Varicose veins are swollen and enlarged veins that usually appear blue or dark purple in colour. They may also be lumpy, bulging or twisted in appearance.
Varicose veins develop when the small valves inside the veins do not function adequately. In a healthy vein, blood flows smoothly from the various parts of the body to the heart. The blood is prevented from flowing backwards by a series of tiny valves that open and close to let blood through. If the valves weaken or are damaged, the blood can flow backwards and can collect in the vein, eventually causing it to be varicose. It is a common condition affecting women more than men. Any vein in the body can become varicose, but they most commonly develop in the legs and feet, particularly in the calves. This can be attributed to the extra pressure exerted on the veins of the lower body.
For most people, varicose veins do not present any serious health problems. They may have an unpleasant appearance, but they usually do not affect the circulation or cause any long-term health problems. Most varicose veins do not require any treatment. Along with their distinctive appearance, symptoms of varicose veins can include:
- aching, heavy and uncomfortable legs
- swollen feet and ankles
- burning or throbbing in the legs
- muscle cramps in the legs, particularly at night
- dry, itchy and thin skin over the affected vein
These symptoms will usually be worse during warm weather or when one has been standing up or under excessive physical strain of legs for prolonged periods of time. The symptoms may improve upon walking around or resting and raising up the legs for some time. In rare cases, they can also cause complications, such as skin discolouration and leg ulcers. Varicose veins are more likely to require treatment if they are causing significant discomfort or if complications develop.
Types of Varicose Veins
The most common types of varicose veins are:
- Trunk varicose veins are near to the surface of the skin and appear thick and lumpy. They are usually visible, often quite long and can look unpleasant.
- Reticular varicose veins are red and are sometimes grouped close together in a network.
- Telangiectasia varicose veins, also known as thread veins or spider veins, are small clusters of blue or red veins that sometimes appear on your face or legs. They are harmless and, unlike trunk varicose veins, do not bulge underneath the surface of the skin.
Causes of Varicose Veins
There are a number of risk factors that can increase the likelihood of developing varicose veins:
Gender
Women are more likely to be affected by varicose veins than men. Research suggests that this may be because female hormones tend to relax the walls of veins, making the valves more prone to leaking. Also the musculo-skeletal structure of females may not be strong enough to provide adequate protection to the strained veins.
Genetics
One’s risk of developing varicose veins is increased if a close family member has the condition. This suggests that our genes have a significant role to play in the development of varicose veins.
Age
As one gets older, the veins start to lose their elasticity and the valves inside them stop working as well. Also the musculo-skeletal structure gets weaker, unable to provide adequate protection to the strained veins.
Being overweight
Being overweight puts extra pressure on the veins, which means they have to work harder to send the blood back to the heart for circulation. This can put increased pressure on the valves, making them more prone to leaking.
Occupation
Some research suggests that jobs that require long periods of standing may increase the risk of getting varicose veins. This is because the blood does not flow as easily when standing for long periods of time.
Pregnancy
During pregnancy, the amount of blood increases to help support the developing baby. This puts extra strain on the circulatory system. Increased hormone levels during pregnancy also cause the muscular walls of the blood vessels to relax. Varicose veins may also develop during pregnancy as the womb (uterus) begins to grow. As the womb expands it puts pressure on the veins in the pelvic area, which can sometimes cause them to become varicose; most women find that the condition significantly improves after their pregnancy.
Diagnosis of Varicose Veins
Varicose veins are diagnosed by their appearance. In addition to examination of the legs on standing, diagnosis will also include detailed investigations like:
- having a family history of varicose veins
- being pregnant
- checking one’sweight (BMI)
- having any deep vein thrombosis (blood clot in one of the deep veins of the body)
- history of leg injuries or surgeries
If deemed necessary, further investigations may be carried out like:
Doppler test
A Doppler test uses an ultrasound scan to provide information about the direction of blood flow in the veins. It provides an indication of how well the valves in the veins work. It is a painless procedure that uses high-frequency sound waves to produce an image to check for any blood clots or obstructions in the venous system.
Colour Duplex Ultrasound Scan
A colour duplex ultrasound scan provides colour images of the vein structure. This allows the specialist to look for any abnormalities in the venous system and also measure the speed of blood flow.
Treatment of Varicose Veins
Not everyone who has varicose veins needs treatment for the condition. No treatment may be necessary in case of no symptoms or discomfort. However, there are some instances when it may be necessary. For example:
- to ease symptoms, in case of any pain or discomfort.
- to treat complications, such as leg ulcers, swelling or skin discolouration
- for cosmetic reasons, to improve the appearance.
There are now a number of different surgical procedures to remove varicose veins, although the first treatment is usually compression stockings. These are stockings that have been specially designed to squeeze the legs and improve circulation.
Compression stockings
Compression stockings are specially designed to steadily squeeze the legs to improve blood circulation. They are often tightest at the ankle and get gradually looser as they go further up the leg. This improves blood flow upwards towards the heart. This can help to relieve the pain, discomfort and swelling in the legs that is caused by varicose veins.
Other treatment options like surgical interventions or some of the procedures described in the following section may be prescribed in cases of:
- any bleeding from a varicose vein that has broken down.
- any previous bleeding from a varicose vein and are at risk of it happening again.
- presence of leg ulcer (open sore) that despite treatment is getting worse or is painful.
- changes to the skin that could benefit from having surgery.
- having several episodes of thrombophlebitis (inflammation of a vein).
- the veins are causing other troublesome symptoms.
- size, extent and location of varicose veins severely affecting one’s quality of life.
