Varicose Veins

Overview

Varicose veins are the superficial appearance of veins due to their enlargement and twisting. These veins are prominent in the legs and show minimal symptoms during the early days. However, affected individuals will likely experience fatigue and pain in the area.

The common phenomenon that leads to varicose veins is increasing venous pressure in the lower limbs as the blood moves upward in the body slowly. Since most of the blood remains confined to the legs, this leads to varicose veins.

Most people suffer from variations of varicose veins, the symptoms of which may range from mild to moderate. While some might need cosmetic procedures based on dermatologists’ consultation, others may require a vascular surgeon.

The treatment may involve home-based care for some patients, while others may have to undergo surgical procedures. Additionally, the condition does not have a definite cause. The risk factors include obesity, lack of exercise, traumatic injury in the legs, and a family history of the condition.

Like varying risk factors, there are multiple options for treatment as well. Some patients may need to change their lifestyles, and others may live with them. There is no doubt that varicose veins affect the quality of life, and patients need significant help with it. Nearly 30% of people are likely to experience varicose veins at some point. In addition, the statistics also reveal that women have more chances of developing this condition as compared to men.

Types of Varicose Veins: 

Varicose veins are classified into various types, each with its own set of characteristics. That's because the body has many different types of veins, and not all of them look the same when they become varicose. Let's look at some of the most common varicose veins.

Saphenous varicose veins:
Saphenous varicose veins affect the saphenous veins in the legs. They swell significantly larger than their intended size and protrude from the skin. The veins appear very large and ropelike. This type of varicose vein can be colourless but still noticeable because it protrudes out.

Reticular varicose veins:
Reticular varicose veins spread like a mesh, covering a larger skin area. The veins are typically thicker and coloured red, green, or purple. Reticular veins don't always bulge out, but they can be unsightly.

Spider Veins:
Spider veins are smaller in size, red or blue in colour, and occur anywhere on the body. Spider veins usually spread in a web shape rather than a mesh shape, and they are thinner and smaller than other varicose veins.

Symptoms:

Varicose veins have several symptoms, which may include:

Veins that are dark purple or blue, and the visibility of these changes varies depending on skin colour.
Veins that appear twisted and bulging, resembling cords on the legs.

An achy or heavy sensation in the legs can worsen after sitting or standing for a long time.
The lower legs are burning, throbbing, cramping, and swelling.
Itching around one or more veins.
Skin colour changes around a varicose vein.
If you are experiencing any of these symptoms, you should see a doctor for an accurate diagnosis and treatment.

Causes:

Weakened valves and vein walls cause varicose veins. Here’s a summary of the causes:

Valve Malfunction: Normally, veins have one-way valves to prevent blood from flowing backwards. If these valves are weak or damaged, blood can back up and pool in the veins, causing them to enlarge.
Risk Factors: Several factors can increase the risk of developing varicose veins, including family history, age, menopause, pregnancy, prolonged standing, being overweight, and a sedentary lifestyle.
Complications: If left untreated, varicose veins can lead to ulcers, blood clots, and bleeding.
Treatment can range from self-care measures like exercise and wearing compression stockings to medical procedures such as sclerotherapy, laser surgery, or vein stripping.

Risk factors:

There are two major risk factors for varicose veins:

• Family history: If you have other family members with varicose veins, you are also more likely to develop them.

• Obesity: Being overweight increases the pressure on the veins.

Other factors that may increase the risk of varicose veins are:

• Age: Aging wears down the valves in the veins that control blood flow. Over time, the valves wear, allowing some blood to flow back into the veins and collect.

• Sex: Women are more likely to develop the condition. Hormones relax vein walls. Changes in hormones before a menstrual period, during pregnancy, or menopause may all play a role. Hormone therapies, such as birth control pills, may raise the risk of varicose veins.

• Pregnancy: During pregnancy, the volume of blood in the body increases. This change benefits the developing baby, but it can also cause the veins in the legs to expand.

• Standing or sitting for extended periods of time: Movement promotes blood flow.
   

Possible Complications:

Since varicose veins directly affect blood flow in the body, they will likely cause significant complications if left untreated. While most people get them treated on time, many fail to observe their development and advancement.

Below are some risks and complications associated with the condition:

• Heavy bleeding

Varicose veins are prominent on the skin, and a slight bump or cut can lead to severe bleeding. Generally, the bleeding is difficult to control and requires immediate help from a medical expert. However, a first aid activity involves lying down, raising the leg, and applying pressure to the wound.

• Blood clots

As mentioned earlier, varicose veins can progress to form clots under the skin. Some of these clots can travel to the lungs and cause pulmonary embolism.

• Walking difficulty

Many people find walking or balancing themselves hard due to pain and tenderness in their legs. Additionally, many patients cannot stand for long due to poor blood circulation in their lower limbs or legs.

• Skin conditions

No matter how unusual it sounds, varicose veins can lead to dermatitis and skin peeling. The progressive disease also leads to skin ulcers near the ankle, called venous ulcers.

• Carcinoma

Long-standing venous ulcers may turn into carcinoma or sarcoma in many cases. However, this progression is very rare, with only 1% of varicose patients suffering from venous ulcers.

• Other risks

Some other risks associated with this condition involve necrosis.
 

When to consult a doctor?

Even though varicose veins show varying symptoms, they might affect the quality of life and make the condition painful. It is imperative to seek a medical expert’s opinion and consult with them about the treatment under the following conditions:

• Frequent pain: In the initial phase, varicose veins are manageable and do not show prominent symptoms. However, the condition progresses and leads to persistent pain that is dull yet uncomfortable. This could mean that the problem has become chronic and requires immediate attention.

