Varicose veins that go untreated tend to get worse over time, not better. What starts as bulging, ropy veins can progress to permanent skin damage, chronic wounds, blood clots, and in rare cases, dangerous bleeding. In the Edinburgh Vein Study, nearly 58% of people with chronic venous disease progressed to a more severe stage over about 13 years, with an annual progression rate of roughly 5%. The speed varies from person to person, but the direction is almost always the same.
How Varicose Veins Progress
Varicose veins are a visible sign of a deeper problem: the one-way valves inside your leg veins have stopped working properly. Blood that should flow upward toward the heart pools in the lower legs instead, creating sustained high pressure in the veins. That pressure doesn’t just stretch the veins. Over months and years, it damages the surrounding skin, fat, and tissue.
Doctors classify venous disease on a scale from C0 (no visible signs) to C6 (an open, active wound). Varicose veins sit at C2. From there, the typical progression moves through swelling that doesn’t go away overnight (C3), then skin discoloration and texture changes (C4), then healed or active leg ulcers (C5 and C6). In one study of patients waiting for elective vein surgery, about 11% progressed to a new clinical stage within one to three years. Almost a third of people with varicose veins eventually develop skin changes that put them at risk for ulceration.
Skin Changes and Permanent Damage
The first noticeable skin problem is usually venous eczema, also called stasis dermatitis. It typically appears around the inner ankle and can spread up the shin. The skin becomes dry, scaly, discolored, and intensely itchy. Scratching damages the skin further and raises the risk of infection. During flare-ups, the skin may weep, blister, or become inflamed enough to be mistaken for a skin infection.
If the underlying vein problem continues, a more serious condition called lipodermatosclerosis can develop. The sustained pressure causes proteins to leak from the veins into surrounding tissue, which triggers chronic inflammation. Over time, the fat and skin of the lower leg harden and scar from the inside out. The skin turns brown from iron deposits left behind by leaking red blood cells, and the lower leg can take on a tight, woody texture. This hardening is progressive. Left alone, it causes permanent scarring and sets the stage for ulcers that keep coming back.
Venous Leg Ulcers
Venous leg ulcers are open wounds, usually near the ankle, that form when damaged skin finally breaks down under the constant pressure. They affect 1% to 2% of the general population and up to 4% of people over 65. These are not small cuts that heal on their own. Venous ulcers are notoriously slow to close, often taking months of compression therapy and wound care. They frequently recur.
The encouraging finding is that the vast majority of these cases are fixable. In a large analysis from the American Vein & Lymphatic Society registry, 97% of venous ulcer patients had surgically correctable disease. That means the reflux causing the ulcer could have been addressed before the wound ever formed.
Blood Clots: DVT and Pulmonary Embolism
Sluggish blood flow in varicose veins creates conditions for clots to form. The most common is superficial thrombophlebitis, a clot in a vein near the skin’s surface. It shows up as a red, hard, tender cord you can feel under the skin, often with warmth and swelling. Superficial clots are painful but usually not dangerous on their own. The concern is what can come next.
A large Taiwanese study of nearly 426,000 adults found that people with varicose veins had a 5.3 times higher risk of developing deep vein thrombosis (DVT) compared to people without varicose veins. DVT occurs in the larger, deeper veins of the leg, and it carries a serious risk: part of the clot can break free and travel to the lungs, causing a pulmonary embolism. The same study found the risk of pulmonary embolism was about 1.7 times higher in the varicose vein group. A separate European cohort study put that number at roughly 2 times higher, with the risk most pronounced in the first three months after a venous disease diagnosis, when the pulmonary embolism risk was elevated by 3.5 times.
These are population-level statistics, not a guarantee that any individual will develop a clot. But they make clear that varicose veins are not purely cosmetic. The underlying valve failure creates real vascular risk.
Spontaneous Bleeding
As varicose veins enlarge and the overlying skin thins, the risk of spontaneous bleeding increases. Small, thin-walled blebs (tiny raised bumps) can form on the lower leg or foot where a varicose vein sits just beneath fragile skin. If the skin breaks, even from a minor bump or scratch, the high venous pressure causes blood to spurt out briskly, especially when you’re standing.
This kind of bleeding can be alarming but is manageable if you know what to do. The most important step is to lie down and raise your leg above the level of your heart, which immediately reduces the pressure driving the bleed. Then apply firm pressure with a pad or cloth. Applying a tourniquet above the bleed actually makes it worse by trapping more blood in the area. People who live alone, are frail, or have especially fragile skin over their veins are at the highest risk for a serious episode.
Daily Life and Long-Term Symptoms
Even before the more dramatic complications develop, untreated varicose veins take a steady toll on quality of life. The hallmark symptoms are heaviness, achiness, throbbing, swelling, and itching in the legs, experienced on a regular basis. These tend to worsen as the day goes on, particularly after long periods of standing or sitting. As the disease progresses, symptoms intensify and begin affecting more areas of daily life: sleep quality, physical activity, what clothing you’re comfortable wearing, social confidence, and emotional well-being. Studies using validated quality-of-life questionnaires consistently show that worsening venous disease tracks directly with worsening symptom burden and reduced overall function.
For many people, varicose veins are a slow-moving problem. The progression from visible veins to serious complications can take years or even decades. But the disease rarely reverses on its own, and the interventions become more complex at each stage. Treating reflux in a varicose vein is a straightforward outpatient procedure. Treating a chronic, recurring leg ulcer with hardened, scarred skin is a much longer road.