Varicose veins, appearing as enlarged, twisted cords beneath the skin, are a common medical condition that goes beyond a purely cosmetic concern. Most frequently found in the legs, they are a physical manifestation of an underlying circulatory problem. Their presence indicates a failure in the venous system designed to return blood to the heart. Ignoring these changes allows the underlying disease to progress, leading to increasingly serious and painful health complications.
Progression to Chronic Venous Insufficiency
Untreated varicose veins inevitably lead to a worsening condition known as Chronic Venous Insufficiency (CVI). The veins in the legs contain valves that push blood upward against gravity. When these valves become damaged or weakened, they fail to close properly (venous reflux). This causes blood to flow backward and pool in the lower extremities, significantly increasing pressure within the veins, known as venous hypertension.
This persistent, elevated pressure drives the chronic symptoms experienced by those with CVI. Patients frequently report a heavy, aching sensation in their legs, which intensifies after long periods of standing or sitting. The congestion of blood also causes dependent edema, a swelling in the ankles and lower legs that is typically worse at the end of the day. Venous hypertension can also manifest as restless legs, a throbbing sensation, or nocturnal leg cramps.
Skin Changes and Tissue Hardening
The long-term effects of venous hypertension cause significant, irreversible damage to the surrounding skin and subcutaneous tissue. Chronic pressure forces fluid, proteins, and red blood cells to leak out of compromised capillaries into the surrounding tissue. When red blood cells break down, they deposit iron, resulting in a permanent brownish-red discoloration known as hemosiderin staining. This leakage triggers a chronic inflammatory response, leading to a condition called lipodermatosclerosis.
The fat and skin tissue beneath the surface become fibrous, hard, and scarred, making the affected areas feel tight, leathery, or “woody” to the touch. This hardening most often occurs in the gaiter area, the lower leg just above the ankle. In advanced stages, this fibrotic process can cause the leg to narrow above the ankle, sometimes described as an inverted champagne bottle appearance.
Acute Risks: Blood Clots and Hemorrhage
Failure to treat varicose veins significantly raises the risk of acute complications, notably blood clot formation and spontaneous bleeding. A clot can develop directly within a varicose vein, a painful condition called superficial thrombophlebitis (SVT). While SVT is typically localized, it is a concern because the clot can extend into the deep venous system.
This extension can lead to Deep Vein Thrombosis (DVT), a dangerous condition where a clot forms in the deep veins of the leg. Untreated varicose veins increase the likelihood of DVT, which poses a serious threat if the clot breaks loose and travels through the bloodstream. If this embolus lodges in the lungs, it causes a life-threatening Pulmonary Embolism (PE).
Another acute risk is hemorrhage. The intense pressure within the enlarged varicose veins causes the overlying skin to become thin and fragile over time. Minimal trauma, such as a bump, a scratch, or shaving, can rupture the vein beneath the thinned skin. Due to the high venous pressure, the bleeding can be profuse and forceful, often requiring immediate medical attention.
Development of Venous Ulcers
Ulcer Formation
The final and most severe outcome of untreated venous disease is the development of venous stasis ulcers. These are chronic, open wounds that typically form near the ankles, often where the skin has been compromised by lipodermatosclerosis. The hardened, inflamed tissue struggles to receive adequate oxygen and nutrients, making it susceptible to breakdown from minor injury.
Healing Challenges and Infection
Once formed, these ulcers are difficult to heal because the underlying venous hypertension prevents normal repair processes. They are often shallow with irregular borders and can persist for months or years, profoundly impacting quality of life and mobility. The open wounds also create an easy entry point for bacteria, leading to frequent and severe infections like cellulitis, which can spread rapidly.