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What Are Varicose Veins?
Varicose veins are veins that have become wider and twisted due to a defect in the valves in the vein. These valves normally prevent the backflow of blood in the vein. Since the valves that prevent the backflow of blood in a section of the vein are not working normally, blood pools along the vein, causing the vein to bulge and swell.
Veins are thin-walled blood vessels that carry deoxygenated blood from the body tissues back to the heart. Varicose veins occur when some of the valves between the deep and superficial veins of the leg no longer function properly.
There are two principal systems of veins in the body:
- Deep veins, which lie among the muscles and carry about 90 percent of the blood.
- Surface -or superficial- veins, which are often visible just under the skin. Surface veins do not have the protective muscular surrounding of deep veins. This means they are weaker and more likely to become varicose.
Surface veins carry blood from the skin and surface areas into the deep veins via connecting channels called perforator veins.
Here is how blood is moved from the legs toward the heart:
- The leg muscles squeeze the deep veins, forcing the blood upward.
- The veins are equipped with “one-way” valves to keep the blood from flowing backwards.
- As the blood is forced upward, the valves open to allow the blood to pass.
- After each heartbeat, the valves close momentarily to prevent back-flow.
When a valve between these two systems fails, blood can flow the wrong way because the pressure in the deep veins is greater than in the superficial veins.
- Instead of taking the blood from the surface veins, the deep veins may actually be pumping blood back into the surface veins.
- This increases the pressure within the surface veins.
- As blood pools in the surface veins and the pressure within these veins increases, more and more valves begin to deteriorate.
- Over a period of time, perhaps years, one valve after another fails.
- Where this happens, the surface veins swell from the excess blood and high pressure, creating varicose veins.
Although varicose veins usually occur in the legs and feet, they can occur on any part of the body. These include veins in the lower end of the esophagus, the lining of the stomach, the colon, the rectum, and the scrotum.
Varicose veins may result in some discomfort. Usually they cause no symptoms, but in some cases they result in serious medical problems. For many people, varicose veins only cause a problem in terms of appearance-the veins can look ropy and twisted, and may bulge out beneath the skin.
|Nice To Know:
Q. Does walking make varicose veins worse?
A. No. Indeed, walking is beneficial. When you walk, the muscles in your legs contract, squeezing the veins, thus helping to force the blood to move forward on its way back to the heart. If walking causes discomfort, you should see your physician to determine why (for example, to exclude any other causes besides varicose veins). Walking is also an excellent form of exercise to help promote good cardiovascular health.
|Nice To Know:
Spider veins are shaped like spider legs and appear in clusters of fine red lines. They commonly occur on the feet, ankles, or thighs, and sometimes the face. This condition goes by several other names, including spider veins, burst veins, venous starts, and telangiectases.
Some health experts consider spider veins a type of varicose veins; others say that they are not varicose veins since they are not subject to any of the complications associated with varicose veins. They are principally a cosmetic problem, although occasionally they may cause symptoms.
|Facts About Varicose Veins
Why Do Varicose Veins Occur?
What Are the Risk Factors for Varicose Veins?
Several factors may accelerate, if not cause, the development of varicose veins.
- Heredity– People with a family history of varicose veins are at greater risk of developing the condition.
- Gender– Women are at greater risk than men, probably because the female sex hormones estrogen and progesterone cause blood vessels to relax, thus separating the valves so that they don’t meet to block the back flow of blood.
- Pregnancy– The circulatory changes of pregnancy that are designed to support the growing fetus also increase risk. Varicose veins may surface for the first time or may worsen during late pregnancy, when the uterus exerts greater pressure on the veins in the legs.
- Obesity– Excess weight puts pressure on surface veins, causing them to weaken.
- Standing and sitting– People who have jobs that require them to stand or sit for long periods also are at increased risk. Prolonged standing can weaken the walls of veins, and sitting can aggravate inflamed veins.
Need To Know:
Birth-control pills, estrogen treatments, and pregnancy raise a woman’s level of sex hormones, putting her at greater risk of developing varicose veins.
What Symptoms Do Varicose Veins Cause?
