Varicose Veins Behind the Knee:

You might have normal-looking legs but notice some pesky varicose veins behind the knees. Or you may have many varicose veins but a large cluster behind your knee.  This is a common problem we hear about from patients every day.  Anatomically this is known as the popliteal space. This is a common area where veins can pop out and becomevisible, even if your legs otherwise look just fine and if all your other veins are healthy and functioning well. Sometimes these veins don’t cause any symptoms and are a cosmetic concern only, but more commonly they occur with swelling, aching, throbbing, or itching and are a medical concern for patients.

What are varicose veins?

Varicose veins are enlarged, twisted veins that can appear dark purple or blue. They occur when the valves within the veins that help regulate blood flow become weak or damaged. Instead of moving blood back to the heart, blood can pool in the affected veins, leading to their bulging appearance. While varicose veins can develop anywhere, including the legs, thighs, and calves, the area behind the knees is particularly susceptible due to the unique anatomy of the popliteal fossa—an area where the circulatory system is more prone to stagnation.

Although they are often painless, some individuals may experience discomfort or mild symptoms associated with varicose veins, especially after prolonged periods of standing or sitting. Symptoms can include a feeling of heaviness, fatigue, or cramping in the legs, particularly towards the end of the day. In some cases, the skin around the varicose veins can become itchy or discolored.

It’s important to understand that while varicose veins are at times only a cosmetic issue, for most patients they become a health concern when there is ache, pain, throbbing, swelling, itching, blood clots or wounds. For example, these veins can be involved in conditions such as superficial vein thrombosis (a blood clot in a surface vein), chronic venous insufficiency (where veins cannot pump enough blood back to the heart), or more serious issues like venous leg ulcers.

What are the symptoms of varicose veins?

Common symptoms of varicose veins can vary in severity and presentation. While some individuals may have no noticeable symptoms at all, others may experience a range of discomforts. Here are the most common symptoms associated with varicose veins behind the knee and in surrounding areas:

1. Visible Bulging Veins: The most obvious symptom is the appearance of enlarged veins that are swollen, twisted, and dark in color. These veins may be seen protruding under the skin, primarily at the back of the knee.
2. Leg Discomfort: Many people report a sensation of heaviness, aching, or throbbing pain in their legs, which may worsen after standing or sitting for extended periods. This discomfort often improves with movement or elevation of the legs.
3. Swelling: Swelling in the legs, particularly towards the end of the day or after prolonged sitting, is common. This can sometimes extend to the ankles and feet.
4. Cramping and Restlessness: Some individuals experience muscle cramps and a restless feeling in their legs, particularly at night. This phenomenon can disrupt sleep and lead to further discomfort.
5. Itching and Skin Changes: The skin surrounding varicose veins may become itchy, irritated, or even discolored. In some cases, individuals have reported a brownish or reddish tint to the skin, particularly near the affected veins. This can be attributed to the blood pooling in the veins and altering skin pigmentation over time
6. Varicose Eczema: A condition that can develop alongside varicose veins is varicose eczema. This manifests as an inflammatory skin condition characterized by redness, scaling, and dryness, often affecting the legs, particularly where the varicose veins are most prominent.
7. Ulcers and Skin Infections: In more severe cases, varicose veins can lead to skin ulcers or sores, particularly around the ankles. These can be painful and slow to heal, marking a significant concern that requires medical attention. Infected wounds or ulcers can also arise due to the pooling of blood and increased pressure in the veins.

When to Seek Medical Attention

While some individuals with varicose veins may experience mild symptoms, for others the symptoms are more advanced, and this becomes a medical concern.  It’s essential to recognize when these symptoms warrant a visit to a healthcare provider. If you notice any of the following signs, seek medical attention promptly:

1. Severe Pain or Discomfort: If your varicose veins are causing persistent pain that interferes with your daily activities or worsens with time, it is important to see a doctor. While mild discomfort is common, severe pain may indicate complications such as thrombophlebitis or chronic venous insufficiency.
2. Swelling: Any significant swelling in your legs, particularly around your ankles, could suggest that your varicose veins are affecting blood circulation. This is especially important if the swelling is accompanied by redness or warmth in the affected area.
3. Changes in Skin Color or Texture: If you notice that the skin around your varicose veins has changed color (such as becoming darker or reddened) or developed a different texture (thickening or becoming scaly), it’s crucial to get it checked. These changes could be signs of more serious conditions like venous stasis dermatitis.
4. New or Worsening Symptoms: If you experience any new symptoms, such as sudden heaviness in your legs, unexpected cramping, or throbbing sensations, it is essential to consult a medical professional. These could indicate an underlying issue that requires further investigation.
5. Open Sores or Ulcers: The presence of sores or ulcers on the legs, particularly around areas with varicose veins, needs immediate attention. These are called Venous Leg Ulcers (VLU).  These wounds can become infected or just fester and not heal for long periods of time if not treated promptly, leading potentially to more severe complications.
6. Blood Clots: If you suspect you may have developed a blood clot (thrombosis) – marked by intense pain along with swelling and warmth – it is crucial to seek urgent medical care, as this can pose a significant health risk.  These vein clots can be superficial (known as superficial vein thrombophlebitis, or SVT), or deep (known as deep vein thrombosis, or DVT).

