Varicose Veins are twisted enlarged veins. The word “varicose” is Latin in origin and comes from the word “varix” which means twisted. The veins most commonly affected are those present on the legs and feet because as you walk and stand upright there’s increased pressure on the lower part of the body.
In many cases, varicose veins and spider veins are just a cosmetic concern while in others there is associated aching and painful discomfort. Spider veins are a very common variation of varicose veins that are not medically significant.
Oxygenated blood is pumped from the heart through arteries to tissues and deoxygenated blood is returned through veins to the heart. The leg veins have to work against gravity to return blood to the heart with the aid of one way valves that open as blood flows towards the heart and close to stop blood from flowing back. Leg muscles help as they contract while walking by squeezing veins deep in the legs.
Varicose veins occur when there is a malfunction of venous valves. Women are affected more often than men and the condition usually shows up in advanced age due to loss of elasticity. As a result, blood is allowed to flow backward and pool in the veins leading to enlargement and varicosities.
The cause is related to our upright posture and there is damage to the valves in the veins making it difficult for blood to travel up against gravity resulting in pooling of blood leading to bulging of the veins.
Factors said to be associated with the development of varicose veins include
heredity, advanced age, female gender (possibly as a result of hormonal changes associated with menstrual cycles, pregnancy, and menopause, hormone replacement therapy and birth control pills), standing for long periods, obesity, crossing legs while seated, smoking and poor diet.
In Pregnancy, there is an increase in blood volume and late in pregnancy, the size of the uterus exerts increased pressure on the veins of the legs leading to varicose veins. There may also be associated haemorrhoids which are varicose veins in and around the anus.
Signs and Symptoms
Varicose veins are dark blue or purple in colour (they contain deoxygenated blood), may appear twisted or may bulge and may occur anywhere along the legs but are commonly seen on the back of the calves or on the inside of the legs.
Spider veins are smaller and are usually red or blue and are seen closer to the skin’s surface. They are commonly present on the legs behind the knees but may also occur on the face. They often look like a spider’s web hence the name.
The symptoms may not be related to the size of the veins and a major concern is their unsightly cosmetic appearance.
Signs and Symptoms may include:
– Aching discomfort and heaviness in legs
– Burning, itching, muscle cramping, throbbing and swelling in the lower legs which tend to feel worse on prolonged sitting or standing
– There may be skin ulcers near the ankles suggesting a complicated situation requiring immediate medical attention
More sever symptoms associated with complicated varicose veins include:
– Thrombophlebitis where the vein becomes painful and red due to venous blockage or inflammation
– Bleeding – veins near the surface can bleed if traumatised and may become a medical emergency if it cannot be stopped
There are other types of varicose veins such as Telangiectases which are small clusters of vessels that look like spider veins but are reddish and found on the upper body and face; Venous lakes which are pools of blood in the veins seen often in the face and neck and Reticular veins which are flat blue veins under the skin which are commonly seen behind the knees.
Diagnosis and Treatment
Varicose veins are readily visible and the extent of valve weakness may be assessed by Doppler ultrasonography. Your doctor may also perform a Trendelenberg test where you lie down and raise a leg in the air to drain the veins, a tourniquet is applied and on standing, varicose veins become visible. The veins may also be outlined by a venogram where a dye is injected to outline the veins and X-rays are taken.
Treatment measures range from self-help measures which include avoiding standing for long periods, weight loss, exercise and elevating legs which can ease discomfort and prevent veins from getting worse to wearing compression socks and procedures like Sclerotherapy, Laser Surgery and Vein stripping.
Sclerotherapy is a procedure where small veins are injected with a sterile chemical solution (sclerosing solution or sclerosant) that damages the walls causing scar tissue to form thus sealing off the vein. A compression bandage has to be worn for 3 to 6 weeks after the procedure.
Surgical Ligation and Stripping involves removing the superficial veins under general anaesthesia. The vein is tied off (ligated) at the top of the leg, a flexible wire is passed through the vein and attached to one end and the wire is pulled stripping the vein out.
Laser Surgery works by sending strong bursts of light into the vein causing it to slowly fade and disappear and does not involve incisions or needles. In Endovenous Ligation Treatment (EVLT) a fine laser probe is passed into the vein resulting in minimal skin damage.
Venous Ulcers are treated by removing the incompetent vein and the use of special bandages to improve blood flow.
Varicose veins cannot be completely prevented but improving circulation and muscle tone can reduce the risk of developing them. Circulation may be improved by exercise, weight control, elevating legs, avoiding tight clothing especially around your legs, groin and waist, avoiding long periods of standing and avoiding crossing legs when sitting.
Vitamin K and the herbal supplement “horse chestnut seed” are known to relieve some of the symptoms of varicose veins.