In many people, varicose veins cause no symptoms, other than the appearance of the bulging, twisted vein beneath the skin.
However, in some people, symptoms include:
- An ache in the affected area
- Swelling of the feet and ankles due to the fluid from stagnant blood leaking through the walls of the veins into surrounding tissues
- A feeling of heaviness, tiredness, and aching, especially at the end of the day or after periods of prolonged standing
- Persistent itching of the skin over the affected area
- Changes in skin color-the skin over the affected area may turn a brownish gray color, especially around the ankles
Varicose veins are often progressive, which means that symptoms may worsen over time. Significant complications are associated with more severe types of varicose veins. Please go to Complications of Varicose Veins.
Need To Know:
People with pain in their legs due to arthritis, narrowed arteries in the legs, and sciatica (pain down one leg due to pressure on a nerve root in the back), may attribute the pain to their varicose veins, when in fact it may be due to one of these other conditions.
Nice To Know:
Because increased progesterone levels are a contributing factor to varicose veins, women may experience more symptoms of varicose veins during their menstrual periods, or the veins may become more noticeable.
How Are Varicose Veins Diagnosed?
Physicians use a variety of techniques to diagnose the severity of varicose veins.
- A simple test called the Trendelenburg test, in which the leg is raised above the level of the heart at a 45 degree angle until the veins are emptied, then quickly lowered. When you stand up, varicose veins, if present, become distended almost immediately.
- A physician may tie a band, or tourniquet, around the upper part of a person’s leg, which stops the flow of blood to the leg and makes varicose veins easier to identify.
Rarely, more detailed tests are required, usually to exclude any other problems. They may include:
- Ultrasound, a diagnostic technique in which high frequency sound waves are used to measure blood flow in deep and surface veins.
- Venography – uses X-ray technology to measure blood flow in the deep veins.
For further information about ultrasound, go to Ultrasound.
What Complications Can Varicose Veins Cause?
In most cases, varicose veins cause few symptoms, however, occasionally, they may cause complications associated with the condition.
- Leg ulcers
The thin-walled varicose veins protrude just under the skin. Bumping or scratching a large varicose vein may cause severe bleeding. Varicose veins bleed more than healthy veins because of abnormally high pressure within the damaged veins.
Need To Know:
If you have a varicose vein that is bleeding, lie down immediately, raise the leg, and apply direct pressure with a clean cloth. The bleeding will then stop. See your doctor for treatment.
Phlebitis means inflammation of a vein. A form of phlebitis that sometimes affects varicose veins is superficial
When clots form in veins near the surface of the body, swelling and redness appear along the affected area of the vein. This condition is not considered life threatening, as opposed to deep vein
Treatment for most cases of thrombophlebitis consists of simply relieving the discomfort. It does not require any specific therapy. Warm compresses over the involved vein and anti-inflammatory medication is usually all that is required.
The most serious consequence of phlebitis is the development of
Ulcers (open sores) are one of the most troublesome complications of varicose veins. They tend to occur most often in the elderly.
- The appearance of ulcers calls for consultation with your doctor as soon as possible.
- Treatment often requires several weeks (and often many months) of professional care before an ulcer heals.
- Chances of recurrence are high.
Leg ulcers also may be caused by arterial diseases, such as atherosclerosis (a disease of the arteries in which fatty material is deposited in the vessel wall, resulting in narrowing and eventual impairment of blood flow). In these instances, there is usually an association with poor circulation and lack of pulses in the leg, none of which usually occurs with varicose veins.
In addition, ulcers can be the result of unhealed leg injury. Or they can be a complication of diabetes.
How Are Varicose Veins Treated?
Treatment for varicose veins depends on the type of veins to be treated and the root cause of the problem.
Patients seek treatment either for purely cosmetic reasons, or because of uncomfortable symptoms such as aching and heaviness in the legs, or because in the late phase of the condition, they are getting skin damage at the ankle which can degenerate into a venous ulcer.
The first essential step in deciding on vein treatment is a good duplex ultrasound scan. This is a scan that looks under the skin surface and locates the precise leaking valve in the veins that is causing the varicose veins you can see on the skin.
