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Varicose Veins

Searching for varicose veins? Here is a detailed article on symptoms, causes, risk factors, treatment options, side effects of varicose veins

A Vein is referred to a blood vessel which returns the deoxygenated blood from the other parts of the body back to the heart and lungs. Valves in the blood vessels will ensure the flow of blood in one way (towards the heart). When these valves become weak or damaged, blood flows backwards. The blood will stock in the veins, which causes swelling in the veins. This is called Varicose veins.

Varicose veins are enlarged veins which can be blue, red, or flesh-colored. Varicose veins are twisted, swollen, and enlarged veins commonly found in the legs and feet. Varicose veins are caused by the weak valves in the veins which let the blood to flow backward, instead of flowing towards the heart.

Most often these Varicose veins found on thighs, backs of the calves, or the inside part of the leg. In women generally after the pregnancy, these can be form around the vagina and buttocks.

Most of the people believe that varicose veins are simply a cosmetic disorder, actually it will be a symptom of certain venous diseases, like chronic venous insufficiency. Proper treatment and care not provided on time causes, this disease to progressively gets worse and causes serious complications.

varicose veins
Fig1. – Varicose veins

Symptoms of Varicose Veins:

In most of the people the varicose veins affect the legs and thighs. Enlarged veins may cause mild swelling of the ankles, especially after standing or walking for long hours.

Common symptoms of the varicose veins includes:

  • Heaviness in the legs
  • Pain and aches
  • Skin darkening
  • Rashes on the skin
  • Ulcers on the ankles in severe cases

In most of the people varicose veins will form in the legs. This is due to the pressure of body weight, gravitational force, carrying the blood from the bottom of the body up to the heart. When compared with other veins in the body, leg veins performs the most toughest job of carrying blood back to the heart (anti-gravitational path in maximum time of the day).

Human legs are made up of a network of veins. A healthy leg vein contains valves that open and close to assist the blood flow to the heart. When the valves that keep blood flowing out of the legs and back to the heart become damaged then venous reflux disease will be developed. Venous reflux disease can cause the blood to stock in the legs and which leads to pain, swollen limbs, leg heaviness and fatigue, skin changes and skin ulcers and the varicose veins. Varicose veins look like knotty bulges under the skin which are blue in color. These bulges are usually one fourth (¼) inch or larger in diameter and will be painful. Varicose veins with blood clot causes inflammation of a vein, noticeable as hot and red painful skin at the site of the clot.

Causes of Varicose veins:

healthy vs varicose veins
Fig2. – Healthy Veins vs Varicose veins

There are many causes for varicose veins, being certain parameters and also the lifestyle of the patient may cause varicose veins, few of the most common causes are:

Genes:

Varicose veins will be caused by family genes. If any of the family member suffers with varicose veins then it might be the cause that the patient will develop the Varicose veins.

Age:

Age is also a factor for the Varicose veins. In India most of the middle aged people are suffering with these Varicose veins. The day to day activities of a person is the main reason for this.

Pregnancy:

During the pregnancy because of hormonal changes and increased pressure in veins due to the uterus grows there is a possibility of Varicose veins to be increased.

Gender:

Varicose veins are mostly common in female due to hormonal changes during puberty, pregnancy and the menopause.

Diagnosis of Varicose veins:

Venous ultrasound test is the best way to know the cause of Varicose veins. Most of the Varicose veins are due to a non-working valve in the main draining vein of the leg. A faulty valve causes the blood to back flow and overflow through smaller veins, which is bloat with the unexpected pressure and visible as varicose veins.

Venous ultrasound test:

Generally vascular surgeons use venous ultrasound test to evaluate the veins of the legs. This ultrasound works on the basis of sound waves it is produced in the tissues and generates diagnostic images. Doctors will identify the infected veins with the help of the diagnostic images and suggest with the best possible treatment options.

Prevention of Varicose Veins:

Heredity and age will increase the possibility of varicose veins. However, patient can help in delaying the development of varicose veins.

