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Varicose Veins: Causes, Treatment and Prevention

Varicose veins are abnormally widened, swollen, dark veins, which are often twisted unlike normal, healthy straight veins. Although they may develop anywhere, they usually affect the superficial veins rather than the deep veins and are most common in the legs, especially the lower legs and feet. For many people varicose veins are merely a cosmetic issue, but in others they may also cause swelling, inflammation, itching, pain and may even develop into a leg ulcer.

Varicose veins affect about half of people over the age of 50 and are more frequent in women than men. In addition to the legs, varicose veins can also occur around the anus (hemorrhoids), in the vulva of a pregnant woman (vulvar varicosities) and around a man’s scrotum (varicocele).

Causes and Risk Factors for Varicose Veins

For blood to travel from the legs to the heart, muscle contractions work against the vein walls to move the blood. As people age, their veins gradually lose elasticity, reducing the movement of blood. Varicose veins may therefore be caused by either elevated blood pressure in the veins or weakness, damage or failure of the valves within the vein. The role of the valves is to ensure that blood is flowing in the right direction. Damaged or leaky valves can cause blood to pool in the legs, leading to swollen, varicose veins. A blood clot, a congenital defect or chronic venous insufficiency may all cause damage to the valves.

The biggest risk factors for varicose veins include:

  • Family history of varicose veins
  • Advanced age
  • Being born with weak leg valves
  • Hormonal changes (e.g., menopause, puberty)
  • Pregnancy, especially during the first and last trimesters
  • History of deep vein thrombosis
  • Standing in one position for long periods of time
  • A tumor in the abdomen
  • Being grossly overweight

Symptoms of Varicose Veins

The most typical symptoms of varicose veins in the legs include:

  • Dark blue, bulging veins just beneath the skin’s surface
  • Spider veins
  • A heavy or achy or tingling feeling in the legs
  • Swelling in the lower legs, especially around the ankles
  • Burning, itching or throbbing around the bulging vein

In case of an injury due to a fall or other accident, patients may also develop chronic venous insufficiency, which may lead to an open sore called a leg ulcer on the lower part of the leg. A leg ulcer is usually very painful because of exposed nerve endings. It is caused by poor blood circulation to the skin near the ankle and requires immediate medical attention. If left untreated, leg ulcer can cause tissue death, which can in the most extreme cases lead to gangrene and result in limb amputation.

Diagnosing Varicose Veins

The doctor takes a patient’s medical history, including their current symptoms and family history and examines the patient’s legs while sitting, standing and walking. A physical examination may also include certain non-invasive tests to measure the blood circulation. Depending on the initial observations, the patient may be referred to a phlebologist (vein specialist) or sometimes to a dermatologist. A Duplex or Doppler ultrasound scan may be ordered to help determine the extent of the condition. These diagnostic tests enable the doctor to take clear pictures of the veins and provide information about the rate of blood flow or any leaking of blood in the vein. The presence of venous clots will also be determined by the ultrasound test. Sometimes, an angiogram may need to be ordered. In this procedure, a contrast medium is injected into the problematic vein to outline the vein on x-rays images.

Treating Varicose Veins

Compression stockings are usually the first course of action when treating varicose veins before considering invasive procedures. Compression stockings have been shown to greatly improve blood flow in the lower legs. However, you should use them only if recommended by your doctor. Wearing compression stockings is often also recommended before and after surgical procedures for removing varicose veins.

Sclerotherapy (injection therapy) is only suitable for patients with small varicose veins. An irritant chemical is injected into the affected veins, causing them to seal off. Compression bandages need to be worn after the procedure to prevent blood from refilling the veins. The risks associated with sclerotherapy include an allergic reaction to the injected sclerosing agent and formation of new spider veins and blood clots in superficial veins. Sclerotherapy may require multiple treatments to show satisfactory results.

Laser surgery can be used to remove small varicose veins and spider veins. Laser therapy works by sending bursts of light onto the varicose vein, which causes it to gradually fade and eventually disappear.

Ambulatory phlebectomy is suitable for treatment of smaller varicose veins. A series of tiny skin punctures is used to extract varicose veins with a phlebectomy hook. This procedure is performed under local anesthesia and keeps scarring to a minimum.

Vein ablation is a catheter-assisted procedure employing laser light or radiofrequency energy to seal off varicose veins. A long, thin tube called catheter with heated tip is inserted into the varicose vein and, as the catheter is pulled out, the vain is destroyed. Vein ablation is reserved for the treatment of larger varicose veins.

Endoscopic vein surgery is used to treat advanced cases of vascular disease when leg ulcers need to be removed. A small endoscope is inserted into the affected veins to visualize vascular abnormalities from inside the vein and close them. For most patients, endoscopic vein surgery is performed on an outpatient basis.

Vein stripping is mainly reserved for treating large varicose veins (e.g. the greater saphenous vein) by surgically removing long segments of the problematic vein. Most patients will not need an overnight stay in a hospital but post-surgery scarring can occur.

Medications are not commonly used to treat varicose veins. The only substance that has been shown to be somewhat effective in alleviating the symptoms of varicose veins by restoring their normal function is a phytochemical called diosmin. Diosmin is mainly present in citrus fruits.

Preventing Varicose Veins

Certain lifestyle changes can help improve the symptoms of varicose veins and prevent their possible recurrence. These include:

  • Avoiding long periods of standing or sitting in one place without taking a break.
  • Engaging in regular exercise, particularly walking.
  • Losing weight, if overweight, in order to relieve unnecessary pressure on the leg veins.
  • Periodically shifting weight from one foot to another and flexing each foot up and down.
  • Avoiding crossing the legs at the knees when sitting.
  • Elevating legs above the level of the heart whenever possible.
  • Avoiding constrictive clothing that is tight around the waist and upper thighs.
  • Wearing compression stocking if recommended by the doctor.
  • Avoiding to wear high-heeled shoes for long periods.

Where to Find More Information:
Society for Vascular Surgery
Circulation Foundation