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Varicose Veins
Varicose Veins
Varicose veins are enlarged, bulging veins that are most often seen on legs and feet. Veins return blood from the rest of the body to the heart. Tiny valves in the veins open to let blood flow to the heart and then close to prevent blood from flowing backward. When vein valves are weakened or damaged,, they allow blood to pool in the veins instead of traveling to the heart. Blood pooling increases pressure and stretches the veins leading to enlarged purple clusters visible below the skin. Although some varicose veins often represent nothing more than a cosmetic concern, in some cases they may signify a more serious problem. Complications from varicose veins range from physical pain and discomfort to life-threatening blood clots and infection. This vein disease is chronic and progressive. Without proper treatment it affects quality of life as symptoms and health risks worsen.
Causes & Risk Factors
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Age - The normal wear and tear of aging may cause your veins to lose elasticity and stretch. Also, the valves in your veins may become weak allowing blood to flow backward and away from the heart.
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Pregnancy - Pregnancy hormones may cause the walls of the veins to weaken and swell. Pressure on the vessels behind the uterus can also cause poor circulation and swelling in the smaller veins of the pelvis and legs.
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Obesity - Excessive weight gain puts additional pressure on your legs and veins.
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Family history - Your chance of developing varicose veins increase if your family members have them too.
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Sitting or standing for long periods of time - Blood doesn't flow as well if you are in the same position for a long periods of time.
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Leg trauma - Previous blood clots or traumatic damage to the valves in the veins can diminish their ability to move blood back to the heart.
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Gender - Women are more likely to develop varicose veins due to hormonal changes which tend to relax the vein walls. These changes normally occur during pregnancy, premenstruation or menopause. Birth control pills and hormone replacement therapy can also increase the risk of varicose veins.
Symptoms
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Large dark blue or purple veins that can often be seen under the surface of the skin
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Veins that appear bulging or twisting like cords on your legs
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Painful, achy or "heavy" legs
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Burning, throbbing, muscle cramping and swelling in your lower legs
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Swelling of your ankles or feet
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Legs that become more painful after sitting or standing for a long time
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Itchy legs, especially on the lower legs and ankles
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Bleeding from varicose veins
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Reddening of the skin around a painful cord in the vein
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Skin ulcers, discoloration and inflammation of the skin and hardening of veins near the ankles (requires medical attention since this may indicate a serious form of vascular disease)
Diagnosis
In order to diagnose varicose veins, the doctor will first review your symptoms and conduct a physical exam by looking at your legs for swelling while you are standing or sitting with your legs dangling. He may also order the following tests:
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Doppler ultrasound - Non-invasive procedure that uses high frequency sound waves to check blood flow in your veins and to look for blood clots.
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Venogram - procedure during which a special dye is injected into your legs and X-rays are taken from the area to further check the blood flow.
Treatment
Treatment of varicose veins may include self-care measures, lifestyle changes and procedures by the doctor to close or remove the affected veins. These procedures include:
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Sclerotherapy - uses a liquid chemical to close off the varicose vein. The chemical injected into the vein causes irritation and scarring inside the vein forcing the vein to close off and fade away. Similarly, Microsclerotherapy uses a fine needle to inject a small amount of liquid chemical into small varicose veins and spider veins causing them to close.
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Foam sclerotherapy - used for larger veins, a foam solution is injected into the vein to close and seal it.
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Laser therapy - A non-invasive procedure that uses light (laser) energy on small blood vessels to adequately heat the veins and cause them to fade away.
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Endovenous ablation therapy - The doctor makes a tiny incision in your skin near the varicose vein and places a catheter (small tube) into the vein. Using lasers or radio waves, the tip of the tube heats up inside the vein and closes it off. Local anesthesia is used during this procedure and you can usually go home on the same day.
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Endoscopic vein surgery - The doctor makes a small incision in your skin near the varicose vein and uses a thin tube with a camera at the end to move through the vein. The vein is ultimately closed with a surgical device at the end of the camera. Endoscopic surgery is normally used on varicose veins that have severe symptoms such as skin ulcers. After the surgery, patients can return to their usual activities within a few weeks.
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High litigation and vein stripping - This solution is employed for more severe varicose veins. In such cases, during a surgical procedure in the hospital and under general anesthesia the dilated vein is either tied off or removed through a small incision in the skin.
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Ambulatory phlebectomy - During this procedure which is used for varicose veins that are close to the surface of the skin, the area around the affected veins will be locally numbed and the veins will be removed through small incisions. You generally remain awake for the procedure and can go home the same day.
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Photoderm therapy - This procedure uses intense, pulsated light to coagulate spider veins and varicose veins of certain sizes. It requires multiple treatments (1 to 6) to be effective and is usually recommended after sclerotherapy or laser therapy do not produce the desired outcome.
Recommended lifestyle changes
In addition to the steps outlined in the 'Prevention' section below, the doctor may recommend compression stockings. These stockings create a gentle pressure up the leg, keep blood from pooling in the veins and decrease swelling in the legs.
Prevention
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Keeping a healthy weight
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Exercising
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Eating a healthy fiber-rich, low-sodium diet
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Avoiding high heels and tight hosiery
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Changing your sitting or standing position regularly
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Elevating your legs
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Not sitting with your legs crossed for long periods of time as it can reduce blood circulation in your legs
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Wearing maternity support hose during pregnancy. These gently compress your lower leg veins to help move blood back to your heart