  • Be active. Moving leg muscles keeps the blood flowing.
  • Keep the blood pressure under control.
  • To temporarily relieve symptoms, lie down and raise the legs at least six inches above the level of the heart. Do this for ten minutes a few times each day.
  • Maintain a normal body weight.
  • Wear prescription compression stockings as specified by the doctor.
  • See a qualified doctor who can diagnose the cause of varicose veins, the sources of venous reflux in the legs and offer a variety of treatment options.

Treatment for Varicose Veins:

Treating varicose veins is necessary if is causes pain or discomfort, to treat complications like leg ulcers, swelling and skin discolouration and also in some cases for cosmetic problems.

After the initial investigations, depending upon the complications doctor may suggest 3-4 months of self care at home. In advanced stage of varicose veins, doctor may opt for surgical procedures to treat the varicose veins.

Self care may include:

  1. Compression Stockings
  2. Injection Therapy or Sclerotherapy

Compression Stockings:

Compression stockings is not suitable for everyone. Doctor will suggest the patient to undergo the Doppler investigation before suggesting this procedure to the patient. This Doppler investigation is useful in testing the blood circulation in the body.

Compression stockings are useful to steadily squeeze the legs to improve the blood circulation. Compression stockings are helpful to relieve the pain, discomfort and swelling in the legs which are caused by varicose veins.

If patient have deep venous incompetence, then patient need to wear these compression stockings for life time even after the surgical procedures.

Injection Therapy or Sclerotherapy:

Sclerotherapy or Injection Therapy is generally used for varicose veins. A Vein is of 15 millimeters diameter can be treated successfully. Sclerotherapy is generally suggested to patients who have tried compression stockings and leg elevation without much success.

In “Sclerotherapy” treatment doctors use a fine needle to inject a substance directly into the vein. This solution irritates the lining of the vein, which causes the vein to swell and the blood to clot. This vein turns into scar tissue which may eventually fade from the view.

There are some potential side effects by using the Sclerotherapy. In some patients due to Sclerotherapy dark discoloration hyper pigmentation in the injected area. Generally, this may happen due to disintegration of the red blood cells in the treated blood vessels. For few patients the discoloration will completely go away within 5 to 6 months.

In few patients there is a possibility of forming spider veins in the area where the sclerotherapy is performed. However, these spider veins will be dissolved with in 6 months.

In very rare cases there might be complications like formation of Ulcers around the area where this Sclerotherapy is performed. Sclerotherapy is very safest treatment in most of the cases as the side effects are very rare.

Apart from regular home remedies, here are few surgical procedures to treat varicose veins:

Surgical Procedures for Varicose veins treatment:

Varicose vein surgery is one of the most common forms of surgery. Varicose veins can be surgically removed or closed off using a number of different techniques. This will not harm the blood supply in the legs, because the blood will be redirected into the other healthy veins. Surgery can be done on both superficial and deep veins. In varicose vein surgery, the varicose veins are removed to relieve the pain and symptoms.

laser surgery for varicose veins
Fig3. – LASER Surgery for Varicose Veins

The most common ways to surgically remove varicose veins are:

  1. Vein stripping
  2. Phlebectomy
  3. Laser treatment for Varicose Veins

Vein stripping:

Two incisions (cuts) are made, one at the top of the leg just below the groin and one behind the knee joint or at the ankle. The vein is then tied or clamped off at the top incision using a technique called vein ligation. A long wire is sent through the lower incision up through the vein, and at the lower end a button-like cap is attached to the wire. This allows the entire vein to be pulled out through the incision near the groin.

For few patients depending upon the complexity of varicose veins, doctors will eliminate the bad vein through some surgical procedures. Blood will be flow through the remaining healthy veins. This is called as Vein Stripping Surgery. In Vein Stripping Surgery the diseased veins are stripped out by passing a flexible device through the vein and remove it through an incision near the groin. This procedure is generally performed in outpatient procedure and in very rare cases it requires admission along with general anesthesia.
Generally, these surgical procedures will cause the pain. The pain is depending upon how extensive the treatment is, the amount of blood loss happened and which part of the body is treated.