Surgery
Large varicose veins may sometimes need to be surgically removed. Varicose vein surgery is usually carried out under general anesthesia, and is a minor surgical procedure.
Ligation and Stripping
Most surgeons use a technique called ligation and stripping, which involves tying off the vein in the affected leg and then removing it. Two small cuts (incisions) are made, one near the groin area at the top of the varicose vein, and the other cut is made further down the leg, usually around the knee or ankle. The top of the vein (near the groin area) is tied up and sealed. A thin flexible wire is passed through the bottom of the vein and then carefully pulled out and removed through the lower cut in the leg. This procedure will not affect the blood flow in the legs, but can causepain, bruising, bleeding, nerve damages or deep vein thrombosis.
Sclerotherapy
Sclerotherapy involves injecting a chemical into the veins. The path of the injection through is analysed using an ultrasound scan. Following sclerotherapy, the varicose veins should begin to improve after a few weeks as the stronger veins take over the role of the damaged vein. Sclerotherapy can cause side effects like blood clots in other leg veins, headaches, lower back pain, and changes to skin colour or temporary vision problems
Radiofrequency Ablation
Radiofrequency ablation involves heating the wall of the varicose vein using radiofrequency energy. The vein is accessed through a small cut that is made just above or below the knee.A narrow tube, called catheter, is guided into the vein using an ultrasound scan. A probe is inserted into the catheter that sends out radiofrequency energy. This heats the vein until its walls collapse, closing it and sealing it shut. Once the vein has been sealed shut, the blood will naturally be redirected to one of the healthy veins.The procedure may cause some short-term side effects, like minor burns to the skin or pins and needles (paraesthesia).
Endovenous Laser Treatment
Endovenous laser treatment involves having a catheter inserted into the vein and using an ultrasound scan to guide it into the correct position. A tiny laser is passed through the catheter and positioned at the top of the varicose vein. The laser delivers short bursts of energy that heat up the vein and seal it closed. The laser is slowly pulled along the vein using the ultrasound scan to guide it and allowing the entire length of the vein to be closed. Some of the side effects of the procedure involve tightness in the legs and the affected areas may be bruised and painful.
Transilluminated Powered Phlebectomy
During transilluminated powered phlebectomy, one or two small incisions are made in the leg. A special light, called an endoscopic transilluminator, will be placed underneath the skin so that the varicose veins can be seen clearly. The affected veins are cut before being removed through the incisions using a suction device.As with endovenous laser treatment, there could be some bruising or bleeding afterwards.
Complications of Varicose Veins
Varicose veins can cause complications because they stop the blood from flowing properly. Most people who have varicose veins will not develop any complications. Some of the possible complications of varicose veins are explained below.
Bleeding
Varicose veins that form near the surface of the skin can sometimes bleed in case of any cuts or bruises. The bleeding may be difficult to stop.
Thrombophlebitis
Thrombophlebitis is inflammation (swelling) of the veins in the leg which is caused by blood clots forming in the vein. This can occur within your varicose veins and it can be painful, look red and feel warm.
Chronic Venous Insufficiency
If the blood in the veins does not flow properly, it can interfere with the way that the skin exchanges oxygen, nutrients and waste products with blood. If the exchange is disrupted over a long period of time it is known as chronic venous insufficiency.
Varicose Eczema
Varicose eczema is a condition that causes the skin to become red, scaly and flaky. This may also develop blisters and crusting of the skin.
Lipodermatosclerosis
Lipodermatosclerosis causes the skin to become hardened and tight, and also turning red or brown in colour. The condition usually affects the calf area.
Venous Ulcers
A venous ulcer develops when there is an increased pressure in the veins of the lower leg. This causes fluid to seep from the vein and collect under the skin. The fluid can cause the skin to thicken, swell and to eventually break down to form an ulcer. Venous ulcers are most commonly formed in the ankle area.
Prevention of Varicose Veins
There is little evidence to suggest that one can stop varicose veins from getting worse, or prevent new ones from developing. However, if one already has varicose veins, there are a number of things that one can do that may help to relieve any pain or discomfort.
Sitting or standing still
If possible, avoid sitting or standing still for long periods of time. If unable to avoid sitting or standing, try to change positions frequently and try to move around at least once every 30 minutes.Do not cross legs because this can make symptoms worse.
Take regular breaks
If possible, take regular breaks throughout the day. Try also to keep thelegs raised while resting, because this will help to improve blood flow.Ideally, raise the legs above the level of the heart.
Exercise regularly
Regular exercise is a great way of keeping your legs active and it will help to improve blood circulation.Exercise will also enable one to maintain a healthy weight, prevent serious health conditions, such as coronary heart disease, as well as improving overall general health and fitness.
References:
1) Varicose Veins Treatment and Prevention; https://www.emedicinehealth.com/varicoseveins /article_em.;Sep. 2016; accessed Nov. 2017.
2) Eric S.H.; Varicose Veins; Society for Vascular Surgery;https://vascular.org/print/patient-resources/vascular-conditions/varicose-veins; accessed Nov. 2017.
3) Varicose Veins Treatment, Symptoms and More; Cleveland Clinic;https://my.clevelandclinic. org/ health/articles/varicose-veins; July 2017; accessed Nov. 2017.
Abraham Mathew Saji is a pharmacist by qualification, engaged in research and development of medicines and their implications on the human body. He is an avid reader in pursuit of knowledge and understanding of technological advancements in the medical and pharmaceutical world. He is even more passionate about sharing his acquired knowledge, which he does by speaking at conferences, lectures and writing. He can be contacted at maz31abr@gmail.com for any clarification.
