Hereditary varicose veins: 45% with one parent, 90% with both

Are varicose veins hereditary?

Yes, and it is the most decisive factor of all. The Varicose Vein Institute of Paris Saint-Joseph Hospital gives precise figures, where most sources merely write that "the risk increases".

• 80% of patients with varicose veins have ancestors who had them.
• One parent affected: the descendant has a 45% risk of developing varicose veins.
• Both parents affected: that risk rises to 90%.

The French National Health Insurance says the same without figures. The risk is higher when several people in the family are affected, and it increases with the number of parents concerned. This predisposition is not a sentence. It does not prevent treatment when the time comes, by surgery, by endovenous techniques, or by the non-invasive HIFU treatment of varicose veins.

What exactly is passed on?

Not the varicose vein, but the ground that makes it possible. The distinction is decisive, and it explains why two equally predisposed people do not follow the same course.

• The quality of the vein wall, its strength and its elasticity.
• The quality of the connective tissue that supports that wall.
• The behaviour of the valves, the flaps spaced along the vein that stop blood from falling back.

This ground determines how fast the valves deteriorate. Paris Saint-Joseph Hospital describes the most frequent process: varicose veins appear through progressive deterioration of the valves of the superficial veins, on predisposed ground, and in the presence of contributing factors.

According to Sonovein®, venous reflux refers to the reversal of blood flow in a vein through valvular incompetence, measured on duplex ultrasound beyond 0.5 seconds in the superficial network, the mechanism targeted by all venous ablation techniques including HIFU treatment.
Reference definition : venous reflux

The hereditary load varies from family to family. Some people develop varicose veins in childhood and follow a severe course. Others, with the same family history, stay stable all their lives. That is what "chronic and progressive disease" covers: progressive does not mean fast.

Also read: The main causes of varicose veins

Does heredity act alone?

Never. It sets the ground, other factors decide the pace. The French National Health Insurance and Paris Saint-Joseph Hospital cite the same ones.

• Sex: chronic venous disease affects three women for one man.
• Age, which progressively alters the vein walls.
• Prolonged standing and stamping, which do not help venous return.
• Excess weight, a sedentary life and exposure to heat.
• Pregnancies, whose effect adds up with their number.

This is why a strong predisposition does not read as a sentence. Paris Saint-Joseph Hospital puts it cautiously. Avoiding varicose veins with a strong family history is not always easy. Their development can be limited, by following a few lifestyle rules and by having them assessed early enough.

The age at which they appeared counts as much as their presence. Varicose veins that showed up at thirty in a parent do not point the same way as varicose veins that showed up at seventy.

Do you need a duplex ultrasound if a parent has them?

No, not systematically. It is the question everyone asks, and the answer from Paris Saint-Joseph Hospital is clear.

• Without venous symptoms and without visible varicose veins, a systematic duplex ultrasound is not justified, even if your mother has varicose veins.
• Otherwise, that is as soon as there is discomfort or a visible vein, it is worth taking stock without waiting too long.

This answer deserves to be known, because family worry often leads to requesting an examination that will bring nothing. Venous screening is not performed on the basis of a family history alone.

What does change is the threshold of attention. With a 90% risk when both parents are affected, persistent discomfort is not left aside for two years. Neither is a first visible vein.

What to watch when you are predisposed

The signs that precede the varicose vein, not the varicose vein itself. The French National Health Insurance lists the manifestations that appear before any visible sign.

• A feeling of heavy legs, at the end of the day.
• Restless sensations, the unpleasant feelings that only movement relieves.
• Night cramps in the calves, and itching.
• Swollen ankles in the evening, which go down overnight.

These signs point towards a venous origin if they increase with heat and prolonged standing, and if they decrease with cold, rest and legs raised.

The consultation criteria are then the same as for everyone. What changes with a heavy family history is the timing: discomfort that settles in deserves advice sooner.

Also read: Varicose veins in men and women: what really differs

What predisposition does not tell you

It tells you neither the timing, nor the severity, nor the outcome. Three clarifications are worth stating, because they come up at every consultation.

• It sets no age. There is no typical age of onset, and the clinical picture can be minimal and very slow to progress.
• It does not predict severity. The disease takes very variable forms, including within one family.
• It does not disappear after treatment. No practitioner can state that a treated person will never have varicose veins again, since venous fragility remains constitutional.

This last point is the most disappointing. Better to hear it before than after. Treating a varicose vein settles a varicose vein, not the ground that produced it.

Also read: Varicose veins and age: when do they appear?