What is the prognosis of varicose veins and spider veins (telangiectasia)?

Updated: Sep 25, 2020
  • Author: Robert Weiss, MD; Chief Editor: William D James, MD  more...
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Patients with significant venous reflux are at high risk for progression to chronic venous ulcers that can be very difficult to treat effectively. With appropriate treatment, the vast majority of patients have a good outcome.

Death can occur because of bleeding from friable varicose veins, [4] but the mortality associated with varicose veins is almost entirely due to the association of this condition with venous thromboembolism. When treating a patient with varicose veins, the possibility of associated deep venous thrombosis (DVT) must always be considered because the mortality rate of unrecognized and untreated thromboembolism is 30-60%. A 2018 study from Taiwan compared 212,984 subjects with varicose veins and 212,984 subjects without varicose veins, all approximately the same average age (55 y) and of similar sex-based proportions (70% women). [5] The observation spanned 14 years, and researchers found 10,630 cases of DVT in the varicose vein subjects versus 1,980 cases in the non–varicose vein subjects. The results suggest that varicose vein patients may have an approximately 5 times greater risk of developing DVT compared with those without varicose veins.

Patients with varicose veins are at increased risk of deep vein thrombosis because venous stasis and injury often cause superficial phlebitis that can pass through perforating vessels to involve the deep venous system.

Varicose veins may arise after an unrecognized episode of deep vein thrombosis that causes damage to venous valves. Such patients have some underlying risk factor for thromboembolism and are at especially high risk for recurrence.

Varicose veins may sometimes serve as an important pathway for venous return in a patient with acute blockage of the deep venous system from any cause. This most often occurs after an episode of deep vein thrombosis, but it may also be a response to tumor growth or to impaired portal flow through a cirrhotic liver.

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