What Are Varicose Veins? What Causes Varicose Veins?

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Main Category: Vascular
Also Included In: Cosmetic Medicine / Plastic Surgery
Article Date: 10 Jan 2012 - 7:00 PST

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Varicose veins are enlarged, swollen, and tortuous (twisting) veins, frequently linked to faulty valves in the vein. They are generally blue or dark purple. People with bulging and/or lumpy varicose veins on their legs may experience aching and heavy limbs. Sometimes, in very severe cases, the varicose veins may rupture, or varicose ulcers may form on the skin.

In healthy veins, the valves within them stop the blood from staying stagnant or flowing back - they open and close so that the blood flows in only one direction. Damaged or weakened valves may allow the blood to flow back and accumulate in the vein, making it varicose. Varicose simply means enlarged or swollen.

According to UK health authorities, up to 30% of all adults are affected by varicose veins. They are more common in adult females than males.



An example of varicose veins in the calf


Although varicose veins may occur anywhere in the human body, they are most commonly found in the legs and feet, particularly in the calves. Experts say that standing and walking places extra pressure on the veins of the lower limbs.

In the majority of cases, varicose veins pose no health or circulation problems; although they may not look nice, they do not usually require treatment (for health reasons).

A number of patients, however, may experience swelling, aching and painful legs. If the patient is in considerable discomfort, or if complications, such as ulcers develop, then treatment is required.



Figure A shows a normal vein with a properly working valve; there is normal blood flow. In Figure B, the varicose vein has a faulty valve, there is abnormal blood flow, the walls of the vein are thin and stretched. The image in the middle shows where in a leg the varicose vein might appear.

According to Medilexicon's medical dictionary:

Varicose veins are "permanent dilation and tortuosity of veins, most commonly seen in the legs, probably as a result of congenitally incomplete valves; there is a predisposition to varicose veins among persons in occupations requiring long periods of standing, and in pregnant women."

What are the signs and symptoms of varicose veins?

A sign is something everybody can detect, such as a rash or bloodshot eyes, while a symptom is something only the patient can feel and describe, such as pain or ringing in the ears.

In the majority of cases, there is no pain. Signs may include:

• Veins can be seen as twisted, swollen and lumpy (bulging); some people have described them as cords
• The veins are blue or dark purple

Some patients may also experience:

• The legs aching
• The legs feel heavy, especially after exercise or at night
• A minor injury to the affected area may result in longer bleeding than normal
• Lipodermatosclerosis - fat under the skin just above the ankle can become hard, resulting in the the skin shrinking
• Swollen ankles
• Telangiectasia in the affected leg (spider veins)
• There may be a shiny skin discoloration near the varicose veins, usually brownish or blue in color
• Venous eczema (stasis dermatitis) - the skin at the affected area is red, dry and itchy
• When suddenly standing up, some patients may experience leg cramps
• A high percentage of people with varicose veins also have restless legs syndrome
• Atrophie blanche - irregular whitish patches that look like scars appear at the ankles.

Varicose veins can appear in various parts of the body, including:

• Legs (most common)
• Rectum
• Pelvis
• Vagina
• Uterus (womb)
• Esophagus

What are the causes of varicose veins?

The circulation system - arteries and veins form part of our circulation system, with blood flowing from the heart into the arteries and to tissues and organs, and coming back to the heart via the veins. The returning blood has to travel against gravity in the veins, this is done through muscle contractions and a system of valves.

The veins have one-way valves that allow blood through, but not back, so that the blood travels in only one direction. If the walls of the vein become stretched and less flexible (elastic), the valves may get weaker. A weakened valve may allow blood to leak backwards, and eventually flow backwards. When this occurs, blood can accumulate in the vein(s), which becomes enlarged and swollen.

Experts are not sure why the walls of veins stretch or why the valves become faulty. In many cases, it occurs for no clear reason.

What are the risk factors for varicose veins?

A risk factor is something, a circumstance, condition or a situation, which raises the chances of developing a condition or disease. The following risk factors are linked to a higher risk of having varicose veins:

• Sex - females are much more likely to have varicose veins on their legs, than males
• Genetics - varicose veins often run in families
• Overweigh/obesity - overweight or obese people have a significantly higher risk of developing varicose veins
• Pregnancy - women are much more likely to develop varicose veins during their pregnancy than at any other time in their lives. A pregnant woman has much more blood in her body, compared to when she is not pregnant - this places extra pressure on the circulatory system. A change in hormone levels and hormone balance can also lead to a relaxation of the blood vessel walls. Both these factors raise the risk of having varicose veins.
  
  As the uterus (womb) grows there is more pressure on the veins in the mother's pelvic area. In the majority of cases, the varicose veins go away after the pregnancy is over (not always and/or sometimes not all of them)
• Age - the older we get, the more likely we are to develop varicose veins
• Some jobs - jobs where the individual has to spend a long time standing up may raise the probability of having varicose veings.

Diagnosing varicose veins

A physical examination, mainly visual, by a qualified doctor will decide whether or not a patient has varicose veins. The patient will be asked to stand while the doctor checks for signs of swelling. The patient may also be asked questions about the symptoms, whether any close relatives have/had varicose veins, and whether they are or have been pregnant. The physician may also ask the patient whether he/she has ever had any leg injury, such as a broken bone, and any history of deep vein thrombosis.

In some cases, a general practitioner (GP, primary care physician, family doctor) may refer the patient to a vascular specialist.