Treatments for varicose veins include:
Treatment of ulcers
Your physician may recommend that you wear compression stockings-also called support hose-to reduce symptoms. These are elasticized stockings worn from the toes to the knee or sometimes to the top of the leg.
Compression stockings are ‘graduated’. That means the pressure of the stocking is higher at the ankle than at the knee. This gradient helps to push blood in the veins up the leg in the correct direction and prevents it ‘pooling’ in the lower part of the leg, which is what happens in varicose veins. Good quality compression stockings do help to reduce swelling, tiredness, and aching in the legs, but elastic hose will not cure varicose veins. A lot of patients also find them uncomfortable to wear long term.
Put the stockings on as soon as you get out of bed, before gravity gets a chance to cause pooling of blood in varicose veins. Keep the stockings on all day. Take them off when you are lying down, with your legs raised above the level of the heart.
You can buy compression stockings in most drug stores. For women who suffer from varicose veins during pregnancy, special prescription vascular-compression pantyhose are available.
Elastic stockings for women are available in a variety of colors and degrees of sheerness. For men, calf-high support hose come in different colors and are made to look like dress socks.
Support hose must be replaced when they begin to lose their compressive power, about every three to four months.
For patients who have difficulty in getting compression stockings on the leg there are a variety of aids to help with this, such as the ‘Medi-butler’ device.
Need To Know:
People with varicose veins should not attempt to wrap their legs with elastic bandages. If bandages are applied too tightly, they may act like a tourniquet, cutting off blood flow to the region.
For very small veins or for the fine ‘spider veins’ seen on the surface of the skin, a type of injection therapy, called sclerotherapy, may be used to close off damaged veins without the need for surgical removal. Sclerotherapy is usually performed in a doctor’s office and works like this:
Using a fine needle, the doctor gently injects an irritating chemical (the sclerosing agent) into the varicose vein.
To minimize discomfort, the doctor may mix a local anesthetic with the sclerosing agent.
The sclerosing agent creates scar tissue inside the vein, which blocks off the flow of blood to that vein, shutting it down permanently.
Need To Know:
Injection treatment is especially useful for treating small varicose veins below the knee. It may also be useful in treating some cases of spider veins.
Sclerotherapy is not suitable for:
Large varicose veins
Varicose veins extending up to the groin
People who are obese
After the procedure:
There may be some discomfort and redness of the skin at the injection sites.
Your doctor will apply a compression bandage to the area. You will need to wear this bandage for a few days and a compression stocking for a few weeks after treatment.
Walking is an important follow-up activity.
Most people are able to return to work and daily chores within 24 hours, if not immediately.
Possible Complications of Sclerotherapy
Sclerotherapy is mostly successful, but not always. Individual varicose veins may occur again and require treatment. Other complications include:
Blood may leak from the treated veins into the surrounding tissue, which produces brownish discoloration on the skin around the treated veins. This discoloration will eventually fade in four to six months, although sometimes it takes as long as a year. In rare cases, the discoloration is permanent.
In rare cases, a small, depressed scar may appear after treatment, or a blood clot may develop in a treated vein.
The procedure may leave a fine network of smaller varicose veins at the site where the larger vein was treated.
Some of the chemical solutions used in for sclerotherapy contain high concentrations of salt, which can temporarily raise blood pressure.
Solutions have caused allergic reactions in some people, but these are rare. The risk is about 1 in 10,000 cases.
An ulcer at the site of the injection may occur in a very small number of individuals who undergo sclerotherapy.
Foam sclerotherapy is a variant of the injection technique described above and is used to treat larger varicose veins. The chemical solution is mixed with air or carbon dioxide to make‘foam’ before injection into the vein. The foam can be mixed up by the treating physician, or there are ready made products such as Varisolve.
Sclerotherapy works by damaging the inside lining of the vein. The sclerotherapy chemical is usually deactivated by contact with the proteins in the blood. Foam sclerotherapy is more effective than liquid sclerotherapy because the foam pushes the blood out of the vein and the contact time between the chemical and the vein wall is prolonged.
