Varicose veins are swollen, twisted superficial veins, usually in the legs, caused by weak valves that let blood flow backward and pool. Risk factors include age, female sex, pregnancy, family history, obesity and long hours of standing.
Key symptoms
- Visible bulging, twisted veins
- Aching, heavy legs that are worse at the end of the day
- Itching and night cramps
- Ankle swelling that improves with elevation
What you find on exam
- Examine the patient standing to see the veins fill
- Skin changes: brown staining, eczema, hardened skin near the ankle
- Venous ulcer, usually above the inner ankle
- Foot pulses; low pulses need an ankle-brachial index before compression
Tests
- Duplex ultrasound to show reflux and rule out DVT
- Ankle-brachial index if pulses are weak
- Usually no blood tests needed
Treatment basics
- Leg elevation, walking and weight loss
- Compression stockings
- Endovenous ablation with radiofrequency or laser for symptomatic reflux
- Sclerotherapy or phlebectomy for remaining veins
- Skin care and compression to heal venous ulcers
Red flags
- Bleeding from a varicose vein: lie down, raise the leg and press firmly
- Hot, red, hard vein or one-sided leg swelling
- Ulcer that does not heal
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; NCSBN 2026 NCLEX-RN Test Plan. Written by Making Synapses. Making Synapses is not affiliated with these organizations.