. |
| C6 | An open leg ulcer (a sore that does not heal). |
Stages C3 to C6 are called chronic venous insufficiency. [Ref: ESVS 2022 Chronic Venous Disease]
Symptoms
Heavy, tired legsAching, throbbing or a feeling of swelling, worse after standing or sitting for a long time.
Itching and burningItchy or burning skin over the veins or near the ankles.
Night crampsLeg cramps, often at night.
Visible changesBulging veins, ankle swelling, darker or harder skin near the ankle, or a sore.
Some people with large varicose veins have no symptoms, and some people have symptoms with no visible veins. Other leg problems can feel the same, so a check-up is worthwhile. [Ref: ESVS 2022 Chronic Venous Disease]
See a doctor soon if:
- a vein becomes hard, red and painful. This is a clot in a superficial vein, and it can spread to the deep veins. About superficial vein thrombosis
- a sore on your lower leg has not healed in 2 weeks.
- a varicose vein has bled, even if the bleeding stopped. See a doctor within a few days. It can bleed again, and the vein should be treated.
[Ref: ESVS 2022 Chronic Venous Disease]
Who is at risk
Women
Older age
Excess weight
Standing for long hours
Family history of varicose veins
Past pregnancies
A past blood clot in the leg
[Ref: ESVS 2022 Chronic Venous Disease]
What happens at your check-up
The main test is a venous duplex ultrasound of the whole leg. It is painless and shows which veins and valves are leaking or blocked. It is done before any treatment, even for spider veins, to look for a larger leaky vein underneath. [Ref: ESVS 2022 Chronic Venous Disease]
If a blockage higher up in the belly or pelvis is suspected, an ultrasound of those veins may be added. A CT or MRI scan is used if a procedure on those veins is planned. If you have a leg ulcer, the arteries are checked too, for example with an ankle-brachial index (ABI). [Ref: ESVS 2022 Chronic Venous Disease]
Your doctor decides which tests you need and explains what the results mean for you.
Heavy legs or varicose veins? Get your veins checked.
Only an examination and an ultrasound can tell which veins are leaking and which treatment is right for you. Dr. Aaron Christopher P. Novales sees patients with vein disease.
Sudden breathlessness or chest pain? Do not wait for a clinic visit. Go to the emergency room now →
How it is treated
About the medicines on this page
Medicines are described here only to help you understand your doctor's plan. Do not buy or take any medicine because you read about it here. Take only what your doctor prescribes for you, and never start, stop or change a dose on your own.
Exercise and a healthy weight
Regular exercise, such as walking, works the calf muscle pump and can ease symptoms. If you are overweight, losing weight helps the veins. [Ref: ESVS 2022 Chronic Venous Disease]
Compression stockings
Stockings that squeeze the leg help push blood upward. They can ease aching, heaviness and swelling. Your doctor will advise the type and strength that is right for you. [Ref: ESVS 2022 Chronic Venous Disease]
If you also have poor blood flow in the leg arteries (PAD), strong compression may not be safe. Your doctor will check your arteries first. [Ref: ESVS 2022 Chronic Venous Disease]
Medicines for symptoms
Your doctor may prescribe medicines that ease heaviness, pain and swelling. They are used if you are not having a procedure, are waiting for one, or still have symptoms after one. They do not remove varicose veins. [Ref: ESVS 2022 Chronic Venous Disease]
Procedures to close leaky veins
A procedure is recommended for varicose veins that cause symptoms, and for skin changes or ulcers caused by leaky superficial veins. Most are done as an outpatient under local anaesthesia, and you walk out the same day. [Ref: ESVS 2022 Chronic Venous Disease]
Heat ablation (laser or radiofrequency): a thin tube seals the leaky main vein from inside. This is the first choice for the main superficial veins.
Non-heat options: medical glue or a combined mechanical and chemical method, for people who prefer a method without heat or numbing injections along the vein.
Foam sclerotherapy: a foam medicine injected under ultrasound closes the vein. Useful for smaller veins and branches.
Phlebectomy: bulging branch veins are removed through tiny cuts.
Open surgery (stripping) is used if ablation is not available. Spider veins are usually treated with injections (sclerotherapy) or skin laser, after any larger leaky vein is treated first. [Ref: ESVS 2022 Chronic Venous Disease]
After a procedure, you may wear stockings for a short time, and an ultrasound check is often done 1 to 4 weeks later. Your doctor also checks your risk of blood clots. If you take a blood thinner, ask your doctor what to do before the procedure. [Ref: ESVS 2022 Chronic Venous Disease]
Blocked deep veins
If a large vein in the pelvis is narrowed or blocked and symptoms are severe, a stent placed through a small puncture may be considered. This is decided by a specialist team. It is not recommended when symptoms are mild. [Ref: ESVS 2022 Chronic Venous Disease]
Venous leg ulcers
A venous ulcer is a sore on the lower leg, often near the ankle, that heals slowly because of high pressure in the veins. [Ref: ESVS 2022 Chronic Venous Disease]
Strong compressionLayered bandages or wraps, applied or taught by trained staff, help the ulcer heal once the leg arteries have been checked.
Treat the leaky vein earlyClosing the leaky superficial vein early helps the ulcer heal faster and lowers the chance it comes back.
Antibiotics only for infectionAntibiotics do not help an ulcer heal unless it is infected.
Keep up compression after healingWearing stockings long term lowers the chance of a new ulcer.
[Ref: ESVS 2022 Chronic Venous Disease]
Daily self-care
Keep movingWalk every day. If you stand or sit for long hours, take breaks to walk or move your ankles up and down.
Wear your stockingsPut them on in the morning, if your doctor has advised them.
Watch your weightLosing extra weight eases the pressure in the leg veins.
During pregnancyAsk your doctor about compression stockings if you have vein symptoms or varicose veins.
[Ref: ESVS 2022 Chronic Venous Disease]
Talk to your doctor about
Bring these questions to your visit.
- What stage is my vein disease, and which veins are leaking?
- Do I need a duplex ultrasound?
- What strength of compression stocking should I wear, and for how long?
- Would a procedure help me, and which type suits my veins?
- Are my leg arteries healthy enough for compression?
Related conditions
Guideline sources for this page
- ESVS 2022 Chronic Venous Disease: De Maeseneer MG, Kakkos SK, et al. European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg 2022;63:184–267.
- ESVS 2021 Venous Thrombosis: Kakkos SK, et al. European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis. Eur J Vasc Endovasc Surg 2021;61:9–82.
- BJGP 2022 Bleeding Varicose Veins: Campbell B, Dilley C, Gohel M. Bleeding from varicose veins: advice in primary care and referral. Br J Gen Pract 2022;72(722):448–449.
- Maravilla 2019: Maravilla L, Salvador DR, Abola MT. National Health and Nutrition Education Survey on Chronic Venous Insufficiency. Philippine Journal of Internal Medicine 2019;57(3):120–126.