Foam sclerotherapy can work quite well, but the main problems are post procedure phlebitis (inflammation of a large vein) which can be sore, staining of the skin and recurrence. About 30% of patients treated with foam sclerotherapy will get a recurrence after 2 years
Surgical treatment of varicose veins may be required to alleviate pain and to put a halt to recurrent bouts of phlebitis.
Surgery is especially beneficial when the large veins of the legs are involved. Surgery may also be chosen for cosmetic reasons.
Surgery can be divided into two main types – ‘open surgery’ such as a high tie and strip procedure and minimally invasive vein surgery techniques.
The main differences between the two options are:
- Requires a general or spinal anesthetic
- Requires a surgical incision in the top of the leg
- The damaged vein in the leg is physically stripped out
- May require a overnight stay in hospital
- Takes approximately 4 to 6 weeks for full recovery
- Has a recurrence rate of up to 30 % at 5 years
Minimally invasive surgery
- Usually performed under local anaesthetic (like going to the dentist)
- Does not require a major incision
- The damaged vein in the leg is sealed from within, usually by a heat based system such as a laser or radiofrequency probe.
- Recovery takes 1 to 2 weeks
- Recurrence rates are variable but estimated at 10 % at 5 years
Open surgical Vein Stripping
Varicose veins can be removed by an operation known as vein stripping. Vein stripping is the only option for removing the saphenous veins (the largest surface veins in the legs) that serve as the major channels for blood among the superficial veins in the leg.
A person undergoing this procedure may receive either general anesthesia (to be asleep for the procedure) or an epidural (a local anesthetic injection into the back that numbs the lower half of the body).
The surgeon makes two small incisions-one in the groin and the other near the ankle or knee.
The surgeon then ligates (ties off) the saphenous vein and its branches at the groin incision.
The surgeon then passes a flexible wire through the vein from the ankle incision. A number of small incisions in the skin are sometimes needed along the vein to guide the wire along the length of the entire vein.
When the wire reaches the groin incision, the surgeon pulls the wire out, bringing the entire vein with it (“strips the vein out”).
Many patients are able to leave the hospital on the same day as the surgery–or at the most, the day following surgery.
It usually takes two to six weeks to recover from the operation. During that time, your physician may ask you to:
Keep the leg or legs bandaged for several weeks following surgery.
Take several short walks, starting with five minutes each time, and slowly increasing the time and distance covered each day.
Lie down frequently and keep your leg elevated above your heart.
The bandages and any stitches used will be removed by the end of the first week, during a follow-up visit to the surgeon’s office.
Most people are able to return to work within one to two weeks of the operation.
Possible Complications of Vein Stripping
The principal complications following vein stripping include:
Occasionally, the procedure can damage superficial nerves along the stripped vein, causing a patchy area of numbness in the leg. The nerves usually recover, however, and sensation returns.
In some instances, it can result in such complications as infection, which will require antibiotic treatment, and bleeding, which can be treated usually by firm pressure.
There is a recurrence rate of approximately 30% at 5 years after vein stripping.
Nice To Know:
About 85 percent of patients experience long-term relief of varicose veins following vein treatment.
Endovenous laser ablation and VeNUS closure
Over the last 10 years there has been a move away from open surgical techniques in the treatment of varicose veins towards minimally invasive operations such as EVLT and VeNUS closure.
Several different types of laser are now used to treat leaking varicose veins under local anaesthetic. The vein treated is the same vein that is stripped out of the leg in the open surgery operation described above. With minimally invasive treatment a fine laser fiber is inserted into the vein through a pin hole nick in the skin, at or around the knee joint. Under ultrasound control the surgeon passes the fiber up the leg to the groin without making any further incisions. The vein is then surrounded by local anesthetic and saline solution by injections into the leg. This protects the other parts of the leg from the heat generated by the laser.
The laser is turned on and the fibre is slowly withdrawn down the vein. The heat of the laser burns the inside of the vein, causing it to seal and not have any blood flow within it. Over the course of a few months the vein usually shrinks away and is destroyed. The technique works well in 98 % of cases.
A bandage is then applied to the leg and the patient can walk right away. Painkiller tablets are needed for a few days after surgery, but most patients get back to normal activities within a week.
