Varicose Veins

Varicose veins are stretched and weakened veins that are close to the surface of the skin and may be visible as ropy, twisted, and bulging cords, generally in the lower leg on the calf. Varicose veins are caused by the blood pooling in the vein due to damaged or malfunctioning valves in the veins; this pooling blood forces the vein to expand, stretching the vein walls and weakening them.

Varicose veins are generally found on the legs and feet because of the stress of standing and walking, but can also appear other places in the body, such as the lining of the stomach, the rectum, the colon, the esophagus, and the scrotum. Varicose veins are distinguished from “spider veins” only by size; varicose veins are larger than 3mm in diameter.

Our doctors can perform a minimally-invasive outpatient procedure called endovenous ablation that will close off the damaged varicose vein. This causes it to be reabsorbed by the body and disappear from view. Other veins take over the job of the reabsorbed vein, so your legs will be free of pain and varicose veins.

SYMPTOMS

• Legs may feel heavy, tired, or achy particularly after standing
• Legs may feel restless, particularly at night (Restless Legs Syndrome)
• Skin over varicose veins may be painful or itchy
• Skin around ankles may be painful or itchy

SIGNS

• Swollen ankles or feet
• Visible veins, possibly twisted, raised, and engorged
• Skin over visible veins may be shiny, brownish or bluish
• Minor injuries to the area may bleed more than normal

Symptoms are indicators of a disease that you experience, while signs are indicators of a disease that can be seen. Your doctor will ask you about the symptoms you experience and examine you for signs.

Varicose veins are commonly diagnosed by a physical examination and discussion of symptoms with your doctor. In addition, there are several simple tests that may be done.

• The Trendelenburg Test checks for varicose veins by raising the leg about the level of the heart so that excess blood will leave your leg. Then you stand up while the doctor watches your legs. As blood rushes back to your legs, any varicose veins will become visible almost immediately.
• A tourniquet may be used to stop the blood flow to the leg so the doctor can identify any varicose veins.

Sometimes, other clinical tests are done to determine if other problems may be causing the varicose veins. They can be a symptom of chronic venous insufficiency, so your doctor may perform one or both of the following tests.

• Ultrasound: Measures blood flow in the deep and surface veins to look for signs of vein damage.
• Venography: Measures blood flow in the deep veins using X-ray technology. This is used to exclude other possible diagnoses.

Most people seek treatment for varicose veins simply because they are cosmetically unattractive. They can also occasionally cause pain and itching, and scratching them can lead to ulcers. There are generally no serious risks associated with varicose veins, though they may be a sign that the veins or valves have been weakened or experienced stress, and an evaluation should be done to check for more serious venous problems.

Some complications that may be experienced are the following:

Excessive Bleeding: Varicose veins are veins that have been damaged and stretched, so the vein walls are very thin, and the blood inside is under more pressure than normal. If an injury occurs that breaks the skin and the vein wall, the vein may bleed more than normal. Follow normal procedures to stop the bleeding – elevate and apply pressure – then contact your doctor.

Ulcers: Ulcers are open sores that can form when the damaged vein does not drain fluid and blood away from the skin. It is difficult to heal ulcers once they have formed, so treatment to prevent ulcers is the best course of action.

Thrombophlebitis: A blood clot that forms in a varicose vein can cause inflammation of the vein. This is a minor and temporary condition that usually requires only warm compresses and anti-inflammatory medication.

Serious complications from varicose veins are rare, but with severe varicose veins, the loss of circulation in the legs may make it difficult to walk or stand for long periods, and in a small percentage of people (0.5% – 1.0%), varicose veins have been found to develop malignant cancer.

Once the vein walls have been weakened and stretched to form varicose veins, they will not simply return to normal on their own.

LIFESTYLE TREATMENT FOR VARICOSE VEINS

Most people can find relief from symptoms without turning to any medical procedures. Simply elevating the legs occasionally can often provide relief from pain and swelling, and the use of compression stockings can be used to reduce the swelling and improve circulation. Compression stockings are specially designed stockings that are worn from the toes to the knee. The compression stockings improve the flow of blood to the heart by putting pressure on the leg muscles that squeeze the veins.

MEDICAL TREATMENT FOR VARICOSE VEINS

The veins that can become varicose are the superficial veins, the ones that are closest to the skin. There is a large network of these superficial veins providing blood to the skin and underlying tissue, so a common treatment for varicose veins is to close off the damaged vein and allow healthy blood vessels to take over. The closed off blood vessel then degrades and is eventually reabsorbed.

There are several techniques that can be used to close off the damaged vein, including sclerotherapy and endovenous ablation. We prefer laser ablation or radiofrequency ablation because they do not require the introduction of foreign materials into the body, and offer quick recovery time and extremely good results.

• Endovenous laser ablation and endovenous radiofrequency ablation are minimally-invasive procedures that involve the use of a tiny tube, called a catheter, to reach the varicose vein by traveling through large veins in the leg. A laser or radio energy is then applied, effectively sealing off the vein. As the catheter is removed, the remainder of the vein is treated, so that it shrinks and will eventually be reabsorbed by the body. The entire procedure takes less than an hour, requires no general anesthetic, and you can return to work the same day. You can read more about it, including pre-procedure preparation and recovery, on our Procedures page.
• Sclerotherapy involves the injection of a solution directly into the vein. The solution irritates the inside of the vein, causing it to swell and stick together. Eventually it turns into scar tissue that fades from view. Sclerotherapy is not appropriate for large varicose veins, varicose veins that extend up to the groin, or for people who are obese.

SURGICAL TREATMENT

Severe varicose veins may require surgery. There are two primary surgical techniques used to treat varicose veins:

• Ambulatory phlebectomy – In the ambulatory phlebectomy procedure, a surgeon takes out small segments of the vein through tiny holes in the skin. Ambulatory phlebectomy is a well-tolerated procedure that requires little recovery time, but it is not appropriate for all varicose veins.
• Vein stripping – Vein stripping is the removal of the saphenous vein, the primary superficial vein in the leg. It is usually done under general anesthetic, and the entire vein is tied off and pulled out of the leg. Vein stripping requires a long recovery time, generally two or three weeks.

The following risk factors have been found for varicose veins:

• Aging
• Family history of varicose veins
• Obesity
• Pregnancy
• Injury
• Prolonged standing
• Menopause
• Use of birth control pills

Varicose veins are affected by the hormone progesterone because it allows blood vessels to relax, preventing the valves from closing completely to prevent the back-flow of blood. This means that women may notice that their varicose veins become more prominent shortly before menstruation cycle or when they use birth control pills. Progesterone is also the reason that women experience more varicose veins during pregnancy.

There are many uncontrollable factors that have shown a strong correlation with development of varicose veins, such as aging and family history. There are steps you can take to reduce the chances of developing varicose veins or prevent them from getting worse. If you are concerned about varicose veins, consider trying the following lifestyle changes:

• Lose weight if you are obese
• Do not wear tight-fitting clothing
• Do not tightly cross your legs while seated
• Do not stand for long periods of time, or if you must, bend your legs occasionally to encourage blood flow
• Elevate your legs when possible to aid blood flow to the heart
• Don’t wear high heels, they do not allow you to use your calf muscles when walking
• Take vitamin C supplements