Varicose veins, the most common vein disorder, affect approximately 40 million Americans. They are large, twisted veins, usually in the legs and feet, that are not transporting blood effectively. They appear as bulging, bluish cords beneath the surface of your skin. If ignored, varicose veins can cause not only discomfort and cosmetic concerns, but also serious complications, such as phlebitis (inflammation of the veins), skin ulcers, and blood clots.

Varicose veins are accompanied by the following signs and symptoms.

• Prominent dark-blue blood vessels, especially in the legs and feet (not "spidery"-looking veins)
• Aching, tender, heavy, or sore legs
• Swelling in the ankles or feet, especially after standing
• Breaks in the skin
• Superficial blood clots
• Bleeding after a minor injury (rare)

Varicose veins develop when your veins stretch and their valves, which prevent back flow of blood, fail. Primary varicose veins result from weakness in the walls of the veins. Secondary varicose veins are most often caused by problems with veins lying deep among the muscles, which carry about 90 percent of the returning blood. These problems include blood clots and the resulting diversion of blood flow into other superficial vessels.

People with the following conditions or characteristics are at risk for developing varicose veins.

• Family history (accounts for 50% of cases)
• Female (three times more common)
• Hormonal changes related to pregnancy, premenstrual period, and menopause
• Standing for long periods
• Obesity
• Tumors
• Certain diseases
• Arteriovenous fistulas (abnormal blood flow between arteries and veins)

If you are experiencing symptoms associated with varicose veins, you should see your health care provider. He or she will conduct a physical exam and also may perform tests to determine how well your veins are functioning and to distinguish between primary and secondary varicose veins. Imaging procedures may also be used.

Conservative treatment may be all that is needed. This may involve avoiding prolonged sitting, standing, or walking; getting regular exercise; elevating your legs on a periodic basis; and wearing compression stockings.

Regular exercise improves vein functioning, and weight loss and exercise decrease the likelihood of blood clots.

• Sclerotherapy—injection of a solution into a varicose vein, followed by application of a compression dressing, in order to obliterate the vein
• Radiofrequency ablation—a new technique in which a catheter is threaded into the varicose vein to heat the vein wall in order to obliterate the vein and improve the function of its valve
• Surgery—removal of the varicose vein

A comprehensive treatment plan for varicose veins may include a range of complementary and alternative therapies.

Eat foods rich in dietary fiber in the form of complex carbohydrates (whole grains) and bioflavonoids (dark berries, dark leafy greens, garlic, and onions).

Potentially beneficial nutrient supplements include vitamin C (500 to 1,000 mg three times per day), vitamin E (200 to 600 IU per day), and zinc (15 to 30 mg per day).

Herbal remedies may offer relief from symptoms. Herbs are generally available as dried extracts (pills, capsules, or tablets), teas, or tinctures (alcohol extraction, unless otherwise noted). Dose for teas is 1 heaping tsp. per cup of water steeped for 10 minutes (roots need 20 minutes).

• Horse chestnut (Aesculus hippocastanum) 500 mg three times per day or standardized Aescin 10 mg three times per day
• Butcher's broom (Ruscus aculeatus) standardized extract (9% to 11% ruscogenin) 100 mg three times per day
• Gotu kola (Centella asiatica) 1,000 mg two to four times per day, or standardized extract (asiaticoside 40%, Asiatic acid 30%, madecassoside 1% to 2%) 60 mg one to two times per day
• Bilberry (Vaccinium myrtillus) standardized extract (25% anthocyanoside) 80 to 160 mg three times per day

Combine the following in equal parts: yarrow (Achillea millefolium), hawthorn (Crataegus monogyna), ginkgo (Ginkgo biloba), marigold (Calendula officinalis), horse chestnut (Aesculus hippocastanum), and ginger (Zingiber officinalis). Take 30 to 60 drops tincture two to three times per day or drink three to four cups of tea daily.

Some of the most common remedies include Aesculus, Fluoricum acidum, Hamamelis, and Secale. Acute dose is three to five pellets of 12X to 30 C every one to four hours until symptoms are relieved.

Cold compresses of witch hazel (Hamamelis virginiana) and yarrow (Achillea millefolium) tea may provide temporary relief.

Acupuncture and massage may help improve the overall circulatory system.

Varicose vein disease is a chronic condition, and new varicose veins often develop after treatment.

Walking after sclerotherapy is important to help promote healing.

If you've had surgical treatment, contact your health care provider if you develop severe pain, tenderness, swelling, scabs, or blisters.

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