Varicose Veins
What Are Varicose Veins?
Varicose veins are swollen and twisted veins that are visible just under the surface of the skin. They appear most commonly in the legs, but also can develop in other parts of the body.
Veins are blood vessels that carry blood from the tissues of the body to the heart. In the heart, blood is pumped to the lungs to pick up oxygen. The oxygen-rich blood is then pumped out to the body through the arteries. From the arteries, blood flows through tiny blood vessels called capillaries, where it gives up its oxygen to the body’s tissues. The blood then returns back to the heart through the veins to pick up more oxygen.
Veins have one-way valves that help to keep the blood flowing toward the heart. When the valves don’t work well, blood backs up and pools in the veins. This causes them to swell and become varicose veins.
Symptoms of varicose veins usually don’t cause medical problems. On occasion, they require treatment for pain, skin problems, blood clots, or other complications. People may choose to have cosmetic treatment to improve the appearance of varicose veins.
Related Vein Problems
A number of other types of vein problems are related to varicose veins.
Spider Veins
Spider veins are a smaller version of varicose veins symptoms. They occur in the capillaries, which are the smallest blood vessels in the body. Spider veins are commonly found on the legs and face, and they usually resemble a spider web or tree branch in shape. They can be red or blue. Spider veins are usually not a medical concern.
Telangiectasias
Telangiectasias (tel-AN-juh-ek-TA-ze-uhs) are small clusters of blood vessels that look similar to spider veins. They are red in color and are commonly found on the upper body, including the face. They can develop during pregnancy and in people who have certain genetic disorders, viral infections, and other medical conditions (such as liver disease). Newly developed telangiectasias are often a reason to see a doctor.
Venous Lakes
Venous lakes are another type of varicose veins disease in which blood collects in the veins of the face and neck.
Reticular Veins
Reticular veins are flat blue veins commonly seen behind the knees.
Hemorrhoids
Hemorrhoids are varicose veins in blood vessels in and around the anus.
Varicoceles
Varicoceles (VAR-i-ko-seals) are varicose veins in the scrotum (the skin over the testicles). Varicoceles may be linked to male infertility and should be checked by a doctor.
Outlook
People with symptoms of varicose veins often require only simple self-care measures, such as performing certain leg exercises, wearing compression stockings, and avoiding long periods of sitting or standing. For those who are concerned about the appearance of varicose veins, several cosmetic treatments are available. Although uncommon, in some cases, complications such as pain, skin ulcers, and blood clots can develop. A variety of medical and surgical procedures are used to treat varicose veins in these more complicated cases.
What Causes Varicose Veins?
Veins, especially those in the legs, have to pump the blood “up hill” to the heart, against gravity. Inside the veins are one-way valves that help with pumping action and prevent blood from flowing backward. These valves allow blood to flow in only one direction, toward the heart. Varicose veins develop when the valves become weakened, damaged, or don’t work well.
Weakness in the valves may be due to weakness in the walls of the veins. This weakness tends to be associated with certain factors, including increasing age, a family history of varicose veins disease, or high pressure inside veins due to overweight or pregnancy.
When the walls of the veins are weak, they lose their normal elasticity, like an overstretched rubber band. This makes them longer and wider and causes the flaps of the valves to separate. Blood is then able to flow backward through the valves, filling the vein and stretching it even more. The vein becomes enlarged, swollen, and often twisted trying to squeeze into its normal space.
Risk Factors
- Genetics. Having a family member with varicose veins may increase the risk for developing them. Approximately half of the people who get varicose veins have a family history of them.
- Age. The normal wear and tear of aging may cause valves to weaken and not work as well.
- Gender. Women are two to three times more likely to develop varicose veins than men. Up to half of American women have varicose veins. Changes in hormones due to puberty, pregnancy, menopause, or taking birth control pills may increase a woman's risk of developing varicose veins.
- Pregnancy. During pregnancy, the growth of the fetus increases the pressure on the veins in the legs. Varicose veins that occur during pregnancy usually improve within 3 to 12 months following delivery.
- Overweight and obesity. Having extra weight on the body can put additional pressure on the veins.
- Prolonged standing or sitting, particularly with legs bent or crossed. When standing or sitting with legs bent or crossed, the veins have to work harder to pump the blood up to the heart.
Common signs and symptoms of varicose veins include:
- Enlarged veins that are visible on your skin
- Mild swelling of your ankles and feet
- Painful, achy, or "heavy" legs
- Throbbing or cramping in your legs
- Itchy legs, especially in the lower leg and ankle (sometimes incorrectly diagnosed as dry skin)
- Discoloration of your skin surrounding the varicose veins
Goals of Treatment
The goals of treating varicose veins may include easing symptoms, avoiding complications, and improving cosmetic appearance. Although treatment can target existing varicose veins, it can't keep new varicose veins from forming.