While doing the surgery doctors will give anaesthesia so, the patient will feel the less pain during the surgery. After the anaesthesia wears off there can be some pain at the incision region.

Phlebectomy:

Phlebectomy Side Effects | Phlebectomy Complications

Very small incisions of just a few millimeters are made along the affected vein. A small hook is used to pull the vein out as far as possible through these incisions and then it is cut and removed in several pieces. Phlebectomy technique is mainly used for smaller veins that branch off of the main veins. This surgical procedure uses the small incisions to avoid the scarring caused when larger cuts are made, this will also help in recovering faster.

Phlebectomy Side Effects:
  • Pain
  • Bleeding
  • Swelling
  • Scarring
  • Skin discoloration
Phlebectomy Complications:
  • Infection
  • Thrombosis
  • Nerve damage are less common
  • A minority of people treated for varicose veins will see them grow back after surgery, which means that further treatment may be needed.

After varicose vein surgery it is usually possible to discharge of the same day, but sometimes an overnight stay in the hospital is required. Patient can resume the usual activities and for the swelling to get better and the incisions to heal.

Laser treatment for Varicose Veins:

Laser treatment will be used to treat small varicose veins applied from the surface of the skin. These Laser rays will apply the intense energy which essentially destroys the small blood vessels in the surface of the skin. This Laser treatment is less invasive than sclerotherapy and vein stripping, as there is no need of the inserting needles or catheters. After this Laser treatment there might be a possibility of temporary discoloration of the skin.

Endovenous Catheter Ablation / Laser Surgery:

For varicose veins which are larger in size, the possible treatment option should be Endovenous Catheter Ablation or Laser Surgery.

In this surgery the catheter will be inserted into a large vein in the lower leg and closes the defected vein by applying heat generated through the laser. When compared to vein stripping surgery this laser treatment is proven to be less painful and also has fast recovery time.

Risk Factors of Varicose Veins:

The most important factors leading to the development of varicose veins include:

  • Heredity
  • Prolonged standing
  • Increasing age
  • Heavy lifting
  • Prior superficial or deep vein clots
  • Female gender
  • Multiple pregnancies

Less physical activity, a higher blood pressure and obesity have also been linked with the presence of varicose veins in females.

Different Stages of Varicose Veins:

Varicose veins are categorized into few stages, which include the following:

varicose veins treatment
Fig4. – Treatment for Varicose Veins

Stage C0:

At this stage there are no visible signs of the disease. Symptoms at this stage include general aches in the legs and a condition called “heavy legs” that can be noticeably worse at night or worsened by exercise.

Stage C1:

Aches in the leg and the first appearance of Telangiectasia, sometimes called Reticular veins or spider veins, in the legs.

Stage C2:

Varicose veins appear, ankle swelling, a brownish-blue shiny skin discoloration near the affected veins.

Stage C3:

Edema, redness, dryness, and itchiness of areas of skin – termed Stasis Dermatitis or Venous Eczema, because of waste products building up in the leg.

Stage C4a:

Cramps may develop especially when making a sudden move as standing up, skin changes due to venous disorders: pigmentation, eczema.

Stage C4b:

Cramps, skin changes due to venous disorders: Lipodermatosclerosis, Atrophie Blanche.

Stage C5:

The area may bleed more than normal and take a longer time to heal. In some people the skin above the ankle may shrink (Lipodermatosclerosis) because the fat underneath the skin becomes hard. As C4 but with healed ulcers.

Stage C6:

Restless legs syndrome, chronic venous insufficiency, whitened, irregular scar-like patches can appear at the ankles, otherwise known as Atrophie Blanche. Skin changes with active ulcers.