• Heaviness in legs: The heaviness could be due to accumulated blood over a long period. The patient might start feeling heaviness or discomfort in the lower limbs only after a chronic condition. Many people might experience numbness in their legs while folding them to sit on a flat surface for a few minutes.

• Inflammation: It might seem minor, but visible varicose inflammation can be life-threatening. In many cases, people experience blood clot formation that could lead to deep vein thrombosis or pulmonary embolism.

• Superficial thrombophlebitis: This type of blood clot occurs just under the skin and is prominent because it causes sharp pain in the body. A patient might feel the veins hardening and becoming red in colour. Even though this clot does not travel to the lungs, it is essential to take it as a warning sign to consult a doctor.

Diagnosis:

Knowing a health problem early can aid on-time treatment and better recovery. Below are the points on how one can diagnose varicose veins:

• Physical examination

This is one of the primary methods for diagnosing varicose veins. It involves the medical practitioner examining the patient’s legs and the visible veins. Since the problem is present in various stages, observing the swelling, discolouration, and bulging is essential.

In addition to noticing the physical appearance, the doctors also press the area and enquire about pain and other symptoms.

• Doppler ultrasound

This is a crucial diagnostic test that helps in diagnosing varicose veins. With this test, doctors can find the presence of blood clots. This non-invasive test uses high-frequency sound waves to analyse the blood flow pattern in the veins.

• Trendelenburg test

This type of physical examination follows a standard procedure to assess the veins. The test looks for irregularities in the valves to understand why the blood cannot flow correctly. The result of this test is either positive or negative.

• Venogram

This particular diagnostic procedure uses a dye as an imaging technique to assess the condition of the veins. The doctor injects a dye in the affected area and takes an X-ray of the region. The dye injected is visible and shows blood flowing through the veins.

A doctor may suggest some more imaging tests to assess the condition and examine the case. These tests aim to discover the presence of blood clots, blockages, and the reason for swelling.

Treatment:

The majority of varicose vein cases can be detected at an early stage. Hence, the treatment plan mainly involves self-care and convenient home-based procedures. However, leaving the veins untreated for a long time might require extensive surgical healing procedures.

Additionally, it is essential to find the underlying cause of the condition to treat it effectively. Thus, below are some treatments for varicose veins:

• Self-care

Home-based treatment and self-care exercises are advisable for people who can detect their varicosities early. This includes leg exercises to improve leg movement and ensure better blood flow. These exercises are specially curated to ease pain.

• Medication

  Medications for varicose veins typically include:

  Sclerosing Agents: These are used in procedures like sclerotherapy, where a solution is injected into the vein to close and seal it. Examples include polidocanol and sodium tetradecyl sulfate.
  Phlebotonics: These oral medications can help reduce swelling and improve symptoms. Examples include diosmiplex and horse chestnut seed extract.
  Pain Relievers: Over-the-counter NSAIDs, such as aspirin, ibuprofen, or acetaminophen, can be used to manage pain and discomfort.
  It’s important to consult with a healthcare provider to determine the most appropriate treatment for your condition. They can provide personalized advice and prescribe medication if necessary. Remember, self-treatment without professional guidance is not recommended due to potential complications and side effects.

• Compression stockings

A compression stocking is wearable like a tight sock that keeps the leg muscles compressed to allow the blood to move efficiently through the vessels. Additionally, the amount of compression varies from brand to brand. However, buying the stockings after consulting with a doctor is always better. These stockings are available as over-the-counter products and also on prescription.

• Surgeries and other procedures

Another way to deal with varicose veins is to go for surgical procedures that heal the condition. However, this is effective for people who are already at the advanced stage of this disease, and other therapies are ineffective for them.

Below are some procedures that you must be aware of to treat varicose veins:

1. Laser treatment

As usual, a laser uses intense bursts of light to fade the varicose veins and allow them to disappear slowly. This is also a noninvasive procedure that does not involve cuts or needles.

2. Catheter-based procedure

This is one of the most preferred treatments for people suffering from more prominent varicose veins. During this procedure, a catheter releasing heat or radio waves is inserted into the veins. By the end of the process, the veins seal shut and remain closed, eventually removing the varicose.

3. Vein stripping

This procedure simply removes veins from the leg to eliminate unwanted varicose. However, removing one vein does not impair the leg's blood flow because the more prominent veins look after it. Additionally, it is essential to go for this procedure when the veins do not connect with the more prominent ones.

4. Ambulatory phlebectomy

This outpatient procedure requires leg tissue scarring to get rid of varicose veins. A series of tiny punctures are made to remove the smaller varicose veins visible on the skin.

Additional Information

Different stages of varicose veins

Although each case of varicose veins might be similar to another, it is essential to be aware of the stages and opt for a doctor’s consultation accordingly.

• Stage 1: Spider veins

This is the first stage of varicose veins, which showcases small, spider-web-like veins in the ankles, neck, face, and other areas.

• Stage 2: Ropy varicose veins

The patient’s legs show a typical rope-like vein structure with knots and wavy patterns. Additionally, this is the stage where people can identify the presence of varicose veins.

• Stage 3: Swelling

In the third stage, the legs and ankles show swelling, which indicates an issue with the circulatory system's valves.

• Stage 4: Discolouration

The fourth stage begins with discolouration in the skin and visible veins in the ankles and calves. The skin might also become reddish or brown in colour and have a leathery texture.

• Stage 5: Ulcers

The final stage begins with skin ulceration, which is also vulnerable to turning into sarcoma or carcinoma. It looks like active bleeding ulcers that appear like open wounds.