Varicose Veins (Chronic Venous Disease)

What it is

Varicose veins are permanently dilated, tortuous superficial veins caused by valve failure and venous reflux. They belong to the spectrum of chronic venous disease (CVD), which ranges from cosmetic telangiectasias to edema, eczema, and venous ulcers.

 

Symptoms

 

  • Heaviness, aching, pressure or “tired legs,” worse by evening

  • Visible bulging/tortuous veins; “spider” or reticular veins

  • Ankle/lower-leg swelling, night cramps, itching, burning

  • Skin changes near the ankle: hyperpigmentation, induration (lipodermatosclerosis)

  • Slow-healing wounds or venous ulcers in advanced disease

 

Potential complications: superficial thrombophlebitis, bleeding from a varix, venous eczema/cellulitis, and less commonly deep-vein thrombosis (DVT) and pulmonary embolism (PE).

 

Why it occurs

 

  • Hereditary weakness of venous wall/valves

  • Female sex, pregnancy, hormonal factors

  • Prolonged standing/sitting, low physical activity

  • Obesity, chronic constipation, heavy lifting

  • Age, leg trauma/surgery, flat feet, tight clothing/footwear

 

When to seek urgent care

 

  • Sudden painful, red, cord-like vein with fever (suspected thrombophlebitis)

  • Acute asymmetric leg swelling and calf pain (possible DVT)

  • Shortness of breath, chest pain, hemoptysis (possible PE) - call 1-03 / 112 in Armenia

  • Bleeding from a varicose vein that is hard to stop

  • Rapidly enlarging ulcer or marked skin infection

 

Diagnosis

 

  • Examination by a phlebologist/vascular surgeon with CEAP staging (C0–C6)

  • Duplex venous ultrasound (gold standard) to map reflux and patency

  • As indicated: coagulation tests, thrombosis risk assessment; dermatology/endocrinology input for skin or metabolic issues

 

Conservative measures (baseline for everyone)

 

  • Graduated compression stockings (fitted class and length). Put on in the morning, remove at night.

  • Activity habits: daily walking; breaks during long sitting/standing; leg elevation 10–15 cm at rest; avoid excessive heat/saunas.

  • Weight & bowel care: weight control; fiber to prevent constipation.

  • Topicals/venoactives: cooling gels; short NSAID courses for acute phlebitis.

  • Exercise/physiotherapy: calf pump activation—heel raises, ankle rolls, cycling motions.

 

Minimally invasive endovenous therapy (first-line for axial reflux)

 

  • EVLA / RFA (endovenous laser or radiofrequency ablation) to close an incompetent trunk (GSV/SSV); ultrasound-guided, ambulatory.

  • Cyanoacrylate adhesive closure — no tumescent anesthesia; rapid recovery in selected cases.

  • Foam sclerotherapy — for tributaries, reticular/spider veins, and as an adjunct to EVLA/RFA.

 

Surgical options

 

  • Microphlebectomy — removal of varicose tributaries via micro-incisions.

  • Combined phlebectomy/stripping — reserved for specific anatomies/large diameters (used less often as monotherapy today).

 

Managing complications

 

  • Acute superficial thrombophlebitis: NSAIDs, compression, mobilization; anticoagulation if extensive or close to deep system (per specialist).

  • Venous ulcers: multilayer compression, modern dressings, infection control, and correction of reflux with endovenous therapy.

 

Recovery & outcomes

 

  • Most patients resume normal activity within 24 hours after endovenous procedures; bruising/cord-like induration along the treated vein is common and resolves over weeks.

  • Compression is typically prescribed for 1–4 weeks post-procedure per protocol.

  • Recurrence or new varices can occur; periodic ultrasound follow-up and lifestyle measures help maintain results.

 

Prevention & lifestyle

 

  • Daily 30–40 minutes of walking or equivalent activity

  • Breaks every 45–60 minutes at work; avoid leg-crossing posture

  • Compression stockings for long flights, pregnancy, or prolonged standing

  • Comfortable shoes (low heel), non-constrictive clothing, weight management

  • Consistent skin care of the lower legs/ankles

 

Which specialist to see

 

A phlebologist/vascular surgeon is the primary specialist. For ulcers: add dermatology/wound care. Suspected DVT/PE requires emergency evaluation.

 

Services & care pathway in Yerevan

 

Typical pathway: initial consultation, duplex ultrasound, compression fitting; when indicated — EVLA/RFA, foam sclerotherapy, microphlebectomy, and ulcer management. Costs depend on method and compression class. On Doctor911.am you can compare clinics and packages and book care online.

 

This material is informational and does not replace in-person medical advice. For acute swelling, red painful veins, bleeding, chest pain, or sudden breathlessness, seek urgent care (Armenia — 1-03 / 112).