Varicose Veins

What are varicose veins?

Veins are vascular structures which return blood to the heart- against gravity. The body has two types of veins- one set under the skin (superficial) and one set deep with the muscles (deep). The superficial veins are the ones that get noticed when they turn into large bulging veins in the legs. Varicose veins can occur in almost anyone and affect up to 35% of people in the United States. You may inherit a tendency to develop varicose veins from a parent. Women, women who have had multiple children, and obese persons are at a higher risk.

What are the symptoms of varicose veins?

You may have no symptoms.

Pain, itching, swelling, burning, leg heaviness or tiredness, skin discoloration. Symptoms typically worsen throughout the day and are partially relieved by elevation or wearing compression socks or stockings.

Sometimes, varicose veins clot and become painful, hot, hard and discolored. This is called phlebitis, an uncomfortable but temporary condition that will get better on its own in 2-3 months. Clots associated with phlebitis are limited to surface veins, and not dangerous - unlike clots in the deep veins (deep vein thrombosis or DVT) that are dangerous because they can travel to the heart or lung and require prompt medical attention. Occasionally, shaving the legs or a minor trauma can cause a varicose vein to burst and bleed. Skin tears or ulceration indicate a very severe case.

What causes varicose veins?

Veins propel blood against gravity to return it to the heart. They have intrinsic “one way” valves to assist with the blood return. Over time, the valves may deteriorate and allow blood to pool into the calves and dilate the walls of the veins. This scenario weakens the vein walls and causes the veins to dilate.

How is the diagnosis of varicose veins confirmed?

All diagnoses begin with a history and physical exam. To assess venous function, your vascular surgeon will examine you standing up and lying down. Ultrasound, a painless non invasive exam, is also used to assess venous function and flow.

Treatment strategies

  • Conservative
    • Stockings
    • Walking
    • Elevation of legs above heart
  • Open surgery- Vein stripping, several small incisions, done insurgery
  • Catheter based procedures
    • Ablation: Uses US guidance to position catheter in vein
      • Laser- office procedure, no incisions, US guidance, “seals” the vein closed with heat
      • Radiofrequency- office procedure, no incisions, US guidance, “seals” the vein closed with heat
      • Chemical ablation- office procedure, no incisions, US guidance, “seals” the vein closed with chemical
  • Sclerotherapy- office procedure, for veins within the skin, small needle used to inject vein causing the vein to spasm & clot

After treatment

After treatment, patients should continue to wear compression stockings to help prevent new varicose veins from forming, and to speed recovery after varicose veins are treated. Regular walking and periodic elevation of the legs should become part of your daily routine to maintain your vein health.

Content reprinted with permission from the Society for Vascular Surgery® (SVS).

 

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