Who Needs Treatment
Varicose veins that cause few signs and symptoms usually don’t need to be treated. Instead, your doctor may recommend simple self-care measures. Varicose veins causing more severe signs and symptoms may need medical or surgical treatment. Treatment may be recommended when the varicose veins are causing skin ulcers, serious skin conditions, blood clots, significant pain, or disruption of daily life activities. Some people with varicose veins may choose to have medical or surgical treatments to improve the cosmetic appearance of varicose veins.
Types of Treatment
Self-Care Measures
Self-care measures are a common option for treating varicose veins. If self-care measures are called for, your doctor may ask you to:
- Avoid excess amounts of standing when possible. Take frequent breaks during prolonged periods of standing.
- Elevate your legs when sitting, resting, or sleeping. Elevating your legs above the level of your heart is very important.
- Wear compression stockings. These are typically worn all day long. Doctors may prescribe special-strength stockings or over-the-counter support stockings, which may be available at pharmacies and medical supply stores.
- Exercise. Exercise gets the legs moving and improves muscle tone, which helps the circulation of blood through your veins.
- Lose weight. Taking off extra pounds may help with blood circulation and pressure on your veins.
- Avoid wearing tight clothes. Tight clothes, especially those that are tight around your waist, groin (upper thighs), and legs, can make varicose veins symptoms worse.
Medical and surgical treatments are used to either remove varicose veins disease or close them. Removing or closing varicose veins usually doesn’t create circulation problems because the blood reroutes itself through other veins. These therapies range from approaches that don’t involve incisions or injections to those that are surgical procedures. It may be necessary to combine therapies, depending on your condition and lifestyle.
Sclerotherapy. This procedure uses a liquid chemical to close off the vein. The solution is injected into the vein to cause irritation and scarring inside the vein, which causes the vein to close off and fade away. It’s usually used to treat smaller varicose veins and spider veins. Sclerotherapy is usually done in the doctor’s office, while you stand. You may need several sclerotherapy treatments to close off a vein completely. In this case, treatments are typically given every 4 to 6 weeks. Following treatments, your legs are wrapped in elastic bandaging to help healing and decrease swelling.
Microsclerotherapy. This procedure is used to treat spider veins and other very small varicose veins. It involves injection of small amounts of a liquid chemical using a very fine needle. The chemical causes scarring in the inner lining of the veins, causing them to close off.
Laser surgery. This procedure uses no incisions or injections. Light energy from a laser is used to make the vein fade away. Laser surgery is typically used to treat smaller varicose veins. With new technology, lasers are more effective than they used to be.
Endovenous ablation therapy. This procedure uses an energy source (either laser or radiowave) to create heat to close off the vein. A tiny incision is made in the skin, and a small catheter (tube) is inserted into the vein. A device at the tip of the catheter heats up the inside of the vein, which causes it to close off. You’re awake during the procedure, but your doctor numbs the area of the vein. You can usually go home on the same day. You may experience less pain and recover more quickly with this procedure than with some of the others.
Endoscopic vein surgery. This procedure uses a tiny camera at the end of a thin tube to move through the varicose veins. A surgical instrument at the end of the camera is used to close the veins. Endoscopic vein surgery is currently only used in severe cases in which there are skin ulcers due to the varicose veins. Only small incisions are required for this procedure.
Ambulatory phlebectomy. In this procedure, small varicose veins symptoms are removed through small incisions in your skin. Ambulatory phlebectomy is typically used to treat varicose veins close to the surface of the skin. You’re awake during the procedure, but your doctor numbs the area of the vein. You can usually go home the same day.
Vein stripping and ligation. In this procedure, veins are tied shut (ligation) and removed (stripping) through small incisions. The procedure is typically used in severe cases, in which the varicose veins cause pain or skin ulcers. You’re given medicine to sleep so that you don’t feel any pain during the procedure.
What To Expect After Treatment
Recovery times vary based on the specific procedure that’s performed. Vein stripping and ligation requires more recovery than most other procedures. Activity is not significantly limited following most other procedures. In fact, walking is often recommended during recovery. Some treatments may require that you wear compression stockings or bandages for a period ranging from a couple days to a few weeks following the procedure.
Common side effects immediately following a procedure may include bruising, swelling, skin discoloration, cramping, and itching. Swelling and skin discoloration may last for several months. Less common side effects include blood clots or nerve damage. An uncommon side effect of sclerotherapy is liquid chemical leaking out of the vein, which could cause tissue damage or ulcers.
Information Obtained From National Institute Of Health