From the desk of our Chief Medical Director, Dr. Domenic Zambuto M.D.

Varicose veins cause patients many concerns. Some concerns involve the appearance of the veins. Other concerns relate to the varicose veins impact on how the legs feel and function. It’s not uncommon for varicose veins to make the legs feel heavy, painful and fatigued especially after prolonged sitting or standing. Varicose veins can cause the legs to swell, develop skin changes or when severe develop ulcers. Most people are aware that varicose veins can increase the risk of developing blood clots. It’s worth discussing this further.

Why do Varicose Veins increase the risk for blood clots?

Varicose Veins are enlarged twisted veins usually located in the superficial (outside) parts of your leg. Because these veins are enlarged and outside the muscle the blood can pool and flows slowly in these veins. Slow moving or non-moving blood can clot. Prolonged sitting or standing and minor trauma can cause a clot to form in these veins. Some people are at higher risk for clotting in general. This includes pregnancy, use of birth control pills, cancer, obesity and recent surgery. There are also hereditary conditions that increase the risk of developing a blood clot. Even someone with no extra risk for clotting can develop a blood clot in their varicose veins.

What types of blood clots are there?

Superficial Thrombophlebitis

Generally, when a blood clot forms in a varicose vein it is called a superficial thrombophlebitis. Phlebitis means an inflamed, painful red vein. Thrombosis means blood clot. Superficial thrombophlebitis is a blood clot in a superficial vein that is inflamed and painful due to the blood clot. Usually (but not always) these clots are within a varicose vein. The exact incidence of superficial thrombophlebitis in not known. It is estimated to be two to three times more frequent than deep vein thrombosis. The risk of superficial thrombophlebitis is increased significantly if you have varicose veins.

A vein doctor can diagnose superficial thrombophlebitis on the basis of history and physical examination. It is important to confirm the diagnosis on ultrasound. About 20% of people with superficial thrombophlebitis will have extension of the clot into a deep vein. These deep vein thrombosis are medically serious and need to be treated and followed differently than clots that are only in the superficial veins. It is important to contact your doctor if you think you have a superficial thrombophlebitis.

Superficial thrombophlebitis treatments generally involve comfort measures including anti-inflammatory medications. This will be reviewed with you and your Vein Institute health-care provider.

Deep Vein Thrombosis (DVT)

Blood clots in the deep veins (deep vein thrombosis) is medically serious. The deep veins are larger veins surrounded by muscles that squeeze the veins when we walk or move our legs. These larger vein clots sometimes break off and travel to the pulmonary arteries. This is called a pulmonary embolus and it can be medically very serious. DVT symptoms include leg swelling, tenderness, pain in the calf, foot or ankle and fatigue in the leg. Sometimes there are minimal or no symptoms. A vascular ultrasound is used to evaluate and diagnosis a DVT.

Although superficial thrombophlebitis is more common DVT is more medically serious. An article from 2018 in the Journal of the American Medical Association found that patients with varicose veins are 5 times more likely to develop DVT.

Proper care for your varicose veins can help reduce your risk of developing clots. This is something you can discuss with your vein doctor at Vein Institute.

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