What Are the Stages Of Varicose Veins and Vein Disease?

A woman sitting on a bed and touching her legs that have varicose veins.

Varicose veins are known as being unsightly, often bulging veins that may be blue or purple, and are often located in the lower extremities. While sometimes they’re just a cosmetic complaint, varicose veins can become uncomfortable and even painful. For some, they can eventually have more serious consequences that require medical attention. 

How do varicose veins start, and what makes them problematic? We’ll cover the stages of varicose veins and the importance of early detection and treatment. 

Stage 1: Spider Veins

Spider veins are often considered early stage varicose veins. They are small, delicate blood vessels that appear near the surface of your skin, named for their spider web-like appearance. 

Spider veins typically result from weakened or damaged capillaries, which are not actually veins. While spider veins are primarily an aesthetic concern, they can sometimes be accompanied by annoying symptoms like itching or burning [1].

They’re not always a predictor or direct precursor to varicose veins. However, they do often act as a sign that you have some underlying venous insufficiency worth taking note of, as this may eventually progress to more visible varicose veins. 

Stage 2: Varicose Veins

Varicose veins are enlarged, twisted veins that typically appear on the legs and feet. They develop when the valves in your veins weaken or fail to function properly, causing blood to flow backward and pool in the veins. This increases pressure within the veins, causing them to swell and become more noticeable [2].

For some people, varicose veins are mostly a cosmetic issue. For others, they can cause more significant symptoms. Varicose veins feel like aching, heaviness, cramping, or swelling in the legs. In more severe cases, varicose veins may lead to complications that require urgent medical attention. 

Stage 3: Venous Insufficiency 

Venous insufficiency means poor circulation in your legs. It occurs when the valves in your veins malfunction, causing blood to pool in your lower extremities instead of efficiently returning to your heart. This can cause swelling and achiness in your legs [3]

Venous insufficiency results from worsening venous reflux disease, which occurs when vein valves malfunction, causing circulation to become turbulent and ultimately pool and flow in the wrong direction.

Over time, venous insufficiency can lead to more significant complications, like more pronounced varicose veins and concerns requiring immediate medical attention. 

Stage 4: Edema

Venous insufficiency can lead to edema, which is the abnormal buildup of fluid in your tissues, causing swelling or puffiness. It occurs when there’s an imbalance between the movement of fluid into tissues and its removal by your blood vessels, such as with venous insufficiency [4]

Edema most commonly occurs in the lower legs, feet, ankles, or hands. It is associated with venous insufficiency and tends to get worse throughout the day, especially after prolonged periods of standing or sitting.

Stage 5: Skin Changes

Ongoing venous insufficiency can lead to more noticeable symptoms, such as changes in your skin that can occur in later and more severe stages of varicose veins.

For example, you might notice discoloration in the form of brownish patches near your ankles or lower legs or thinning and more fragile skin that seems to be more prone to injury than usual. The skin may feel leathery and hard to touch as blood leaking from vessels enters the surrounding skin tissues [5].

Some people experience venous eczema — or stasis dermatitis — a condition characterized by itchy and irritated skin. 

Stage 6: Venous Ulcers

In more severe cases, chronic venous insufficiency can lead to venous ulcers, which are open wounds that often occur near the ankles and can be difficult to heal. 

These can develop because of ongoing pressure and inflammation within your affected veins and impaired circulation in your leg. This can compromise the integrity of your skin. The cracking and peeling of skin can lead to enlarged ulcers. Furthermore, when your circulation is impaired, the surrounding tissues don’t receive as much oxygen and nutrients as they need, contributing to impaired wound healing. 

As you can imagine, skin ulcers can be painful and interfere with everyday life. They also require immediate medical treatment as they can lead to infections and have a high rate of recurrence [6].

Prioritize Your Vein Health Today

If you’re reading this and are concerned that you may have beginning stages of varicose veins or more significant vein disease, know that not all patients experience all six of these varicose vein stages. However, it’s important to be aware of how varicose veins can progress so you can seek prevention, early detection, and effective treatments as appropriate. 

At Empire Vein Specialists, our team of board-certified physicians is committed to helping you navigate vein concerns and improving your quality of life. This may include varicose vein treatment. 

We offer a number of modern vein services, which can be done in the comfort of our office under localized anesthesia, allowing for quick recovery. Ask us about: 

  • VenaSeal™ Closure System: We are the #1 provider of this FDA-approved treatment that works by sealing the affected veins using a medical adhesive.
  • ClosureFast™ Closure System: This option delivers radiofrequency (RF) energy directly into the affected vein using a very narrow catheter inserted via a tiny incision.
  • Sclerotherapy: This procedure is used for spider veins and smaller varicose veins. It injects a sclerosing solution known as Asclera into the affected veins, sealing them closed.
  • Phlebectomy Vein Removal: This option removes large veins from the legs in small sections, using tiny incisions too small to require suturing.
  • Compression Therapy: This is a non-invasive management option using snug-fitting socks or stockings to put constant pressure on the legs to improve blood flow.

If you’re interested in learning more about varicose vein stages and treatment options, we invite you to contact us today at 1-800-VARICOSE (1.800.827.4267). 


  1. Sandean DP, Winters R. Spider Veins. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563218/ 
  2. Antani MR, Dattilo JB. Varicose Veins. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 8, 2023.
  3. Patel SK, Surowiec SM. Venous Insufficiency. [Updated 2023 Jul 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430975/ 
  4. Oliveira RÁ, Mazzucca ACP, Pachito DV, Riera R, Baptista-Silva JCDC. Evidence for varicose vein treatment: an overview of systematic reviews. Sao Paulo Med J. 2018;136(4):324-332. doi:10.1590/1516-3180.2018.0003240418 
  5. Mallick R, Raju A, Campbell C, et al. Treatment Patterns and Outcomes in Patients with Varicose Veins. Am Health Drug Benefits. 2016;9(8):455-465.
  6. Probst S, Weller CD, Bobbink, P. et al. Prevalence and incidence of venous leg ulcers—a protocol for a systematic review. Syst Rev 10, 148 (2021). https://doi.org/10.1186/s13643-021-01697-3