Complications of Untreated Varicose Veins #5: Swelling

Swollen Ankles

Leg swelling is a common symptoms of varicose veins and venous insufficiency. The legs often feel heavy. It is common to notice sock lines around the ankles by the end of the day.

Complications of Untreated Varicose Veins and Venous Insufficiency #5: Swelling of the Ankles/legs

Leg swelling (swelling is also known as edema), is a common complaint related to varicose veins and underlying venous insufficiency. Leg swelling can be present simply from underlying venous insufficiency without visible signs of varicose veins or spider veins. As a result, a venous insufficiency study by duplex ultrasound scanning is part of the recommend work-up for leg swelling.  The swelling usually affects the ankles.  Most people with vein-related swelling experience progressive swelling throughout the day, that is worse at night time and improved in the morning (they usually wake up with normal appearing legs in the morning but by night-time, shoes may feel tight.) Vein-related swelling is worse at the end of the day, with prolonged standing, sitting or with air travel, heat and menstruation.  The degree of swelling varies from one person to another.

Compression stockings and legs elevation will help reduce swelling.   If the swelling can be attributed to the varicose veins or venous insufficiency, correction of the underlying vein problem will reduce swelling.

Complications of Untreated Varicose Veins #4: Leg Ulceration


Venous leg ulcers make up 70% of all chronic leg wounds. They usually occur in the inner ankle or outer ankle locations.


Before and after treatment of a venous leg ulcer.
Copyright @ La Jolla Vein Care.

A leg ulceration is the most severe form of chronic venous insufficiency.  This is referred to as a ‘venous leg ulcer.’  Venous leg ulcers make up 70% of all chronic leg wounds.  Therefore, the venous leg ulcer is much more common than a diabetic or arterial ulcer.  It is caused from long-standing pressure within the leg veins, resulting from 1) venous reflux through faulty valves, 2) a blockage within the deep veins or 3) from the inability to use the calf muscles or a combination.  Venous reflux is the most common cause for a venous leg ulcer.  The increased pressure within the leg veins (we call this venous hypertension) causes an inflammatory response. Inflammation then causes changes in the skin, usually around the ankles (this is where pressure is the greatest).  The inflammatory process will cause the skin around the ankles to become brown or discolored, and eventually the skin will break open.  The leg wound can be healed by treating the underlying vein condition.  Venous leg ulcers can also be prevented by early intervention with non-invasive procedures.  If you have signs of chronic venous insufficiency (such as skin discoloration around the ankles) you should address your underlying vein condition to prevent the skin from breaking open.

Complications of Untreated Varicose Veins #3: Spontaneous Bleeding

Complications of Untreated Varicose Veins #3: Bleeding or Hemorrhage Caused by Vein Rupture

Untreated varicose veins are at a higher than usual risk of bleeding or spontaneous rupture.   Over time, varicose veins become larger, and the vein wall becomes weak and stretched out. These veins, which are already weak are also under high pressure (because of venous reflux, or the ‘backflow’ and pooling of blood in these veins). As a result, the high pressure can cause the veins to spontaneous burst and bleed heavily. Because they are under high pressure, they bleed like an arterial bleed and patients describe the bleeding as ‘blood shooting across the room.’  The varicose veins that are susceptible are veins closest to the surface of the skin

Most patients describe that it occurs during or after a warm shower (warm water causes veins to relax and dilate, allowing more blood to pool within the veins) or during sleep. It is painless and patients report that they notice it because they feel something wet in bed.  Patients who are on blood thinners can lose large amounts of blood, especially if it occurs while they are sleeping. Some people have required blood transfusions. The small blue spider veins around the ankle are equally at risk of rupture as are the larger bulging veins.

vv hemorrahge

This is a patient who experienced spontaneous hemorrhage of their varicose veins. Notice the appearance of the blue, bulging veins that we describe as, ‘blue blebs.’ These veins are dilated, weak, and are close to the surface of the skin. The pooling blood within these veins causes high pressure, ultimately resulting in a spontaneous rupture or hemorrhage. The bleeding is rapid since varicose veins are under high pressure.  This is a common condition that we see at La Jolla Vein Care.

If someone you know has experienced bleeding from their varicose veins, they should be seen by a doctor. Treatment will prevent the veins from bursting again.  This is a common condition that we see at La Jolla Vein Care.

Complications of Untreated Varicose Veins #2: Cellulitis

Complications of Untreated Varicose Veins and Venous Insufficiency #2: Cellulitis

Cellulitis is a bacterial infection of the skin and tissues beneath the skin. Cellulitis infections can occur in the legs of people with untreated varicose veins and chronic venous insufficiency.  The reason for this is chronic venous insufficiency causes inflammation within the skin and underlying tissues. This inflammatory process causes the skin to become firm, eczema like, dry, itchy and fragile. Healthy skin acts like a barrier to bacteria, preventing infections. But, in chronic venous insufficiency, the skin is fragile and this barrier is susceptible to bacterial infections, that can enter the tissues through cracks or breakages within the skin.  In chronic venous insufficiency, the skin around the ankles is most affected and infections can begin here.

