Varicose Veins

Varicose veins are enlarged, twisted blood vessels with valves that do not work properly. Veins are the blood vessels of your body that carry blood back to your heart using a series of one-way valves. When the venous valves fail, blood is not circulated properly. The leaky valves cause blood to back up and pool inside the vein. This creates increased pressure and stretches the vein wall, causing enlarged and twisted blood vessels. These swollen vessels appear under your skin as blue, bumpy, rope-like veins called varicose veins.

Causes

Many factors add to the development of varicose veins. Among them are: heredity, gender, pregnancy, occupation, activities, trauma, age, weight and hormones.

• Heredity: is a major factor in most medical conditions.
• Gender: women are affected more than men, although 25 percent of men 30 to 40 years of age have some type of vein problem.
• Pregnancy: as many as 70 to 80 percent of pregnant women develop varicose veins during their first trimester. Varicose veins tend to worsen with each pregnancy, but often resolve or improve after birth.
• Jobs and Activities: people who spend a great deal of time on their feet or have jobs that require them to sit all day are much more likely to develop varicose veins and their symptoms.
• Age: varicose veins and spider veins occur at any stage of life, but they are increasingly prevalent with advancing age. Seventy five percent of women at the age of 60 have signs of varicose veins.
• Obesity:  an elevated body-mass index (BMI) of 30 or greater is associated with varicose veins. BMI is a measure of body fat based on height and weight.
• Hormones: Hormone Replacement Therapy [HRT], fertility treatments and oral contraceptive medications tend to aggravate varicose veins.
• Inactivity: inability to use the leg muscles due to leg injury, or muscle or ankle weakness, increases the risk of developing varicose veins.

Signs and Symptoms

• Aching, tenderness
• Heaviness, fatigue
• General restlessness in the legs
• Burning pain
• Throbbing pain
• Itching around the veins
• Leg cramps, particularly at night
• Soreness behind the knees
• Ankle swelling
• Skin discoloration or inflammation at the ankle
• Skin sores or ulcers on the lower leg usually near the ankle

Complications

For some, varicose veins are a cosmetic issue. For others, varicose veins may represent a serious medical condition. There are several adverse consequences of untreated varicose veins. Over time, untreated varicose veins may cause swelling and changes in your skin to occur. Your skin may turn a brownish color near the ankles and may become rough and itchy. The skin may ultimately break down, causing a leg wound or ulceration.

Since varicose veins are under high pressure, they may rupture. This usually occurs in the small, blue-like varicose veins located near your ankles where the pressure is greatest. This is a serious condition because bleeding is sudden and blood loss is quick, similar to an arterial bleed. In other cases, stagnant blood within a varicose vein may cause a superficial blood clot to form. This often causes the vein to become inflamed, a condition called superficial thrombophlebitis.  Your skin may become red, tender, firm and warm along the course of the vein. Although it is painful, it is not a serious condition but may take up to two months to resolve.

Diagnosis

For most people, varicose veins can be diagnosed by an experienced physician during a routine physical exam. However, underlying vein problems may be present that are not visible to the naked eye. As a result, the exam is coupled with a Duplex Ultrasound scan.

This scan is a noninvasive and painless test that is used to better evaluate the superficial and deep venous system. It is necessary to make an accurate assessment of the extent of the varicose veins, as well as to create the best treatment plan. This outpatient test can be performed in a medical office or a vascular laboratory.

Treatment Options

Varicose veins may be treated with lifestyle changes and medical procedures. The goals of treatment are to relieve symptoms, prevent complications, and for some, to improve appearance.

• Lifestyle Changes – These changes are often the first treatment for varicose veins. Lifestyle changes can significantly reduce symptoms. These changes include:
  • Avoid standing or sitting for long periods of time
  • Exercise
  • Weight Loss
  • Leg elevation

• Compression Stockings – Your doctor may recommend compression stockings to reduce symptoms, leg swelling and decrease the risk of thrombophlebitis. Medical grade compression stockings require a prescription. Over the counter support hose or Thrombo Embolic Deterrent (TED) hose are not adequate to reduce symptoms in venous disease.

• Vein Procedures – A number of new techniques and devices have made treatment simpler and more effective. Vein stripping surgeries are rarely performed these days and most varicose veins can be removed without surgery in an outpatient setting.  There are two main types of treatments.
  • Foam Sclerotherapy – This procedure involves the injection of a foamed sclerosant medication into the vein. The solution irritates the vein lining, causing it to collapse.  The collapsed vein is eventually broken down by the body and vanishes over several weeks.
  • Endovenous Ablation – Endovenous ablation procedures use heat to collapse and close the vein, instead of a chemical solution, such as sclerotherapy. Heat is generated by laser (also known as endovenous laser therapy or EVLT) or radiofrequency sources (VNUS Closure®).