Definition

Varicose veins are dilated, tortuous, elongated superficial
veins that are usually seen in the legs.

Description

Varicose veins, also called varicosities, are seen
most often in the legs, although they can be found in
other parts of the body. Most often, they appear as lumpy,
winding vessels just below the surface of the skin. There
are three types of veins, superficial veins that are just
beneath the surface of the skin, deep veins that are large
blood vessels found deep inside muscles, and perforator
veins that connect the superficial veins to the deep veins.
The superficial veins are the blood vessels most often
affected by varicose veins and are the veins seen by eye
when the varicose condition has developed.

The inside wall of veins have valves that open and
close in response to the blood flow. When the left ventricle
of the heart pushes blood out into the aorta, it produces
the high pressure pulse of the heartbeat and pushes
blood throughout the body. Between heartbeats, there is a
period of low blood pressure. During the low pressure
period, blood in the veins is affected by gravity and wants
to flow downward. The valves in the veins prevent this
from happening. Varicose veins start when one or more
valves fail to close. The blood pressure in that section of
vein increases, causing additional valves to fail. This
allows blood to pool and stretch the veins, further weakening
the walls of the veins. The walls of the affected
veins lose their elasticity in response to increased blood
pressure. As the vessels weaken, more and more valves
are unable to close properly. The veins become larger and
wider over time and begin to appear as lumpy, winding
chains underneath the skin. Varicose veins can develop in
the deep veins also. Varicose veins in the superficial veins
are called primary varicosities, while varicose veins in the
deep veins are called secondary varicosities.

Causes and symptoms

The predisposing causes of varicose veins are multiple,
and lifestyle and hormonal factors play a role. Some
families seem to have a higher incidence of varicose
veins, indicating that there may be a genetic component
to this disease. Varicose veins are progressive; as one
section of the veins weakens, it causes increased pressure
on adjacent sections of veins. These sections often develop
varicosities. Varicose veins can appear following
pregnancy, thrombophlebitis, congenital blood vessel
weakness, or obesity, but is not limited to these conditions.
Edema of the surrounding tissue, ankles, and
calves, is not usually a complication of primary (superficial)
varicose veins and, when seen, usually indicates
that the deep veins may have varicosities or clots.
Varicose veins are a common problem; approximately
15% of the adult population in the United States have
varicose veins. Women have a much higher incidence of
this disease than men. The symptoms can include aching,
pain, itchiness, or burning sensations, especially when
standing. In some cases, with chronically bad veins,
there may be a brownish discoloration of the skin or
ulcers (open sores) near the ankles. A condition that is
frequently associated with varicose veins is spider-burst
veins. Spider-burst veins are very small veins that are
enlarged. They may be caused by back-pressure from
varicose veins, but can be caused by other factors. They
are frequently associated with pregnancy and there may
be hormonal factors associated with their development.
They are primarily of cosmetic concern and do not present
any medical concerns.

Diagnosis

Varicose veins can usually be seen. In cases where
varicose veins are suspected, but can not be seen, a
physician may frequently detect them by palpation
(pressing with the fingers). X rays or ultrasound tests can
detect varicose veins in the deep and perforator veins and
rule out blood clots in the deep veins.

Treatment

There is no cure for varicose veins. Treatment falls
into two classes; relief of symptoms and removal of the
affected veins. Symptom relief includes such measures
as wearing support stockings, which compress the veins
and hold them in place. This keeps the veins from
stretching and limits pain. Other measures are sitting
down, using a footstool when sitting, avoiding standing
for long periods of time, and raising the legs whenever
possible. These measures work by reducing the blood
pressure in leg veins. Prolonged standing allows the
blood to collect under high pressure in the varicose veins.
Exercise such as walking, biking, and swimming, is beneficial.
When the legs are active, the leg muscles help
pump the blood in the veins. This limits the amount of
blood that collects in the varicose veins and reduces
some of the symptoms. These measures reduce symptoms,
but do not stop the disease.

Surgery is used to remove varicose veins from the
body. It is recommended for varicose veins that are causing
pain or are very unsightly, and when hemorrhaging or
recurrent thrombosis appear. Surgery involves making an
incision through the skin at both ends of the section of
vein being removed. A flexible wire is inserted through
one end and extended to the other. The wire is then with-
drawn, pulling the vein out with it. This is called “stripping”
and is the most common method to remove superficial
varicose veins. As long as the deeper veins are still
functioning properly, a person can live without some of
the superficial veins. Because of this, stripped varicose
veins are not replaced.

Injection therapy is an alternate therapy used to seal
varicose veins. This prevents blood from entering the
sealed sections of the vein. The veins remain in the body,
but no longer carry blood. This procedure can be performed
on an out-patient basis and does not require anesthesia.

It is frequently used if people develop more varicose
veins after surgery to remove the larger varicose
veins and to seal spider-burst veins for people concerned
about cosmetic appearance. Injection therapy is also
called sclerotherapy. At one time, a method of injection
therapy was used that did not have a good success rate.
Veins did not seal properly and blood clots formed. Modern
injection therapy is improved and has a much higher
success rate.

Prognosis

Untreated varicose veins become increasingly large
and more obvious with time. Surgical stripping of varicose
veins is successful for most patients. Most do not
develop new, large varicose veins following surgery.
Surgery does not decrease a person’s tendency to develop
varicose veins. Varicose veins may develop in other locations
after stripping.