Cellulitis usually begins as a small area of pain and redness on the skin. This area spreads to surrounding tissues, resulting in the typical signs of inflammation such as redness, swelling, warmth, and pain.  Fever and chills may develop and the redness will spread affecting more of the leg. It is treated with antibiotics. If you believe you have signs of cellulitis, you need to contact your doctor right away as untreated cellulitis can spread rapidly.

This complication can be avoided by treating the varicose veins and eliminating underlying venous insufficiency, which will in turn reduce inflammation and improve the skin condition.  Practicing good skin hygiene is important. Keep your skin moisturized so that it doesn’t flake or crack easily. If the skin is not broken or leaking fluid but is inflamed, your doctor may recommend an anti-itch cream, such as one containing hydrocortisone; a cream containing zinc oxide to protect the skin; or an antifungal cream to prevent fungal infections.

Skin that is leaking fluid is treated with wet compresses. If you have ulcers on your legs, your doctor will show you how to apply layered compression bandages to protect the skin and maintain blood flow.


Complications of Untreated Varicose Veins #1: Phlebitis

What Possible Complications Can Occur From Untreated Varicose Veins?

Over time, complications can develop from untreated veins. These include:

  • Superficial phlebitis


    A superficial thrombophlebitis (also known as STP) refers to a blood clot that has formed within the vein causing it to become painful and inflamed. The overlying skin becomes red, hot and painful to touch. The blood clot forms as a complication of varicose veins, because the blood is not circulating well in varicose veins.

  • Skin discoloration and eczema around the ankle
  • Skin sores or ulcers usually near the ankle
  • Burst or hemorrhaged vein
  • Chronic venous insufficiency
  • Infection of the skin, or cellulitis

This blog post will discuss phlebitis. Phlebitis refers to the painful swelling and inflammation within a vein, usually a varicose vein.  A thrombophlebitis is swelling and inflammation of a vein caused by a blood clot. A phlebitis is common with varicose veins, and thrombophlebitis less common but still a potential complication from untreated varicose veins.  A thrombophlebitis refers to a blood clot that has formed within the vein causing it to become painful and inflamed. The overlying skin becomes red, hot and painful to touch.

The blood clot forms because the blood is not circulating well in varicose veins. The blood is stagnant in varicose veins and is more likely to form clots. When blood clots are formed within varicose veins, this is called a superficial thrombophlebitis (since varicose veins sit near the skin surface).  This is often referred to as an STP.

The following symptoms are often associated with thrombophlebitis:

  • Inflammation (swelling) in the part of the body affected
  • Pain in the part of the body affected
  • skin redness (not always present)
  • Warmth and tenderness over the vein

Thrombophlebitis of varicose veins can be avoided by wearing compression stockings daily (prevents pooling of blood), leg elevation, staying active and treating the varicose veins.  If you think you have phlebitis, you should see a doctor. An ultrasound examination is may be necessary.

DVT (Deep Venous Thrombosis) Afflicts American Idol

On Friday, former American Idol contestant Michael Johns suddenly died at age 35, allegedly from a blood clot that formed in his ankle. No official details have been released, but TMZ is reporting that Michael Johns twisted his ankle.  Other celebrities who have made relatively recent headlines for suffering from DVT include Real Housewives of Atlanta star, Nene Leakes, and Tennis Star Serena Williams.  Other well known figures such as

Richard Nixon, Dan Quayle, Dick Cheney and David Bloom have all suffered a potentially fatal deep venous thrombosis (DVT).

Deep venous thrombosis (DVT) mainly affects the large veins in the lower leg and thigh. The clot can block blood flow and cause swelling and pain. When a clot breaks off and moves through the bloodstream, this is called an embolism. An embolism can get stuck in the brain, lungs, heart, or other area, leading to severe damage.

Blood clots may form when something slows or changes the flow of blood in the veins. Risk factors include:

  • Bedrest
  • Cigarette smoking
  • Family history of blood clots
  • Fractures in the pelvis or legs
  • Giving birth within the last 3 months
  • Heart Failure
  • Obesity
  • Recent surgery (especially hip, knee, or female pelvic surgery)
  • Too many blood cells being made by the bone marrow

You’re also more likely to develop DVT if you have any of the following conditions:

  • Blood that is more likely to clot (hypercoagulability)
  • Cancer
  • Taking estrogens or birth control pills.
  • Long airplane flights: London’s Heathrow Airport reports one passenger death a month from DVT. One nearby hospital recorded thirty passenger deaths from DVT in the past three years including a 28-year-old man. To reduce the risk of DVT during air travel,  passengers are advised to wear compression stockings on flights, frequent moving aroudnt he cabinand pumping the calf muscles, leg elevation and avoidance of sedentary positions for long periods of time without moving.

