Varicose veins

Varicose veins

Definition:

Varicose veins are gnarled, enlarged veins. Any vein may become varicose, but the veins most commonly affected are those in your legs and feet. That's because standing and walking upright increases the pressure in the veins of your lower body.

For many people, varicose veins and spider veins — a common, mild variation of varicose veins — are simply a cosmetic concern. For other people, varicose veins can cause aching pain and discomfort. Sometimes varicose veins lead to more-serious problems. Varicose veins may also signal a higher risk of other circulatory problems. Treatment may involve self-care measures or procedures by your doctor to close or remove veins.

Symptoms:

Varicose veins usually don't cause any pain. Signs you may have varicose veins include:

• Veins that are dark purple or blue in color
• Veins that appear twisted and bulging; often like cords on your legs

When painful signs and symptoms occur, they may include:

• An achy or heavy feeling in your legs
• Burning, throbbing, muscle cramping and swelling in your lower legs
• Worsened pain after sitting or standing for a long time
• Itching around one or more of your veins
• Skin ulcers near your ankle, which can mean you have a serious form of vascular disease that requires medical attention

Spider veins are similar to varicose veins, but they're smaller. Spider veins are found closer to the skin's surface and are often red or blue. They occur on the legs, but can also be found on the face. Spider veins vary in size and often look like a spider's web.

When to see a doctor
Self-care — such as exercise, elevating your legs or wearing compression stockings — can help you ease the pain of varicose veins and may prevent them from getting worse. But if you're concerned about how your veins look and feel, and self-care measures haven't stopped your condition from getting worse, see your doctor.

Causes:

Arteries carry blood from your heart to the rest of your tissues. Veins return blood from the rest of your body to your heart, so the blood can be recirculated. To return blood to your heart, the veins in your legs must work against gravity. Muscle contractions in your lower legs act as pumps, and elastic vein walls help blood return to your heart. Tiny valves in your veins open as blood flows toward your heart then close to stop blood from flowing backward.
Causes of varicose veins can include:

• Age. As you get older, your veins can lose elasticity causing them to stretch. The valves in your veins may become weak, allowing blood that should be moving toward your heart to flow backward. Blood pools in your veins, and your veins enlarge and become varicose. The veins appear blue because they contain deoxygenated blood, which is in the process of being recirculated through the lungs.
• Pregnancy. Some pregnant women develop varicose veins. Pregnancy increases the volume of blood in your body, but decreases the flow of blood from your legs to your pelvis. This circulatory change is designed to support the growing fetus, but it can produce an unfortunate side effect — enlarged veins in your legs. Varicose veins may surface for the first time or may worsen during late pregnancy, when your uterus exerts greater pressure on the veins in your legs. Changes in your hormones during pregnancy also may play a role. Varicose veins that develop during pregnancy generally improve without medical treatment within three months after delivery.

Complications:

Complications of varicose veins, although rare, can include:

• Ulcers. Extremely painful ulcers may form on the skin near varicose veins, particularly near the ankles. Ulcers are caused by long-term fluid buildup in these tissues, caused by increased pressure of blood within affected veins. A discolored spot on the skin usually begins before an ulcer forms. See your doctor immediately if you suspect you've developed an ulcer.
• Blood clots. Occasionally, veins deep within the legs become enlarged. In such cases, the affected leg may swell considerably. Any sudden leg swelling warrants urgent medical attention because it may indicate a blood clot — a condition known medically as thrombophlebitis. 

Treatments and drugs:


Fortunately, treatment usually doesn't mean a hospital stay or a long, uncomfortable recovery. Thanks to less invasive procedures, varicose veins can generally be treated on an outpatient basis.
Self-care
Self-care — such as exercising, losing weight, not wearing tight clothes, elevating your legs, and avoiding long periods of standing or sitting — can ease pain and prevent varicose veins from getting worse.

Compression stockings
Wearing compression stockings is often the first approach to try before moving on to other treatments. Compression stockings are worn all day. They steadily squeeze your legs, helping veins and leg muscles move blood more efficiently. The amount of compression varies by type and brand.
Stockings come in a variety of strengths, styles and colors. With the variety offered, you're likely to find a stocking that you're relatively comfortable wearing.
You can buy compression stockings at most pharmacies and medical supply stores. Prices vary. Prescription-strength stockings also are available.

When purchasing compression stockings, make sure that they fit properly. Using a tape measure, you or your pharmacist can measure your legs to ensure you get the right size and fit according to the size chart found on the stocking package. Compression stockings should be strong, but not necessarily tight. If you have weak hands or arthritis, getting these stockings on may be difficult. There are devices to make putting them on easier.

Additional treatments for more-severe varicose veins
If you don't respond to self-care, compression stockings, or if your condition is more severe, your doctor may suggest one of these varicose vein treatments:

• Sclerotherapy. In this procedure, your doctor injects small- and medium-sized varicose veins with a solution that scars and closes those veins. In a few weeks, treated varicose veins should fade. Although the same vein may need to be injected more than once, sclerotherapy is effective if done correctly. Sclerotherapy doesn't require anesthesia and can be done in your doctor's office.
• Laser surgeries. Doctors are using new technology in laser treatments to close off smaller varicose veins and spider veins. Laser surgery works by sending strong bursts of light onto the vein, which makes the vein slowly fade and disappear. No incisions or needles are used.
• Catheter-assisted procedures. In one of these treatments, your doctor inserts a thin tube (catheter) into an enlarged vein and heats the tip of the catheter. As the catheter is pulled out, the heat destroys the vein by causing it to collapse and seal shut. This procedure is usually done for larger varicose veins.
• Vein stripping. This procedure involves removing a long vein through small incisions. This is an outpatient procedure for most people. Removing the vein won't affect circulation in your leg because veins deeper in the leg take care of the larger volumes of blood.
• Ambulatory phlebectomy (fluh-BEK-tuh-me). Your doctor removes smaller varicose veins through a series of tiny skin punctures. Only the parts of your leg that are being pricked are numbed in this outpatient procedure. Scarring is generally minimal.
• Endoscopic vein surgery. You might need this operation only in an advanced case involving leg ulcers. Your surgeon uses a thin video camera inserted in your leg to visualize and close varicose veins, and then removes the veins through small incisions. This procedure is performed on an outpatient basis.

Varicose veins that develop during pregnancy generally improve without medical treatment within three to 12 months after delivery.

Be a cautious consumer
When it comes to treatment options for varicose veins, it pays to be a cautious health consumer. Advertisements claiming "unique," "permanent" or "painless" methods to remove varicose veins may be appealing, but they may not actually measure up to those claims. Before having any procedure, ask your doctor about any health risks and possible side effects.

You may want to inquire about treatment costs, as well. Many insurance policies don't cover the expense of elective cosmetic surgery for varicose veins. However, in many cases, if you have signs or symptoms such as swelling and bleeding, insurance may cover the treatment.
Current treatments for varicose veins and spider veins are effective. However, it's possible that varicose veins can recur.