Varicose Veins and Vein Thrombosis: Symptoms, Risks, and When to See a Doctor
Aching, heavy legs by evening, swollen ankles, and visible spider veins on the skin — one in three adults experiences this at some point. Most often, the culprit is varicose veins. But sometimes similar symptoms signal thrombosis — a far more dangerous condition. This article explains how to tell the difference, when to seek urgent help, and what you can do to prevent problems.
Varicose veins: how to recognise them
Varicose veins are abnormally enlarged surface veins, most commonly in the legs. The vein walls lose elasticity, the valves stop working properly, and blood begins to pool. The veins stretch, become twisted, and bulge beneath the skin.
Typical symptoms of varicose veins:
- visible enlarged, twisted veins — bluish or greenish — beneath the skin of the legs;
- heaviness and fatigue in the legs, worsening by evening and after prolonged standing;
- swelling of the ankles and lower legs, especially at the end of the day;
- night cramps in the calf muscles;
- itching and burning along the course of the veins;
- spider veins (telangiectasias) — small red or blue vessels visible under the skin.
Risk factors: family history (if a parent had varicose veins, the risk is 3–4 times higher), pregnancy, prolonged standing or sitting at work, excess weight, sedentary lifestyle, and use of hormonal contraceptives.
Important: varicose veins progress slowly, over years. In the early stages they may cause no discomfort — only a cosmetic issue. Without treatment and prevention, complications gradually develop: skin changes, chronic venous insufficiency, and thrombophlebitis.
Deep vein thrombosis — a dangerous complication
Deep vein thrombosis (DVT) is the formation of a blood clot in the deep veins, most often in the calf or thigh. Unlike varicose veins, which affect surface veins, DVT is potentially life-threatening. The main danger: the clot can break off and travel to the lungs, causing pulmonary embolism (PE) — one of the leading causes of sudden death.
Symptoms of deep vein thrombosis:
- pain in the calf or thigh — usually dull, bursting, worsening with walking and pressure;
- swelling of one leg — asymmetric swelling (one leg noticeably larger than the other) is a characteristic sign of DVT;
- redness and warmth of the skin over the affected vein;
- bluish discolouration of the skin in massive thrombosis.
Signs of pulmonary embolism (PE) — call emergency services immediately:
- sudden breathlessness without obvious cause;
- chest pain that worsens with breathing;
- cough, sometimes with blood;
- rapid heartbeat;
- loss of consciousness or near-fainting.
Risk factors for DVT: prolonged immobility (bed rest, long flights over 4 hours), recent surgery, cancer, pregnancy and the postpartum period, hormonal medications, inherited clotting disorders, and obesity.
Leg swelling: varicose veins or the heart
Leg swelling is one of the most common symptoms for which people seek medical advice. There are many causes, and not all are vein-related. Here is how to distinguish venous swelling from other types:
Venous swelling (varicose veins, chronic venous insufficiency):
- worsens by evening, improves after sleep and elevating the legs;
- often one-sided or asymmetric;
- accompanied by heaviness, fatigue, sometimes itching;
- skin over the swelling is normal or slightly bluish.
Cardiac swelling (heart failure):
- bilateral and symmetric;
- accompanied by breathlessness, especially when lying down;
- builds gradually and does not resolve after sleep;
- often combined with abdominal swelling (ascites).
Renal swelling: appears in the morning, first around the eyes, may also affect the legs; accompanied by changes in urine tests.
Lymphatic swelling (lymphoedema): firm, does not pit on pressure, does not reduce after elevating the legs.
If swelling appears suddenly, is asymmetric, or is accompanied by pain, breathlessness, or skin redness — see a doctor without delay.
When to see a phlebologist urgently
A phlebologist is a doctor specialising in vein disorders. A routine visit is needed if you have varicose veins, swelling, leg heaviness, or spider veins. But some situations cannot wait:
- Acute pain, swelling, and redness along a vein — signs of thrombophlebitis (inflammation of a surface vein with clot formation). Requires urgent assessment, as it can spread to the deep veins.
- Asymmetric swelling of one leg with pain — suspected deep vein thrombosis. Venous ultrasound is needed within hours.
- Bleeding from a varicose vein — press the bleeding point, raise the leg above heart level, and call emergency services or go to a surgical unit urgently.
- Venous ulcer — a non-healing wound on the lower leg or ankle — a sign of severe chronic venous insufficiency requiring specialist treatment.
- Symptoms of pulmonary embolism (breathlessness, chest pain, coughing blood) — call emergency services immediately.
Not sure whether to see a phlebologist, vascular surgeon, or GP? Use the doctor routing tool.
Prevention and management
It's not possible to completely prevent varicose veins with a genetic predisposition, but slowing their progression is very achievable.
- Compression hosiery. Medical compression stockings or socks (class 1–2) reduce pressure on the veins, decrease swelling and fatigue. Especially important during pregnancy, long flights, and jobs that involve standing.
- Physical activity. Walking, swimming, and cycling are the best exercises for veins. They activate the calf "muscle pump" that helps blood move upward. Avoid prolonged standing in one position.
- Weight control. Every extra 10 kg increases pressure in the leg veins by approximately 10%.
- Leg elevation. During rest, raise your legs above heart level for 15–20 minutes. Avoid sitting with legs crossed — this impairs blood flow.
- Temperature. Hot baths, saunas, and prolonged sun exposure dilate veins and worsen venous tone. Contrast showers, on the other hand, are beneficial.
- Venotonics. Medications based on diosmin, hesperidin, or rutin improve vein wall tone. Used as an adjunct to main treatment — on a doctor's prescription.
If you're troubled by leg symptoms, try describing them to our assistant — this helps determine whether urgent assessment is needed.
Frequently asked questions
Can varicose veins be treated without surgery?
Already enlarged veins cannot be eliminated without intervention. But modern minimally invasive methods — sclerotherapy (injecting a solution that seals the vein) and laser ablation — allow treatment without incisions, on an outpatient basis. Classical surgery (phlebectomy) is used for large trunk varicosities. The choice of method depends on the stage and anatomy of the veins — decided by a phlebologist or vascular surgeon.
Are spider veins dangerous?
Telangiectasias (spider veins) are dilated small surface vessels. They are not dangerous in themselves and are primarily a cosmetic concern. However, their appearance can be an early sign of chronic venous insufficiency. They are treated with laser or sclerotherapy.
How do I tell thrombophlebitis from varicose veins?
Thrombophlebitis (vein inflammation with clot) causes acute pain, redness, and hardness along the vein, with the skin feeling warm to the touch. With ordinary varicose veins without inflammation, these signs are absent — only heaviness, swelling, and visible veins. Thrombophlebitis requires urgent medical attention.
Do I need to wear compression stockings all the time?
With established varicose veins or chronic venous insufficiency — yes, daily throughout the day. For preventive use (pregnancy, flights, standing work) — only during periods of increased strain. The compression class and type of garment are selected by a doctor.
Are varicose veins hereditary?
Yes. Family history is one of the main risk factors. If both parents had varicose veins, the probability of developing them reaches 90%. If only one parent was affected — around 45–50%. This does not mean varicose veins will definitely develop, but prevention is especially important.
Symptomatica is an informational reference service. Not a medical service; does not diagnose or prescribe treatment. For any symptoms, please consult a doctor.