What Are Varicose Veins?
Varicose veins are twisted, swollen veins near the surface of the skin. Veins are the vessels that return blood to the heart after oxygen has been delivered to the body’s tissues. Valves along the walls of the veins permit blood to flow in only one direction. Varicose veins occur when weak or defective valves allow blood to flow backward or stagnate within the vein, a condition known as venous insufficiency.
In this condition, the one-way valves within veins no longer function and therefore allow blood to flow backwards away from the heart and towards the floor. This reversal of blood flow leads to the pooling and stagnation of blood within veins of the leg. If left untreated, this stagnant blood leads to symptoms such as leg swelling, fatigue, heaviness, pain, cramps, and restless legs as well as to the of large unsightly varicose veins.
Chronic obstruction of veins from prior blood clots can also cause varicose veins, but in most cases no underlying abnormality can be identified.
Varicose veins may appear in the groin and labia and also cause chronic pelvic pain in women, a condition known as pelvic congestion syndrome. They may also occur in the anus, where they are known as hemorrhoids. While not a serious health risk, varicose veins can be lifestyle limiting and greatly affect one’s quality of life. If left untreated, varicose veins can lead to skin discoloration, superficial thrombophlebitis, and in some cases, blood clots.
Less troubling are sunburst patches of finer veins, called spider veins, which can appear on the skin of the legs, ankles, or face. Although they are more of a cosmetic issue, spider veins don’t usually cause pain or interfere with circulation
Who Gets Varicose Veins?
Varicose veins are quite common, but they are two to three times more common in women than men. Incidence increases with age, and about 50% of people over the age of 50 have varicose veins. They often occur in the legs, but can develop in almost any part of the body. Approximately half of all patients who develop varicose veins have a family history of the condition.
- Enlarged, swollen, knotted clusters of purple veins, usually in the back of the calf and/or along the inner side of the leg.
- Edema (swelling in the legs).
- Aching or a sensation of heaviness in the legs, accompanied by occasional pain ranging from a dull throb to a burning sensation.
- Rash on the skin, itching above the affected veins.
- Skin discoloration and ulcers on the inner aspect of the ankles (in advanced cases).
- Muscle cramps
- Restless legs
- The cause of most cases is unknown.
- Chronic venous (vein) obstruction from prior deep vein thrombosis (blood clots) may play a role.
- Hereditary factors appear to have an effect. People of Irish or German descent are at highest risk.
- Other risk factors include pregnancy, prolonged standing or sitting, obesity, lack of exercise, and increased age.
- Gender (more common in women)
What If You Do Nothing?
Although varicose veins are usually benign in nature, it is becoming increasingly well known that varicose veins and venous insufficiency greatly affect quality of life. Without treatment, the veins may worsen with time (unless they are associated with pregnancy, in which case they may disappear after the birth). If you have a severe case, especially one that involves leg ulcers, contact your physician.
Spider veins in the legs may fade eventually on their own. If they are too unsightly, you can get medical treatment.
- Diagnosis of varicose veins involves physical examination. Visual changes in the veins and skin of the legs are usually quite apparent. However, in order to determine the cause and develop the best treatment plan, diagnostic tests often are preformed.
- The most common test performed is a Duplex ultrasound with color flow. This test uses the reflection and transmission of sound waves to form images of structures under the skin. The color flow aspect can be used to determine the direction of the blood flow. Blood flowing in one direction appears blue and blood flowing in the opposite direction appears red. Ultrasound can also detect where the problem originates so that corrective action can be taken.
- Ultrasound often cannot visualize veins located in the pelvis or in the deep venous system of the legs. In these cases, magnetic resonance venography or CT venography may be used. Historically, venography without magnetic resonance (i.e., “dye” or contrast injected into the vein via a catheter) has been used; however, this invasive test has widely been replaced by Duplex ultrasound with color flow.
- Treatment for varicose veins depends on the cause and severity of the condition. In many cases, multiple modalities are used.
- Start by following the steps to prevent varicose veins (see Prevention).
- Raise the foot of your bed from two to four inches with blocks to aid circulation at night.
- Avoid scratching itchy skin above varicose veins; this may cause ulceration or profuse bleeding.
- Special elastic graduated compression stockings prevent blood from pooling in the veins may be recommended. These compression stockings do not cure the problem, but should improve symptoms. It is important that your physician prescribe the proper strength of compression stockings for your needs.
- For superficial varicose veins, sclerotherapy (injection of chemicals that harden and shrink the vein) is an option. Blood is rerouted through other veins. The treated veins gradually fade.
- There are several surgical procedures to treat or remove varicose veins:
- Laser surgery. In this procedure, which is primarily used to treat smaller varicose veins, light energy from a laser is applied to a varicose vein, causing it to collapse.
- Endovenous ablation therapy. This therapy uses lasers or radiowaves to shrink varicose veins and has become the gold standard in the treatment of varicose veins and venous insufficiency. The doctor inserts a thin tube (catheter) into your vein through a small puncture. Intense heat from a laser or high-frequency alternating current travels through the catheter and seals the vein, blocking blood flow. You’ll usually be able to walk and go home the same day. The vein will shrink and disappear over time.
- Endoscopic vein surgery. For this procedure, a small camera is inserted into the vein and is used to visualize the vein. Small incisions along the course of the vein are made in order to remove the vein. Endoscopic vein surgery is performed under general anesthesia and is generally used in severe cases, when varicose veins are causing skin ulcers. However, with more advanced and modern procedures like endovenous ablation therapy, this procedure is not commonly performed.
- Ligation and vein stripping. Surgical ligation (tying off) and removal (stripping) of the varicose vein is the definitive therapy in severe cases. Other veins compensate for the absent one(s). With the introduction of endovenous ablation therapy, this procedure is not commonly performed except in certain circumstances.
- Maintain a healthy weight and engage in regular, moderate exercise.
- Avoid standing or sitting for long periods. Walk regularly; walking improves circulation.
- If you have varicose veins already, you should probably avoid strenuous running or jumping, since very vigorous activity can cause pain and/or swelling in the legs.
- Elevate the legs above hip level periodically throughout the day—for example, by lying down with your legs resting on a pillow. Do not cross your legs.
- Avoid tight shoes, belts, or other restrictive clothing.
- If you have any signs of venous insufficiency, talk to your doctor about whether you would benefit from wearing compression stockings.
When To Call Your Doctor
- Call a doctor if symptoms of venous insufficiency interfere with normal activities, or if you develop large varicose veins or ulcers. If you are concerned about the appearance of varicose veins, talk to your doctor while they are still in the early stages.
Deepak Sudheendra, M.D., R.P.V.I., Assistant Professor of Interventional Radiology and Surgery at the University of Pennsylvania Perelman School of Medicine, with an expertise in Vascular Interventional Radiology and Surgical Critical Care, Philadelphia, PA. Review provided by VeriMed Healthcare Network.