The following diagnostic tests may also be ordered:

• Doppler test - this is an ultrasound scan to check the direction of blood flow in the veins to see whether the valves are working properly. This test can also check for blood clots or obstructions in the veins.
• Color duplex ultrasound scan - this ultrasound test provides color images of the structure of veins, which helps the doctor identify any abnormalities. This test can also measure blood-flow speed.

What are the treatment options for varicose veins?

If the patient has no symptoms or discomfort and is not bothered by the sight of the varicose veins, treatment might not be necessary. However, if there are symptoms, treatment may be required to reduce pain and/or discomfort, address complications, such as leg ulcers, skin discoloration or swelling. Some patients may also want treatment for cosmetic reasons - they want to get rid of the "ugly" varicose veins.

Compression stockings



Compression stockings


Compression stockings squeeze the patient's legs and improve circulation. They are generally very tight around the ankles, and gradually get looser higher up the leg. Compression stocking encourage proper blood flow upwards - against gravity - back towards the heart.

Many patients also find that compression stockings help with discomfort, pain and swelling. No studies have convincingly demonstrated whether they stop the varicose veins from worsening, or even prevent them. Studies that have been carried out have had mixed and conflicting results.

For best effect, doctors say that patients should put compression stockings on as soon as they get up, and keep them on all day until they go to bed. Some people find them uncomfortable, especially during long hot summers.

Compression stockings must be worn properly. They need to be pulled all the way up so that each part of the leg gets the right amount of compression. Patients should not allow them to roll down, or they may dig into certain parts of the leg. If you are not happy with their fit, tell your doctor or nurse. Compression stockings can be custom-made.

Some patients may find the stockings make their skin dry and flaky. If this happens to you, tell your doctor.

Surgery

If varicose veins are large they may need to be removed surgically. This is usually done under general anesthetic (the patient is unconscious during the procedure). In most cases the patient can go home the same day - if surgery is required on both legs, he/she may need to spend one night in hospital.

Laser treatments are often used to close off smaller veins and also spider veins. Strong bursts of light are applied to the vein, which gradually fades and disappears. In such cases there are no incisions or needles used.

Ligation and stripping - this involves tying off the vein and then removing it. Two incisions are made, one near the patient's groin at the top of the target vein, and the other is made further down the leg, either at the ankle or knee. The top of the vein is tied up and sealed. A thin, flexible wire is threaded through the bottom of the vein and then pulled out, taking out with it the vein through the lower incision. Surgery will not affect blood flow in the leg, because veins deep within the patient's leg will assume the role of the damaged veins.

Ligation and stripping can sometimes result in bruising, bleeding and pain. In extremely rare occasions there may be deep vein thrombosis.

After surgery, most patients will need between one to three weeks to recover before going back to work and other normal duties. During the recovery time, compression stockings are worn. If there is deep venous incompetence, compression stockings will need to be worn long-term. This is when there are problems with the valves in the veins, or blockages.

Sclerotherapy - a chemical is injected into small and medium-sized varicose veins which scars and closes them. A few weeks later they should fade. A vein may need to be injected more than once.

Radiofrequency ablation - the wall of the varicose vein is heated using radiofrequency energy. A small incision is made either above or below the knee, and with the help of an ultrasound scan, a narrow tube (catheter) is threaded into the vein. The doctor inserts a probe into the catheter which emits radiofrequency energy. The radiofrequency energy heats up the vein, causing its walls to collapse, effectively closing it and sealing it shut. Radiofrequency ablation is usually done with a local anesthetic. Some patients may experience paresthesia (pins and needles) and minor skin burns. After the procedure, compression stockings need to be worn for a few weeks.

Endovenous laser treatment - a catheter is inserted into the patient's vein. A small laser is threaded through the catheter and positioned at the top of the target vein, delivering short energy bursts that heat up the vein, sealing it shut. With the aid of an ultrasound scan, the doctor threads the laser all the way up the vein, gradually burning and sealing all of it. This procedure is done under local anesthetic. There may be some nerve injury, which is usually brief.

Transilluminated powered phlebectomy - an endoscopic transilluminator (special light) is threaded through an incision under the skin so that the doctor can see which veins need to be taken out. The target veins are cut and removed with a suction device through the incision. A general or local anesthetic may be used for this procedure. There may be some bleeding and/or bruising after the operation.

Complications linked to varicose veins

Any condition in which proper blood flow is undermined has a risk of complications. However, in the majority of cases, varicose veins have no complications.

If complications do occur, they may include:

• Bleeding - varicose veins near the skin may bleed if the patient's skin is cut or he/she bumps their leg. The bleeding may go on for much longer than normal. If this occurs, the patient should lie down, raise their leg and apply pressure directly onto the bleeding area. If the bleeding continues, get medical help.
• Thrombophlebitis - blood clots form in the vein of the leg, causing inflammation of the vein. The affected area can feel warm, may look red, and might also be painful. Treatment usually involves wearing compression stockings. For pain, the doctor may prescribe a suitable painkiller.
• Chronic venous insufficiency - this is when the skin does not exchange oxygen, nutrients and waste products with the blood properly, because the blood flow is weak. If this occurs over the long-term, it is called chronic venous insufficiency.
  
  People with chronic venous insufficiency may develop varicose eczema, lipodermatosclerosis (hard and tight skin), and venous ulcers.

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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