What are varicose veins?

Normal Vein	Vericose Vein

Varicose veins are swollen veins that can be seen through the skin. They occur in the superficial veins in the legs and often look blue, bulging, and twisted.  Large varicose veins can cause aching and fatigue as well as skin changes like rashes, redness, and sores. Left untreated, varicose veins may worsen over time.

As many as 40 million Americans, most of them women, have varicose veins. They usually affect people between the ages of 30 and 70. Pregnant women have an increased risk of developing varicose veins, but the veins often return to normal within 1 year after childbirth. Women who have multiple pregnancies may develop permanent varicose veins.

You have t wo kinds of veins in your legs.

• Superficial veins lie close to your skin.
• Deep veins lie in groups of muscles and lead to the vena cava, your body's largest vein, which runs directly to your heart.
• Perforating veins connect superficial veins to deep veins.

Veins return oxygen-poor blood back to your heart. The blood in your leg veins must work against gravity to return blood to your heart. To help move blood back to your heart, your leg muscles squeeze the deep veins of your legs and feet.  One-way flaps ,called valves,   keep blood flowing in the right direction. When your leg muscles contract, the valves open.  When your legs relax, the valves close. This prevents blood from flowing backward.

The entire process of sending blood back to the heart is called the venous pump .  When you walk and your leg muscles squeeze, the venous pump works well. But when you sit or stand, especially for a long time, the blood in your leg veins can pool and increase the pressure in your veins.

Deep veins and perforating veins are usually able to withstand short periods of increased pressures. However, if you are a susceptible individual, your veins can stretch if you repeatedly sit or stand for a long time. This stretching can sometimes weaken the walls of your veins and damage your vein valves. Varicose veins or spider veins may result.

Spider veins are mild varicose veins that look like a nest of red or blue lines just under your skin. They are not a serious medical problem, but can be a cosmetic concern to some people.

What are the symptoms?

Standing or sitting for too long may worsen symptoms of varicose veins.  These symptoms include:

• a heavy, burning, tired, restless, or achy feeling in your legs
• leg cramps at night
• small clusters of veins in a winding pattern on your leg, or soft, slightly tender knots of veins.
• skin changes including discoloration, irritation, and the formation of sores.

If you have severe varicose veins, you have a slightly increased chance of developing deep vein thrombosis (DVT), a  serious medical condition that may cause sudden and severe leg swelling. DVT  requires  immediate medical attention.

What causes varicose veins?

High blood pressure inside your superficial leg veins causes varicose veins.   Factors that can increase your risk for varicose veins include:

• having a family history of varicose veins
• being overweight
• lack of exercise
• smoking, standing, or sitting for long periods of time,
• having DVT

What tests will I need?

Your physician will need to know information concering  your general health, medical history, and symptoms. He wil examine the texture and color of any prominent veins and may apply a tourniquet or direct hand pressure to observe how your veins fill with blood. To confirm a diagnosis of varicose veins, your physician may order a duplex ultrasound test.

Duplex ultrasound uses high-frequency waves to measure the speed of blood flow and to see the structure of your leg veins. The test can take approximately 20 minutes for each leg. Besides showing varicose veins, duplex ultrasound can help determine whether your varicose veins are related to some other medical condition.

How are varicose veins treated?

Your physician will recommend methods to relieve your symptoms. If you have mild to moderate varicose veins, elevating your legs can help reduce leg swelling and alleviate other symptoms. Your physician may instruct you to prop your feet up above the level of your heart 3 or 4 times a day for about 15 minutes at a time.  When you must stand for a long period of time, flex your legs occasionally to keep blood circulating.

Compression Stockings

For more severe varicose veins, your physician may prescribe compression stockings Compression stockings are elastic stockings that squeeze your veins and stop excess blood from flowing backward. They can also help heal skin sores and prevent them from returning.  For many, compressions stocking effectively treat varicose veins, relieving pain and swelling and preventing  future problems.

When noninvasive treatments do not relieve your symptoms, you may require a surgical or minimally invasive treatment, depending upon the extent and severity of the varicose veins.

Vein Stripping

To perform vein stripping, your physician disconnects and ties off all varicose veins associated with the saphenous vein, the main superficial vein in your leg.  Your physician then removes this vein from your leg.  A procedure, called small incision avulsion, can be done alone or together with vein stripping. Small incision avulsion allows your physician to remove varicose veins from your leg using hooks passed through small incisions.