Increased venous pressure causes superficial veins in the lower extremities to become dilated and tortuous. Risk factors include tobacco use, obesity, pregnancy, and the use of oral contraceptives. Individuals with congenital weakness of the veins are more affected by increased venous pressure.
As the vein valve leaflets stretch, they become incompetent and allow backward blood flow. Increased venous pressure furthers venous distention and worsens varicosities.
Often referred to as spider veins, telangiectasias are characterized by visible vessels less than 1 mm in diameter. Spider veins may appear bluish-black, purple, or red. Although more common on the face and legs, telangiectasias may develop anywhere on the body.
Varicose veins include reticular veins characterized as flat, blue-green varicosities. Small reticular veins are caused by increased venous pressure and are often considered a cosmetic concern. Usually hereditary, reticular veins may also progress as telangiectasias.
Dilated veins larger than 3 mm in diameter are defining characteristics of varicose veins. They may be small and harmless or large and bulging. Described as tortuous, the veins are enlarged and twisted, caused by increased venous pressure. The patient may complain of an itchy, tingling, or cramp-like leg sensation. Other symptoms include swelling, restless legs, fatigue, and nocturnal leg cramps.
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