Definition

Varicose veins, also spelled sometimes as vericose veins, are enlarged or engorged superficial veins in the legs that appear bluish or purplish. You see them more commonly in women than in men and usually during childbearing and advanced age. About 23% of US adults have varicose veins.

Vein varicosity occurs in the superficial veins of the legs, which are normally not visible. Varicosity makes them visible and it is not a pretty sight. They present cosmetic problems and in long-standing cases, health complications such as ulceration and blood clots can occur.

Though symptoms are common, causes vary, familial tendency accounting for 50 percent of the cases. Surgery remains the only permanent treatment option and involves the removal of the engorged veins.

Normally, these superficial veins of the legs drain into the deep veins of the legs. These deep veins then transport blood from the legs to the heart against gravity.

Along their length, these deep veins are provided with one-way valves that have leaflets, which prevent the blood from flowing backward due to gravity.

The deeper veins in the leg propel blood upwards towards the heart with the help of the pumping action of the leg muscles.

When this normal mechanism fails, you develop varicose veins. It is a chronic condition, which can last for years or a lifetime.

How and why you get varicose veins?

When the leaflet valves of the leg veins do not function properly, the blood stays back in the veins. There is a backflow of the blood due to which blood accumulates in the deep veins and then in the superficial veins, which causes them to become engorged resulting in vein varicosity.

The superficial engorged veins of the leg become visible through the skin and are called varicose veins. Vein varicosity is, therefore, a result of engorgement of the veins in the legs due to improper blood flow through the veins and caused by increased blood pressure in the veins from weakened or damaged one-way valves.

Causes and risk factors

  • Hormonal: High estrogen levels predispose to vein varicosity and could be the reason for their higher prevalence among women. These high estrogen levels may be caused by obesity, ovarian tumors, liver disease, hormonal contraceptives, and certain medicines.
  • Smoking is another avoidable risk factor that can lead to more severe forms of chronic venous disease, including venous ulceration. A possible cause could be venous endothelial damage.
  • Post-thrombotic syndrome that develops subsequent to deep vein thrombosis (DVT) may result in varicose veins in the absence of  primary venous insufficiency
  • Family history could be due to venous valvular incompetence. In about 50% of cases, the reason is family history, and is associated with an inborn weakness of the venous walls or the one-way valves inside veins that keep blood from backing up.
  • Pregnancy can give rise to varicose veins due to high estrogen state and venous hypertension.
  • Menopause: Menopause significantly reduces the amount of estrogen and progesterone produced in the ovaries as a result of which women of menopausal age are at a higher risk of developing varicose veins. Estrogen and progesterone maintain the good health of capillaries and veins and good blood flow in women. Low progesterone and estrogen levels cause loss of collagen and smooth muscle function of the blood vessel wall, which promotes varicose veins and predispose to venous insufficiency and venous thrombosis.
  • Advancing age: As our age advances, the one-way valves in our veins become weaker and lose their function of maintaining one-way blood flow towards the heart. The blood flow goes backward due to gravity and accumulates in the veins engorging them and causing them to become varicose.
  • Obesity is a major risk factor that can increase your risk of developing varicose veins. The extra fat in your abdomen puts pressure on the abdominal veins into which the veins from the legs drain. This puts back pressure on the veins of the legs causing the veins to become engorged and varicose.
  • Prolonged standing. The occupational compulsion of prolonged standing hours can cause veins and valves to overstrain. Blood may pool in the leg veins, increasing pressure in those veins, causing the valves to become weak and inefficient and leading to varicose veins.
  • Straining due to chronic constipation or during urination due to an enlarged prostate
  • Any pathology obstructing the vein

Varicose vein symptoms

  • Any superficial vein in the body can become varicose, but the veins most commonly affected are those in your lower limbs.
  • You will see dark purple or bluish bulging veins below the skin that appear like cords.
  • The affected leg feels heavy and is painful.
  • Skin becomes bluish around the varicose vein site.
  • The ankle of the affected leg becomes swollen.
  • You feel leg cramps.
  • There is itching near the varicose veins. Scratching can lead to a varicose ulcer, which does not heal easily.

