Varicose veins affect 1 in 5 Americans and are more common in women. The word “varicose” is from the Latin for gnarled, and present as bulging, enlarged veins of the legs due to increased pressure generated when standing or walking.
A less obvious variant are so-called “spider” veins, which are small broken blood vessels under the skin.
Causes
Veins return blood to the heart and so work against gravity. To prevent backflow leg veins have one-way valves. When these valves become faulty blood leaks backwards and pools in the veins. This leads to ballooning or varicosity of these veins.
The main valves of the leg veins are located in the groin and behind the knee with smaller valves located at various levels throughout the leg.
Some risk factors for developing varicose veins are;
- Family history of varicose veins
- Female gender
- Pregnancy; due to the hormonal changes and increasing blood volume. Most will improve within 3 months of delivery, but may not fully resolve
- Increasing age can lead to faulty valve function
- Obesity places increased pressure on leg veins
Symptoms
In most people, varicose veins present only a cosmetic problem but in severe cases can cause unsightly veins to bulge on the inside of the leg from groin to ankle, and/or behind the knee.
In some cases, however, varicose veins can cause aching or burning discomfort especially after periods of prolonged standing.
Other symptoms can include;
- Swelling in the lower legs
- itching around the varicose vein
- In severe cases, purple/brown discolouration of the skin especially at the ankle
- Skin ulcers around the inner ankle or calf require immediate medical attention
Occasionally, varicose veins clot or thrombose and become red and hard. They may also bleed and require urgent medical attention.
Treatment
As varicose veins are a largely cosmetic complaint it is prone to opportunism. Be wary of expensive clinics promising “painless”, “permanent” or “lunchtime” cures and research options carefully.
Treatment options:
- No treatment. In most cases, varicose veins pose no health risk and in the case of spider veins or small varicose veins, people may decide that the cosmetic issues are not enough to warrant intervention
- Compressions stockings. Wearing graduated compression stockings, especially during periods of prolonged standing, can ease any aching or discomfort. It will also help prevent progression of the condition.
- Sclerotherapy. Injection of small-medium sized veins with an agent to scar and close the veins can be performed in the office without anaesthesia. Compression of the area is required for a period afterwards, and some areas may require repeated injections.
- Ultrasound and Laser therapies.These therapies use radiofrequency or laser energies to scar and obliterate the veins, without removing them. They can be used on spider and smaller veins, and more recently are being used on the larger veins by directly inserting a catheter into the vein under a light anaesthetic.
- Surgical stripping. This has long been the gold standard of varicose vein treatment and involves a small incision in the groin to tie off the main leaky valve, as well as 1-2mm incisions over the bulging veins to remove them completely. These incisions are usually invisible within weeks and the procedure is performed as a day procedure or with one overnight stay. Surgery is the most proven method of long-term success.
Over time, further degeneration of valves can occur leading to a recurrence of varicose veins within the leg. In general this occurs in 5-10% of cases and particularly in young women who have pregnancies subsequent to treatment.
Prevention
- Exercise to get blood moving in the legs
- Weight loss can decrease leg pressure
- Elevate legs above heart level after prolonged periods of standing
- Avoid long periods of standing or sitting, especially cross-legged. Change position every 30 minutes.
- Wear compression stockings during pregnancy