If you might have a DVT, it is important to see a doctor. Signs of a DVT may be sudden leg pain and swelling. It can be diagnosed by ultrasound imaging. See our other blogs about ultrasound imaging and DVT detection.

What is a Superficial Thrombophlebitis?

A thrombophlebitis is swelling and inflammation of a vein caused by a blood clot. There are two main types of thrombophlebitits: deep venous thrombosis (affects deeper, larger veins) and superficial thrombophlebitis (affects veins near the skin surface).  This is often referred to as an STP.

The following symptoms are often associated with thrombophlebitis:

  • Inflammation (swelling) in the part of the body affected
  • Pain in the part of the body affected
  • skin redness (not always present)
  • Warmth and tenderness over the vein

The following increase your chances for thrombophlebitis:

  • Being hospitalized for a major surgery or with a major illness
  • Disorders that make you more likely to develop blood clots
  • Sitting for a long period of time (such as on a long airplane trip)
  • Varicose veins

An STP is common complication of varicose veins. But, it can also indicate an underlying problem with blood clotting.  In some cases, there may also be a concurrent blood clot in other veins, such as the deep veins (DVT) which can be serious. For this reason, a duplex ultrasound examination is used to look at the deep veins and other veins not visible to the naked eye for the presence of blood clots.

If it is localized to a small surface vein, it can usually be treated with  aspirin or other anti-inflammatory medication to reduce pain and inflammation, compression stockings, and cold/warm packs to also reduce inflammation and discomfort. The discomfort is usually improved within 6 weeks but it can take a few months to resolve.

If the superficial thrombophlebitis is extensive or if it appears to be ‘migrating’ up the leg, a blood thinner may be necessary.  You should see your doctor if you develop an STP.


A thrombophlebitis is swelling and inflammation of a vein caused by a blood clot. This patient has a superficial thrombophlebitis, which is a blood clot in the superficial, surface veins. You can see redness in the inner thigh of this patient, which is caused by the inflammation and swelling from the blood clot. It can be very painful. You should see your doctor for superficial thrombophlebitis.


8 Warning Signs of Vein Disease: #5 Pregnancy Related Varicose or Spider Veins


Pregnant women should talk with their doctors about using medical compression therapy during pregnancy to reduce the risk of varicose veins and vein related issues.

8 Warning Signs of Vein Disease: #5 Varicose or Spider Veins, especially during or after pregnancy. During pregnancy, the amount of blood greatly increases throughout the body to almost double the normal volume, stretching leg veins far beyond their normal capacity.  Even though the visible signs of varicose veins may disappear after birth, the damage done to veins during pregnancy may be permanent and can cause pain and discomfort later in life. These problems may be avoided if compression therapy is prescribed during pregnancy. Women with a history of vein disease in their family or who experience swelling, pain or varicosities in the their legs during pregnancy are strongly urged to talk to their doctors about medical compression therapy or be evaluated by a vein specialist.

8 Warning Signs of Vein Disease: #4 Swollen Ankles


Ankle swelling related to varicose veins and venous insufficiency may be subtle, leaving indentations from socks.

Swollen Ankles at Night

Thick, swollen ankles are signs that blood or other fluid is congested in the leg and / or leg veins. Over time, damaged vein walls can become even more stretched out and permeable, allowing fluid and protein to filter from the veins into surrounding leg tissue. When you lie down at night, the pressure from gravity is equalized across your leg. Usually, vein related swelling (venous edema) becomes apparent later in the day or worse throughout the day and improved with leg elevation or overnight during sleep.  Often in the morning, there may be no swelling. But, as the day progresses gravity causes poo

Pooling of blood around the ankle in incompetent veins. Venous insufficiency is one of the most common causes of ankle swelling that worsens throughout the day. Sometimes, the swelling can be subtle, leaving indentations from sock lines. Or, it may cause the skin to feel firm, shiny, or puffy by the end of the day.

If you have swelling, you should discuss it with your healthcare provider. Venous insufficiency can be diagnosed with a venous duplex sonogram, which is a non-invasive study of the leg veins.

8 Warning Signs of Vein Disease: #2 Discoloration of the Skin


Discoloration of the Skin

venous leg ulcers

Chronic venous insufficiency (CVI) can cause the skin to become discolored, usually around the ankles. Over time, ulcerations or skin wounds may develop.

Over time, leakage of the blood into the area surrounding the veins can cause tissue to die. The resulting pooling of blood in the tissue causes a darkening of the skin. It is at this stage that the skin is actually stained by your own blood.  This is also known as venous stasis skin changes, skin hyperpigmentation or venous stasis dermatitis because the skin is often inflamed, itchy and eczema-like.  This is most frequently caused by venous reflux, an underlying condition that can be treated. When skin changes like these are present, the condition is termed chronic venous insufficiency.  Over time, the skin condition may worsen and the skin may become darker, firm to touch, scaly and itchy, and the skin may break down causing a venous leg ulcer.