What are the signs and symptoms of chronic superficial venous insufficiency/varicose veins?

The main symptoms of venous insufficiency are generally vague and overlap with symptoms of other diseases, making diagnosis very challenging without the telltale sign of bugling varicose veins.

Compounding this is the fact that much understanding of superficial veins has come from recent advances in ultrasound, so many physicians out in practice do not have much exposure to this new information.

Classic symptoms include a dull/aching pain that is generally annoying but “in the background”, and typically worsens during the day as gravity takes its toll. Leg heaviness and fatigue also top the list of symptoms that patients complain about. Ankle swelling, usually symmetric and bilateral in patients with no prior heart disease, is a common sign. Patients will also complain of itching and heat with a “prickly” feeling.

Finally, many patients will experience cramping or charley horses, especially at night, as well as restlessness that manifests as patients constantly moving their legs around in bed and propping pillows between their legs.

The last symptom, restlessness, is an interesting topic as many questions arise distinguishing this from restless leg syndrome. While still controversial, our experience at The Vein Institute and some recent literature suggests that while restless leg syndrome definitely has a neurological component for many, varicose veins can definitely cause a restless feeling as well.

We know this because nearly all of our patients who describe restlessness as a symptom describe complete relief following treatment. Therefore, it is unclear as to whether restlessness is a separate symptom that is seen in restless leg syndrome and chronic superficial venous insufficiency, or if restless leg syndrome actually has two separate etiologies.

Either way, our experience is that patients who have restless legs and chronic venous insufficiency who undergo treatment typically have resolution of their symptoms.

Sign & Symptoms

  • Dull ache/throbbing in legs
  • Leg heaviness
  • Restlessness of legs
  • Skin color changes/darkening of skin especially around ankles
  • Leg/ankle swelling
  • Bulging large, ropey veins
  • Charley horses
  • Hardening of skin
  • Easy bruising/bleeding from legs
  • Ulcers/skin breakdown on leg

Signs of chronic superficial venous insufficiency include the obvious hallmark of bulging varicose veins. In addition, ankle swelling which is not secondary to heart or kidney disease is common. Corona phlebectatica is a chronic manifestation that includes purplish discoloration of the ankle with numerous tiny bulging or spider veins. Skin discoloration/darkening in the dependent gaiter region is called stasis dermatitis and is a sign of longstanding disease. When severe, lipodermatosclerosis can occur, which is hardening of the skin secondary to inflammation of the fat under the epidermis. These patients have a tapering of their legs above the ankles, forming a constricting band resembling an inverted champagne bottle. Finally, venous stasis ulcers are the dreaded consequence, and they may be confused with ulcers from other etiologies.

Various photos of multiple presentations of varicose veinsVarious photos of multiple presentations of varicose veins.

Stasis dermatitis Stasis dermatitis showing skin darkening secondary to poor skin vein circulation. (above & below)

More Stasis dermatitis

Severe stasis dermatitis Severe stasis dermatitis with inflammation, maceration, and early ulceration.

Venous stasis ulcersVenous stasis ulcers classic of severe chronic superficial venous insufficiency.

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