VeNUS closure is a very similar technique which uses a radiofrequency probe rather than a laser fibre to generate the heat required to close the vein. The fibre is inserted into the vein also under ultrasound control and local anaesthetic.
EVLT and VeNUS closure can be performed in a doctor’s office rather than in a formal operating theatre. For these reasons, minimally invasive treatments are now very popular for the treatment of varicose veins with both patients and surgeons alike.
After EVLT or VeNUS closure there may be a few residual veins on the calf. These can be removed by ambulatory phlebectomy or sclerotherapy to imporve the cosmetic appearance of the leg.
In ambulatory phlebectomy, a surgeon makes a series of tiny puncture holes along the vein and then takes out small segments of the vein under local anaesthetic.
The tiny incisions require no stitches. Most people experience very little pain after the operation and are able to walk immediately following surgery.
Nice To Know:
Ambulatory phlebectomy can be preformed in one 30-minute session under local anesthesia in a physician’s office or an outpatient center. The surgery rarely leaves scarring.
Latest developments in minimally invasive vein surgery have concentrated on trying to develop treatments which do not require any injections into the leg (as with EVLT and Venus Closure). Two of these newer techniques are Clarivein and the Sapheon glue system. Both of these operations are relatively new and still in evaluation.
Clarivein works by combining sclerotherapy with a mechanical disruption of the inner vein wall by a rotating device. The device is insterted into the vein in the same way as a laser fibre or VeNUS probe and passed up the faulty vein to the top of the leg. Because no heat is generated by the procedure it is almost painless for the patient.
The Sapheon glue system is also inserted at the knee and a special cyanoacrylate tissue glue (similar to a medical ‘super glue’) is injected into the vein at multiple levels in the leg. Compression is used to get the vein to seal shut, again without generation of heat.
More follow up is needed with both of these techniques to ascertain the long term success of the newer operations in making the varicose veins stay away !
A venous ulcer is an open sore on the leg, usually around the ankle area. A venous ulcer is a complication of longstanding varicose veins. High pressure in a leaking vein over a long period of time will damage the skin in the lower part of the leg. Before the skin ulcerates, there are a characteristic series of changes. Initially the skin becomes dry and itchy – this is called ‘venous eczema’. The skin then develops a dark pigmentation and becomes hard and leathery. Eventually the skin can break down into an ulcer. Because the development of a venous ulcer takes a long time, they are more common in elderly people.
Venous ulcers are very hard to treat. They cause significant pain, discomfort and disability. The mainstay of treatment of an ulcer is compression bandaging of the leg in tandem with surgery on any leaking veins identified by ultrasound scanning.
With good compression bandaging, 90% of venous ulcers will heal up within 3 months. Surgery to the leaking veins may speed this up and reduce the risk of the ulcer recurring. Venous ulcers are very labour intensive and costly and require diligent regular nursing input.
Larger venous ulcers may require plastic surgery is required to cover the ulcers with skin grafts in order to achieve healing.
The best treatment for a venous ulcer is not to get one in the first place – in other words by prompt treatment of varicose veins before the condition degenerates into serious skin damage and ulceration.
How Can Varicose Veins Be Prevented?
Most people can reduce the risk of developing varicose veins, or lessen the severity, by practicing the following behaviors suggested below. The same applies to preventing its reoccurrence following treatment.
Preventing Varicose Veins
Varicose Veins During Pregnancy
Many women develop varicose veins during pregnancy. In fact, it has been estimated that as many as 40 percent of all pregnant women suffer from varicose veins.
There are three main causes for the development of varicose veins during pregnancy:
- The principal cause is the hormonal changes that occur during pregnancy. Increased levels of the hormone progesterone cause blood vessels to relax. This may allow the two halves of the valves in the vein to separate slightly, so that they don’t meet to block the back-flow of blood.
- The enlarged uterus (the organ that holds a developing fetus), pressing against the major veins in the pelvic region, tends to add to the overall problem. The result is an increase in the pressure in the leg veins that are subject to becoming varicose.
- A family history of varicose veins tends to increase the likelihood of varicose veins developing during pregnancy.