Frequently Asked Questions:

Generally patients will have many queries related to the treatment, here are most commonly asked questions by patients during their varicose veins treatment course:

  1. Varicose veins are dangerous?
  2. What problems can occur if left untreated?
  3. Varicose veins once treated will recur after some time?
  4. What are the side effects in treating varicose veins?

Varicose veins are dangerous?

In some cases varicose veins may not cause any problems, or they might be the cause of aching pain, throbbing, and discomfort. In few cases, varicose veins can lead to more serious health problems which includes:

  • Sores or skin ulcers due to long-term backing up of blood pools. These are very painful and hard to heal. These sores or ulcers cannot heal until the backward blood flows in veins are repaired.
  • Significant Blood loss will cause due to the skin over the vein becomes thin and easily injured.
  • Superficial thrombophlebitis which is a type of blood clot forms in a vein below the skin. Due to which redness to the skin, a firm, tender, warm vein and pain or swelling in the area of the varicose veins.
  • Deep vein thrombosis in which a blood clot is formed in a deeper vein. It causes a pulling feeling in the calf, pain, redness and swelling. In some cases it might not causes significant symptoms. If this blood clot reaches the lungs then it will be a big problem.

If Varicose veins don’t cause any discomfort, it is not required to consult the doctor. Rarely, these Varicose veins causes discomforts which leads to serious problems. In that situation it is better to consult an expert doctor for the better treatment process.

Generally, Doctors who provide surgical treatments like vein stripping and laser ablation include general and vascular surgeons will do the treatment for the Varicose veins. Sclerotherapy and laser treatment are performed by dermatologists, though some general, vascular, and plastic surgeons. It is suggested, before deciding the treatment plan be sure to ask the doctor about his or her experience in performing the procedure need to be done and also the pros and cons of the treatment process.

What problems can occur if left untreated?

Most people with varicose veins do not develop complications. It is impossible to predict who will develop the complications. The size of the varicose vein is no related to the complications.

Complications that may occur include:

Superficial Thrombophlebitis:

In this condition, the varicose vein is inflamed and tender. A clot is usually present in the vein.

Bleeding:

Even with minor trauma, the varicose vein may be associated with bleeding. Because the vein is under high pressure, the bleeding can be quite profuse.

Venous Eczema:

The skin round the vein may become dry and very itchy.

Venous Pigmentation:

This is brown staining of the skin around the ankle. It is due to the leakage of small amount of blood from the veins into the skin.

Venous Ulceration:

Ulcers at the ankle region.

Varicose veins once treated will recur after some time?

There is a possibility of varicose veins to recur. This will depend on many factors like diagnosis, the method used and suitable treatment option for the particular condition. Also, in some cases depending upon the skill of doctor. Sometimes the body may form a new vein where the old vein is removed by the surgeon.

If the infected vein is not properly destroyed through sclerotherapy there might be possibility of reopen or a new vein may appear in the infected area. There is no proper treatment method is established to free from the recurrence.

As there is a possibility of recurrence in all types of treatments no such treatment is available that prevents the appearance of new veins in future.

What are the side effects in treating varicose veins?

Before deciding the best possible treatment option it is always advisable to get the awareness about the safety and potential side effects of each treatment. If Doctors or nurses asked the patient attender to sign any consent before the procedure it is better to enquire in detail about the procedure that the patient is undergoing.

In Surgical removal of veins possible potential side effects are general surgical side effects performed under anaesthesia also includes nausea, vomiting and postoperative infections in the area of the wound. There is also possibility of scarring on the skin where the incisions are made and possible blood clots in the area of surgery is performed.

In Sclerotherapy, possible side effects depends on the substance used for injection. It is better to be cautious for people who have allergies. Sometimes these allergic reactions may be severe. Rarely this Sclerotherapy can leads to blood clots in the area where varicose veins are formed.

Due to Laser treatments Scarring and color changes in the area of the skin where the varicose veins are affected.

In all kinds of the treatment options the most possible and worrisome complication is formation of blood clots. Sometimes patient needs to undergo further treatments like blood thinners or other treatment and there is a very low risk of causing the death.

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