Diagnosis of Varicose Veins Behind the Knee

Diagnosing varicose veins typically involves a thorough physical examination complemented by imaging techniques with ultrasound. Here are the common diagnostic steps your healthcare provider may utilize in a consultation:

1. Medical History and Physical Exam: A healthcare professional will begin by taking a detailed medical history to understand your symptoms and any risk factors. During the physical exam, they will inspect your legs for visible signs of varicosities and may check for abnormalities such as swelling, discoloration, or skin changes that could indicate underlying venous issues. They may also ask about your family history of varicose veins, previous medical conditions, lifestyle factors, and any symptoms you’ve lately experienced, such as leg pain or heaviness.

2. Ultrasound Imaging: To evaluate the function of the veins and check for underlying problems such as valve dysfunction or blood clots, your doctor may order a Doppler ultrasound. This non-invasive test uses sound waves to create images of your blood flow, helping to determine the severity of your condition and guide treatment options.

3. Venography: In certain advanced cases, a doctor may recommend venography, an imaging test that involves injecting a contrast dye into a vein to take X-ray images. This method can provide detailed insights into the structure of the veins and identify any abnormalities that may not be visible through a standard ultrasound.  This is generally reserved for advanced cases where one suspects issues with the pelvic veins.

4. Ankle-Brachial Index (ABI): This simple test compares your blood pressure in your ankle with the blood pressure in your arm. This is a measurement to screen for peripheral arterial disease (PAD). A lower reading in the ankle may indicate peripheral artery disease or other circulatory issues, which can sometimes accompany varicose veins. This can suggest the need to treat arterial blockages if indicated..

Assessing Risk Factors

Part of the diagnosis process for varicose veins behind the knee involves evaluating your risk factors to better understand your chances of developing this condition. Your healthcare provider may ask about the following:

Family History: Genetics play a significant role in the development of varicose veins. If you have a family history of venous disorders, this could increase your risk.

Age and Gender: As you age, the likelihood of developing varicose veins increases, particularly among women. Hormonal changes during pregnancy, menopause, and hormonal treatments can contribute to weakened vein walls.

Obesity: Excess weight puts additional pressure on the veins in your legs, leading to venous insufficiency and contributing to varicosities. Weight management can be a vital component of both prevention and treatment.

Prolonged Sitting or Standing: Occupations or lifestyles that require long periods of standing or sitting can affect blood circulation, increasing the risk of varicose veins. Encourage movement or changes in position to promote healthy blood flow.

Previous Injuries or Conditions: If you have a history of leg injuries or existing venous conditions, you may have a higher tendency to develop varicose veins.

Why Does This Happen?

Visible veins in the popliteal space can develop for several reasons. Often, it’s due to the natural aging process or genetic factors. These veins may not be indicative of underlying venous problems, but they can still be bothersome from an aesthetic point of view.  It can be related to veins coming off the refluxing great saphenous vein (GSV), Small Saphenous Vein (SSV), anterior saphenous vein (ASV), posterior accessory saphenous vein (PASV) or incompetent perforator veins (IPVs).  Venous ultrasound can usually map out the source fo reflux that results in a cluster behind the knee and that can inform the treatment plan offered.

How are varicose veins diagnosed?

The good news? These veins are usually readily treated in an outpatient setting in clinics like the Inovia Vein Specialty Clinic. Here’s the typical process:

1. Evaluation by a Vein Expert: The first step is to get an evaluation from a vein specialist. They’ll take your medical history, perform a physical examination, and determine if any additional tests, such as a venous ultrasound, are needed.
2. Conservative measures:  We generally begin with conservative measures such as compression hose, NSAIDS, elevation, exercise and weight management.  If that does not help, one might consider vein treatment procedures. Vein Treatment Procedures:  There are a number of procedures that can be done under local anesthetics in the office setting where patients can walk in, get treated, and even drive home and resume work the next day. This includes RFA, Venaseal, Varithena, ambulatory phlebectomy and sclerotherapy.   For example, sclerotherapy involves injecting a special medical solution into the veins, causing them to shrivel up and eventually be absorbed by the body. These treatments typically requires a few out patient office based sessions, depending on the number of veins and whether one or both legs need treatment.
3. Patience is Key: It’s important to remember that it takes time for veins to fade away after treatment with ablation, phlebectomy or sclerotherapy. The treated veins can appear darker before they start to disappear, so planning this treatment in the winter can be ideal. This gives your body time to heal and for the veins to fade before summer rolls around.  However, one can choose to treat them any time.
4. Insurance: For patients with medical indications for treatment, the treatments are usually covered by most insurance plans.  For those with only cosmetic concerns, insurance does cover treatments, however we can provide a direct pay price for you to consider after a consultation that allows us to understand the extent of what you might need. It is common that patients are not sure and thus a consultation with an expert can help sort through these questions.

Ready for a Consultation?

If you’re concerned about veins on the back of your knees, consider scheduling a consultation with one of our vein specialists. At Inovia Vein Specialty Clinics, we’re here to help you assess your options and find the best treatment plan for you. We serve the Oregon and Southwest Washington region of the Pacific Northwest