Varicose veins that develop during pregnancy usually disappear after delivery. Unfortunately, varicose veins are likely to recur in each succeeding pregnancy, often sooner than during the previous pregnancy. Also, varicose veins may become increasingly prominent with each succeeding pregnancy.
Varicose Veins: Frequently Asked Questions
Here are some frequently asked questions related to varicose veins:
Q: If I have varicose veins, will I pass them on to my children?
A: Not necessarily. There are many factors that put you at risk of developing varicose veins. Your children can limit their risk by adopting preventive behaviors.
Q: Does walking make varicose veins worse?
A: No. Indeed, walking is beneficial. When you walk, the muscles in your legs contract, squeezing the veins, thus helping to force the blood to move forward on its way back to the heart. If walking causes discomfort, you should see your physician to determine why walking is causing your discomfort (i.e. to exclude any other causes besides varicose veins). Walking is also an excellent form of exercise to help promote good cardiovascular health.
Q: How long must I wear support hose?
A: You should wear the support hose every day, all day. Because support hose lose their elasticity over time, a new pair should be purchased every three to four months.
Q: Are there any medications I can take to help relieve the discomfort I experience with my varicose veins?
A: The best things you can do to ease your pain is to wear support hose, avoid periods of prolonged standing, and elevate your legs at the end of the day.
Q: If surgery leaves scars, why would I choose it as a treatment option? After all, the reason I want to get rid of my varicose veins is because they are ugly. Why should I replace them with ugly scars?
A: The scars will fade over time and if, necessary, can be covered with special cosmetic preparations.
Q: Will I become increasingly disabled over time if I develop varicose veins?
A: Varicose veins are progressive, which means that symptoms worsen over time. However, there are measures you can take to prevent or lessen symptoms. One does not become disabled by varicose veins.
Varicose Veins: Putting It All Together
Here is a summary of the important facts and information related to varicose veins:
- As many as 40 million adults (1 in 5) in the United States suffer from varicose veins.
- Pregnancy, excess weight, jobs that require long periods of standing or sitting, and a family history of varicose veins may increase a person’s risk of varicose veins.
- For some people, varicose veins may just be a cosmetic problem; in most cases, varicose veins do not cause a health problem.
- In rare cases, varicose veins may cause complications or be a symptom of damage to deep veins.
- Varicose veins can be prevented in some cases. And medical and self-help techniques can relieve the discomfort and disfigurement of varicose veins easily and safely.
Varicose Veins – Glossary
Here are definitions of medical terms related to varicose veins:
Blood clot: A semisolid mass of coagulated red and white blood cells
Compression stocking: A tightly fitted elastic sock, either from the toes to the knee or to the top of the leg, which applies a gentle pressure to the leg and helps with the flow of blood in the veins
Phlebitis: Inflammation of a vein, usually refers to the veins just beneath the skin
Postphlebitic leg: After long-term phlebitis involving deeper veins, leg may become discolored, scaly, and swollen, with hardened areas beneath the skin and painful ulcers
Saphenous veins: The largest surface veins in the legs
Sclerotherapy: A process in which a physician injects an irritating chemical directly into the affected veins, which causes the veins to scar
Spider veins: Veins shaped like spiders legs that appear in clusters of fine red lines, commonly on the feet, ankles, or thighs, and sometimes the face
Superficial veins: Veins near the surface of the skin
Thrombophlebitis: Inflammation of a vein associated with the formation of a blood clot
Thrombosis: The process of forming a blood clot
Tournique: A tightened band
Trendelenburg test: A test in which the leg is raised above the level of the heart at a 45 degree angle until the veins are emptied, then quickly lowered, causing varicose veins to bulge out
Ulcers: Open sores, a break in the skin
Valve: A membranous structure in an artery or vein that folds or closes to prevent the return flow of blood passing through it
Veins: Thin-walled blood vessels that carry blood from the body tissues back to the heart
Varicose Veins: Additional Sources of Information
Here are some reliable sources that can provide more information on varicose veins:
American Academy of Dermatology
American Venous Forum
National Heart, Lung, and Blood Institute