What are varicose veins?

Varicose veins are the visible and large, bulging, surface veins, felt under the skin. They generally are larger than one eighth inch in width, and are usually located along the inside part of the calf or thigh. Varicose veins develop due to weakness of the vein wall and because the valves of the veins no longer work. Under the pressure of gravity these veins can continue to expand and, in time, they may become longer, twisty, pouched, thickened and painful.

Spider veins and reticular veins are often mistaken for varicose veins. They are the visible purple or greenish-blue veins which are visible. They are easily seen (but not felt) and are usually located at the surface skin layers. Reticular veins are larger than spider veins but smaller than varicose veins and may cause symptoms. Spider veins typically do not cause symptoms, and treatment for these is frequently cosmetic unless symptoms are present.

Vein problems are among the most common chronic conditions in North America. In fact, more people lose work time from vein disorders than from artery disease. Varicose veins affect up to 25% of women and 15% of men. By the age of 50, nearly 40 percent of women and 20 percent of men have significant leg vein problems. It is estimated that at least 20-25 million Americans have varicose veins.

Who is at risk?

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

• Family history of varicose veins

• Prolonged standing

• Increasing age

• Heavy lifting

• Prior blood clots in superficial or deep veins

• Multiple pregnancies

Limited physical activity, high blood pressure and obesity have also been linked with the presence of varicose veins in women.

What are the signs and symptoms?

Varicose veins may be entirely symptom free and cause no immediate health problems. Treatment in such cases is usually considered cosmetic. When symptoms are present, the most common are ankle and leg swelling, heaviness or fullness, aching, restlessness, fatigue, pain, cramps and itching. Varicose veins can also be associated with ulcers (sores) of the legs. In the most severe cases, varicose veins may lead to thickening and discoloration of the skin of the legs, eczema and non-healing sores around the ankle area. Varicose veins, especially when they are very large, are at risk of forming a blood clot, a condition known as superficial thrombophlebitis. If you experience any of these symptoms, talk with your doctor. Don't ignore leg pains.

What are the causes?

The causes of varicose veins are related to non-functioning vein valves. Vein valves are designed to allow blood to flow from the legs toward the heart against gravity, while preventing reverse flow back down the legs. Reverse flow is called venous reflux. Vein valves may fail to close due to either (1) vein wall weakness that causes the vein to enlarge and the valves to leak; (2) a history of blood clots in the vein that damage the valves; or (3) an absence of vein valves since birth. Varicose veins can be hereditary, often occurring in several members of the same family. Varicose veins can also develop after trauma or injury.

Regardless of cause, defective valves cause venous blood to stagnate (pool) in the legs, leading to high blood pressure in the leg veins. This may result in further enlargement of the varicose veins, increasing the likelihood of advanced symptoms such as skin changes and ulcers at the ankles. Reflux in the largest superficial veins, such as the saphenous veins, is often an underlying cause of painful varicose veins. Venous reflux is a condition than can be progressive. If left untreated, it can worsen and cause more advanced symptoms.

How are varicose veins diagnosed?

The most accurate and detailed test is a duplex ultrasound exam which provides an ultrasound image of the vein to detect any blockage caused by blood clots, and to determine whether the vein valves are working properly or have evidence of reflux.

How are varicose veins treated?

Traditional treatments include making life-style modifications, wearing compression stockings and taking some medications. Patients with varicose veins are encouraged to lose weight, exercise and elevate their legs. Compression stocking are effective in reducing swelling and pain. Vein Clinics Northwest carries a variety of prescription and non-prescription compression hose, including athletic recovery stockings.

If these traditional treatments are not successful, then endovascular procedures or surgery is recommended. Catheter-directed (endovascular) techniques have revolutionized the treatment of varicose veins, with reduced complications and time away from work. Vein stripping used to be the traditional treatment for bad valves in the veins however it is rarely used today due to the advancement of less invasive procedures.

What you can do!

You can't do anything about your heredity, age, or gender. However, you can help delay the development of varicose veins or keep them from progressing. Some things you can do:

• Be active. Moving leg muscles keeps the blood flowing.

• Work with your doctor to keep your blood pressure under control.

• To temporarily relieve symptoms, lie down and raise your legs at least six inches above the level of your heart. Do this for at least 10 minutes a few times each day.

• Strive for a normal and healthy weight.

• Wear your prescription compression stocking as specified by your doctor.

• Schedule a consultation with Dr. Stafford at Vein Clinics Northwest who can diagnose the cause of your varicose veins, the sources of venous reflux in your legs, and offer a variety of treatment options.