Complications of varicose veins

Complications of varicose veins occur due to poor circulation of blood in the veins in the legs. They include:

  • Inability to stand for a prolonged period
  • Dermatitis of the skin can develop, which may lead to ulcer formation.
  • Rarely, a long-standing ulcer becomes malignant.
  • Any injury to the affected leg may result in severe bleeding.
  • Due to sluggish circulation of the blood, there may be blood clotting. However, being in the superficial veins, these clots are harmless.

Diagnosis

The doctor will ask you about your symptoms and he will conduct a physical examination of your legs. This is usually enough to confirm the diagnosis of the varicose veins.

However, he may ask for an ultrasound test to see if the valves in your leg veins are functioning normally and also to rule out the formation of any blood clot.

Varicose vein treatment options

There is an initial therapy for varicose veins to help the patient tide over the symptoms such as pain.

  • Periodically, during the day, adopt a sitting or sleeping position to elevate the legs above heart level. This will help to empty the engorged veins with the help of gravity.
  • Wear compression stockings in the morning before you start walking. This will keep the engorgement of the varicose veins to the minimum. It will prevent symptoms such as swelling and avoid painful cramps that tend to occur toward the end of the day and at night.

There are various varicose vein treatments and their main purpose is to close or remove the varicose veins so that the blood flows through the good veins.

1) Sclerotherapy

This procedure entails the injection of medicine or foam into the affected vein to obliterate it. This is not very successful. Occasionally, an allergy to the medicine may develop.

2) Varicose vein laser treatment

Varicose vein laser surgery requires that the varicose vein be first visualized with the help of an ultrasound machine. Under the vision, the laser is passed over it to close the affected vein. It is usually done for small spider veins. This is not time-proven and repetitive treatment with laser is required.

3) Surgery for varicose veins

There are various procedures of varicose vein surgery that are followed depending on the severity and age of the case.

  • Ambulatory Phlebectomy. In this type of surgery, the doctor first maps the affected vein on the skin, and then through a series of tiny incisions, he removes the varicose vein. This procedure of vein removal is performed under local anesthesia and generally indicated in larger veins.
  • Veno-stripping. This procedure is indicated in the varicosity of the long Saphenous vein. Through an incision in the groin and at the knee, the doctor inserts a tunneling flexible device and pulls out the long saphenous vein. He then ties its connections to the deep veins of the legs. He stops the bleeding by compression. After ten days, the patient is able to resume normal duties. The disadvantage of veno-stripping lies in the fact that this is the vein that is used for cardiac bypass surgery and it becomes unavailable for a bypass if required at a later date.
  • Endovenous Thermal Ablation is a newer alternative to vein stripping. It is indicated in larger veins such as the great saphenous vein or the small saphenous vein. In this procedure, the doctor introduces a catheter in the varicose vein through a small incision and passes heat through the catheter. He then removes the catheter and the varicose vein collapses due to scarring by the heat.

Varicose veins during pregnancy

During pregnancy, it is best to wait for about three months to twelve months after delivery for treating varicose veins because until then, most of the varicose veins will disappear.

Prevention of varicose vein

There is no way to completely guarantee the prevention of varicose veins. However, improving your blood circulation and muscle tone may considerably reduce the risk and prevent an existing condition from getting worse. If you have a hereditary predisposition, follow the tips below to prevent this condition.

  • Avoid drinking alcohol.
  • Avoid standing for a long time.
  • Lose weight, if you are overweight.
  • If you have chronic constipation, get it treated.
  • If you an enlarged prostate, get it treated.
  • If you have a sitting job, take periodic breaks and walk around a bit.
  • Resort to walking exercise every day.
  • Avoid a tight belt around the midriff.

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