Varicose veins are twisted, enlarged veins. Any vein that is close to the skin’s surface (superficial) can become varicosed.
The arteries bring oxygenated blood from the heart to the rest of the body. The veins return oxygen-poor blood back to the heart. Varicose veins are twisted, enlarged veins. Any vein that is close to the skin’s surface (superficial) can become varicose.
There are three groups of veins in the legs:
- The superficial veins which are found under the skin,
- The deep veins which are found deep in the leg between the muscle groups, and
- The perforating veins (or perforators) which connect the superficial with the deep veins.
Varicose veins are the result of elongation and swelling of the veins lying under the skin in the subcutaneous fat and usually affect the lower limbs. This swelling of the veins is due to the weakening of the vein wall and the abnormal function of the vein valves (i.e. folds of their lining which should close and prevent blood from flowing backwards towards the feet). Varicose veins occur in the superficial veins and vary in size from the slightly dilated veins to the very tortuous and weak veins; they may cause skin damage in the form of stasis dermatitis and leg ulcers.
Chronic venous disease the system C-E-A-P
C: Clinical Signs
E: Etiology
A: Anatomic Distribution
P: Pathophysiology
C0: Venous reflux but no visible sign of venous disease
C1: Spider veins
C2: Varicose veins
C3: Varicose veins with oedema
C4: Skin Pigmentation (Lipodermatosclerosis)
C5: Healed venous ulcer
C6: Active venous ulcer
If venous valves do not function properly and “leak”, the blood refluxes, i.e. flows backwards to the feet. The pooling of blood increases the pressure in the veins, a condition called venous hypertension. When the superficial leg veins (veins directly under the skin) are affected, this condition is called superficial venous reflux, and may gradually lead to the appearance of varicose veins.
The increased frequency of varicose veins causing symptoms in women may have a hormonal cause. Other aggravating factors are obesity and professions requiring standing for long periods of time.
Apart from the primary, there are the secondary varicose veins, when reflux in the valves of the superficial veins is caused by obstruction of the deep veins of the leg, usually resulting from a previous episode of deep venous thrombosis, and the congenital varicose veins, like Klippel-Trenaunay syndrome (a venous malformation).
Can pregnancy cause
varicose veins?
In a high percentage, individuals with varicose veins remain symptom free for a long period of time, even in cases of large varicose veins. On the contrary, other people with smaller veins may have symptoms.
Apart from their unsightly appearance, the commonest symptoms of varicose veins are pain or aching around the veins, burning, itching, numbness and feeling of heaviness in the calf. Occasionally, there may be some oedema (swelling) around the ankles. The symptoms are usually worse at the end of the day and when the weather is warm.
In a few people, the high pressure in the veins causes skin damage of the gaiter area of the leg (medial aspect of the leg), which becomes reddish, brown or black and may develop eczema (or dermatitis). Chronic venous insufficiency is the name of the disorder, and if it is allowed to continue, non-healing leg ulcers may develop.
Other complications of varicose veins can be episodes of bleeding through the skin and superficial thrombophlebitis (presenting with redness, pain and induration over an inflamed and clotted vein).
In a high percentage, individuals with varicose veins remain symptom free for a long period of time, even in cases of large varicose veins. On the contrary, other people with smaller veins may have symptoms.
Apart from their unsightly appearance, the commonest symptoms of varicose veins are pain or aching around the veins, burning, itching, numbness and feeling of heaviness in the calf. Occasionally, there may be some oedema (swelling) around the ankles. The symptoms are usually worse at the end of the day and when the weather is warm.
In a few people, the high pressure in the veins causes skin damage in the skin of the gaiter area of the leg, which becomes reddish, brown or black and may develop eczema (or dermatitis). This condition is called chronic venous insufficiency, and if it is allowed to progress, non-healing leg ulcers may appear.
Other complications of varicose veins can be episodes of bleeding through the skin and superficial thrombophlebitis (presenting with redness, pain and induration over an inflamed and clotted vein).
When should I consult a
Vascular surgeon?
Do not hesitate to see the vascular surgeon even if simply the presence of the swollen veins causes anxiety to you. If you think that you have symptoms related to your varicose veins, it is important that other causes of the symptoms are ruled out, before they are attributed to the varicose veins. If you have any queries, discuss what worries you with your doctor.
More specifically, you need to consult the vascular specialist if you get symptoms like ache, pain, heaviness, burning, itching or swelling; also, if you have developed complications like swelling of a varicose vein which is painful, red or warm to the touch, if a skin eruption has appeared in the lower leg, if there are leg ulcers or if a vein has bled.
Leg varicose veins tend to get worse with time. If you take certain precautions in time, their deterioration may slow down. The earlier you see the vascular surgeon and start treatment, the greater the benefit with regard to your symptoms and the cosmetic result.
After varicose veins have been successfully treated, they do not come back. This is why it is reasonable that they are treated early. You do not need to finish with all your planned pregnancies before you begin treatment. Of course, new varicose veins may appear in a subsequent pregnancy, but at least the veins already treated will never reappear.
The diagnosis of varicose veins is easily made by the vascular surgeon by conducting a physical examination and assessing the veins with a continuous wave Doppler. The specialist is qualified to decide whether duplex ultrasonography of the leg veins will be of any additional help. The best studies are performed by doctors specially trained in vascular ultrasound scanning.
For symptom relief and for preventive reasons, you may be recommended to wear graduated compression stockings (or a panty-hose), usually class 1 (18-25 mmHg) or class 2 (25-35mmHg). Compression hosiery is used during the day. It requires replacement by new hosiery every 3-4 months, because of its gradual loss of the degree of compression by use. For definitive treatment, however, the damaged veins and their connections need to be surgically removed or blocked. The type of varicose vein operation varies from case to case, as the anaesthesia does; the latter can be general, regional or local.
Open ligation and stripping – needs anesthesia, grion incision. Can lead to skin bruising and pain at operative site. Time to resume normal activities is delayed.
Thermal ablation – EVLA (endovenous laser ablation) / RFA ( Radio frequency ablation). Can be done as daycare procedure under local anesthesia. (5-6) injections. Can start walking immediately after surgery . fast recovery and can resume normal activities from next day
Non thermal ablation- GLU injection. Can be done as a daycare procedure under local anesthesia. Single injection. Patient can resume normal activities the very same day.
Drug therapy a rather limited role in the management of varicose veins. It seems, however, that it may offer symptomatic relief in some cases either on its own or together with the use of compression stockings.
With regard to pelvic varices, the method we use today is a minimally invasive technique (venography and embolization of the responsible, or feeding, veins) occasionally in combination with local avulsions or sclerotherapy of the varicose veins.
Can varicose veins appear
AGAIN after the operation?
Appearance of new varicose veins following a well performed procedure may occur in 20-25% of the cases in a period of 10 years. Occasionally, a new procedure may be required.
Can removal of my varicose
veins be HARMFUL?
Varicose veins, as well as spider veins, are damaged veins, which do not function properly. Their removal is not only harmless, but it improves the venous circulation in the leg. From the moment varicose veins appeared, the nearby healthy veins have taken over their work, i.e. returning the blood to the heart.
What can I do to HELP
myself?
Avoid prolonged standing and having a sedentary life. If you need to remain seated for a long period of time, interval walking for a few minutes or flexing the leg will help. Elevate your legs over the heart level, whenever it is possible.
Do not wear tight clothes. Avoid obesity. Avoid exposing your legs to the direct sunlight or other sources of heating.
Follow your doctor’s advice in regard to the use of compression stockings.
