Varicose veins are twisted, enlarged veins, often dark blue in color, near or raised above the surface of the skin. Some will experience discomfort from swelling, throbbing or cramping at night. The skin tissue around the varicose vein may not be receiving enough nourishment so itching or burning of the skin over the vein is not uncommon.
Causes of Varicose Veins
In healthy veins, blood travels in one direction only, towards the heart. In contrast, varicose veins are abnormal or damaged veins that have lost their ability to efficiently return the deoxygenated blood back to the heart. Blood leaks back through weakened valves and pools in the vein, distending and twisting the vein. This condition is called venous reflux and is often the underlying cause of varicose veins.
An estimated 10-20% of adult Americans have varicose veins. While the cause of varicose veins is not known, a number of contributing risk factors have been identified.
Contributing Risk Factors
- Heredity - Varicose veins tend to run in families. A defect in vein walls or valves is the greatest contributing factor in 70% of cases.
- Gender - Women are much more likely to get varicose veins than men.
- Age - Presence of varicose veins is a progressive condition that worsens in frequency and severity with age.
- Obesity - Excess weight increases the pressure on vein valves and can lead to their weakening.
- Hormones - Changes in hormone levels brought on by puberty, pregnancy, menopause, hormone replacement therapy and the birth control pill can cause varicose veins to develop.
- Pregnancy - An increased progesterone level, increased volume of blood in the body and increased pressures on the pelvic veins are all contributors. Veins usually improve within 3 months after delivery and may disappear completely. However, more abnormal veins are likely to develop and persist after subsequent pregnancies.
- Occupation - People whose jobs require them to stand or sit for prolonged periods of time have an increased risk of developing varicose veins. While standing still or sitting, there is an increase of blood pressure on the closed vein valves that contributes to their weakening.
Complications of Untreated Varicose Veins include:
- They become painful, unattractive and worsen over time.
- Fluid buildup or swelling in the leg.
- Swelling and pain in the calf after sitting or standing for an extended period of time.
- Changes in the color and pigmentation in the skin around the ankles and lower legs.
- Dry, itchy skin or rashes in the area of the varicose vein.
- Open sores or ulcers.
Treatment for Small Varicose Veins
Sclerotherapy is a non-surgical treatment for a varicose vein that involves injecting a saline or detergent-like solution into the vein, causing the lining of the vein wall to swell, stick together and ultimately seal shut. Once the vein is sealed, the flow of blood is stopped and scar tissue develops in the vein. With the diseased vein sealed, blood is forced into healthier veins. The treated vein is absorbed and eventually becomes nearly invisible. The procedure is minimally invasive, does not require anesthesia and can be performed in a doctor's office. Side effects of sclerotherapy may include mild stinging, bruising, and rashes around the injection site.Treatment for Medium-sized and larger varicose veins
Larger Varicose Veins can be removed by a procedure called stab avulsion or phlebectomy. This procedure can be performed using local or general anesthesia. Small stab incisions are made in the skin to allow a tool to be placed through the skin to hook the vein and pull it out through the skin incision. The vein is then pulled until it breaks, causing the varicose vein to be removed in pieces. This process is repeated until all targeted varicose veins have been eliminated. Common side effects may include pain, bruising, scarring, hematoma, and bleeding. Laser surgery can be used to destroy varicose veins by sending a very strong beam of light onto the vein, making the vein slowly disappear. There are no needles or incisions. Patient discomfort is limited to a small pinch when the laser hits the skin. Cooling the skin prior to and after the 15-20 minute procedure can usually soothe this. Side effects are minimal and include some redness and swelling of the skin that disappears within a few days. Patients may also notice some skin discoloration for a week or two after treatment. Most veins require two to five treatments to achieve the desired results.
Procedures for Large or Deep varicose veins
Vein Ligation and Stripping or Phlebectomy involves surgically removing medium to larger varicose veins near the skin surface by inserting a surgical instrument with a hook into small incisions in the skin and pulling veins out in segments. The procedure is often repeated 10 to 20 times per leg until all visible varicose veins have been removed. Most people are able to return to their normal daily and recreational activities within a few weeks. Vein ligation and stripping is effective in producing long-term results in 85% of people. Some common side effects from vein stripping and ligation surgery may include temporary pain or discomfort, bruising, hematoma, numbness, and less frequently wound infection. Vein stripping is an invasive procedure and should not be performed on older individuals for whom surgery poses a risk due to other medical conditions. It is also not an appropriate choice for people who have circulatory problems of the legs, skin infections, blood-clotting defects or an abnormal passageway between and artery and vein. Pregnant women are also inappropriate candidates for vein stripping.
VNUS® Closure® Procedure is a minimally invasive treatment alternative to traditional vein stripping surgery. The VNUS Closure® procedure was cleared for marketing in the US in March 1999. The VNUS Closure® procedure is becoming increasingly popular as doctors become more familiar with this treatment. The procedure is done by placing a very small tube (catheter) into the vein to deliver radio frequency energy to the vein wall, causing it to collapse and seal shut. Once the diseased vein is sealed, healthy veins will take over and redirect the blood flow. The procedure is minimally invasive and can be performed under local anesthesia in a doctor's office. Patients have reported feeling little, if any, pain during the procedure and most return to their normal activity within a day. Some common side effects may include temporary tenderness and numbness. Most patients report a noticeable improvement in their symptoms in 1-2 weeks following the procedure and experience good cosmetic outcomes with little to no scarring. As the VNUS Closure® procedure becomes more commonly used, more and more insurance companies are covering the costs, when deemed medically necessary.
Preventing Varicose Veins
There is no way to prevent varicose veins from occurring. However, by adhering to the following suggestions, you may be able to alleviate symptoms of varicose veins and slow down the progression of the condition.- Maintain a healthy weight to avoid placing excess pressure on your legs.
- Avoid crossing your legs while sitting.
- Do not sit or stand for extended periods of time. Be sure to shift your weight from side to side or get up and stretch every 30 minutes.
- Avoid tight clothing that might constrict your waist, groin or legs, such as garter belts.
- Wear elastic support stockings.
- Control your salt-intake to prevent inadvertent water retention and swelling.
