Overview For many people, the often large, ropey-looking veins bulging from their legs are  enough to keep them from wearing shorts or skirts. Most people consider them  just plain unsightly, but the truth is they are indications that there may be  something more serious going on that should be evaluated and treated. The  underlying condition, lower extremity venous reflux disease or “varicose vein  disease,” is a common medical condition that affects up to 50% of the adult  population. Women are affected one and a half times more frequently than men.  Once you have varicose veins, they often worsen as you become older. If either of your parents had varicose veins, you are more likely to have them yourself.   Understanding Our Anatomy Circulation is the process by which blood flows away from the heart to  the rest of the body and then back to the heart again. We have two  types of blood vessels: arteries that carry blood away from the heart  and veins which return blood to the heart. Superficial veins lie just  below the skin and deep veins lie within the muscles of our legs. Veins and arteries vary greatly. Arteries are under more pressure.  (Blood pressure of 120 mmHg is normal arterial pressure. The blood  pressure of a vein in the same location might vary from 6-15 mmHg.)  Because veins have such little assistance from the heart, they  compensate by having one-way valves that help the blood constantly  move in one direction. The veins also rely a great deal on the  movement of our leg muscles squeezing the veins and thus pushing  the blood along. (That’s why leg swelling is often worse at the end of  the day after sitting or standing for an extended time. The leg muscles  when we walk actually pump the blood in the veins back to the heart.) In a damaged vein, the valves no longer work and the vein walls become weak  and dilated. This allows the blood to leak backwards through the valve. Over  time, blood pools in the veins and varicose veins may result. What starts as  merely unsightly can turn dangerous if swelling and blood clots form where  blood moves too slowly.   Symptoms Symptoms include leg aches, fatigue, discomfort, swelling, itching, burning and  cramps, especially at night. You may see small spider veins and/or the more  dramatically enlarged and bulging varicose veins. Many people have symptoms  without anything visible, but no matter what your symptoms are, your quality of life  is probably affected. You don’t participate in the activities you love; you don’t wear  the clothes you like; you may have two sets of shoes so that you have one pair for  morning and another pair for the afternoon when your feet are swollen. You  probably can’t stand on your feet all day like you used to do. Aching in your legs  may interrupt your sleep, making you feel tired and sluggish throughout the day.   Diagnosis As we mentioned earlier, symptoms often include leg fatigue  (worse at the end of a day), swelling, itching and cramping (often  during the night.) Many people have a combination of these  symptoms without having the obvious visible signs of varicose  veins. Diagnosis is based on a combination of symptoms, a physical  exam and, most importantly, an ultrasound (sound wave) test of  the deep and superficial veins in your legs. This is a non-invasive  test that can quickly and easily be performed in the office