Varicose Veins

Overview

VascularClinicAd-springVeins use one-way valves to block the blood from flowing backward, against the flow of gravity, as they carry blood from the body’s organs back to the heart. If valves become weak and don’t close properly, blood can flow backward and collect in the veins. This is called “reflux.” Reflux can cause the veins to become enlarged and twisted. Such veins are called varicose veins. The condition of having varicose veins is called “Superficial Venous Insufficiency“.

Any vein can become varicose, but varicose veins occur most commonly in the legs and feet. Varicose veins are common, especially among older women and even in men. Pregnant women commonly develop varicose veins.

Spider veins are similar to varicose veins, except much smaller. Please see the page devoted to treatment of spider veins for more information.

Possible Causes

Veins carry blood from the body’s organs and parts to the heart. When the valves that keep the blood flowing toward the heart, rather than away from it, malfunction, the blood remains in the vein, and the vein becomes enlarged and possibly misshapen. If a person stands up for extended periods of time, he or she may be at a higher rick of developing varicose veins.

  • Congenitally defective valves:
    Some people are born with valves that do not work properly. These can lead to varicose veins relatively early in a person’s life.
  • Thrombophlebitis:
    Thrombophlebitis occurs when one or more varicose veins develop a blood clot and inflammation.
  • Pregnancy:
    When a woman is pregnant, her body produces more blood to care for the growing fetus. The body undergoes changes focused on getting the most blood possible to the fetus. The growing uterus may also cause flow through the veins of the pelvis and abdomen to become limited. Additionally, female hormones cause changes in the veins that can lead to varicose vein formation.
  • DVT (Deep Vein Thrombosis):
    Previous blood clots in the deep veins of the leg can destroy the valves or render them unable to function. This leads to reflux and varicose veins.
  • Idiopathic:
    Many times a cause for varicose veins cannot be found. There is a hereditary component to this disease—half of all patients treated for varicose veins have a family history. Obesity, occupation, and gender all contribute to varicose vein formation.

 

Symptoms

Varicose veins are dark purple or blue and may appear like cords of rope or blue threads. They may become twisted or bulging. They most commonly appear on the back of the calves and knees or on the inside of the leg. Symptoms may include the following:

  1. Enlarged veins, visible beneath the skin. Smaller veins, called “spider veins,” may be present.
  2. Pain, aching or a heaving feeling in the legs, especially in the evening, after standing all day. Night cramps may occur.
  3. Mild swelling of the ankle; more severe swelling is possible. You may experience itching, burning, or discomfort.
  4. Brown discoloration of the skin around the ankles. The skin may turn thick and tough.
  5. Skin ulcers around the ankles. This is the most severe complication of varicose veins.

The above symptoms are listed in the order of severity. Many people consider varicose veins a cosmetic problem, but once symptoms occur (including those listed above), varicose veins should be considered a legitimate health concern.

Diagnosis

Diagnosis of varicose veins typically comes when a doctor examines a patient’s legs for the appearance of swelling, particularly when the patient stands. Occasionally an ultrasound will also be performed to get a better idea of the blood flow in the legs, and to check for blood clots. The ultrasound can also check for reflux in the veins, to see if blood is traveling away from the heart, indicating malfunction of the valves.

Treatment Options

Varicose veins that appear during pregnancy will often improve within several months. Patients who develop varicose veins may be asked to take several steps to help their condition:

  • Avoid long periods of standing.
  • Elevate the legs when sitting or laying down.
  • Wear elastic support hose.

Many patients may require treatment for their varicose veins. If so, one of the following treatment options may be appropriate:

  • Sclerotherapy:
    This treatment involves injection of a solution that closes the varicose veins. The injected vein(s) should fade after several weeks. Sclerotherapy does not require anesthesia and can be done at the doctor’s office. Please see the Sclerotherapy page to learn more.
  • Laser ablation:
    New technology in laser treatment can effectively treat varicose veins in the legs, upper body, and face. No incisions are needed.
    For more information, please see our poster.
  • Catheter-assisted procedures:
    Large superficial veins that have reflux can be treated by inserting a catheter into the vein. The tip of the catheter is heated, and the heat collapses the vein as the catheter is removed. Catheter-assisted procedures use laser or radio waves as a heat source to destroy varicose veins. Other instruments use rotating blades to destroy clusters of veins.
  • Vein stripping:
    Several surgical procedures are available to remove varicose veins. The doctor makes small incisions in order to remove a longer vein. The long, diseased vein is stripped from the thigh and leg to control its contribution to varicose veins.
  • Ambulatory phlebectomy:
    Several tiny skin punctures are used to remove smaller varicose veins. Some local anesthesia may be administered, but the procedure is still outpatient.
  • Endoscopic vein surgery:
    This operation typically will only be used to treat severe varicose veins of a particular type that include leg ulcers. A tiny video camera is inserted into the leg to visualize and close veins. Only small incisions are needed. It may be used in combination with other procedures, and in the future may be replaced by newer technologies.