Varicose Veins: Causes, Symptoms and Treatment

Painful and unsightly, this condition targets women more than men.

The role of veins in the body

Veins are the blood vessels that carry de-oxygenated blood from the rest of the body to the heart. The deoxygenated blood contains carbon dioxide, which is a waste product of the metabolism of all cells.

Veins can be differentiated into three types:

• Superficial veins away from the centre of the body near the surface of the skin.
• Deep veins close to the centre of the body and away from the surface.
• Perforating veins connecting the two.

What are varicose veins?

Arteries have thick layers of elastic tissue or muscle to help circulate oxygen-rich blood from the lungs to all other parts of the body. In order to push blood back to our heart, veins depend mainly on the surrounding muscles and a network of cup-like, one-way valves. As blood flows through a vein, the valves open alternately to allow blood through, then close immediately to prevent backflow.

These valves do not work properly in varicose veins. This allows blood to pool in the vein making it hard for our muscles to push the blood uphill. Blood continues to pool in the vein instead of flowing from one valve to the other. This increases the pressure on the veins and the possibility of congestion while leading to a twist and bulge in the vein. As superficial veins have less muscle support compared to deep veins, they are more likely to become varicose.

Causes of varicose veins

• A family history of varicose veins and older age predisposes to it.
• Women are more commonly affected compared to men.
• Pregnancy, obesity, prolonged standing and weight gain are risk factors.
• Congenital abnormalities of veins, weakness of vein walls and infection of veins (phlebitis).
• Blood clots or obstructions inside veins.

Symptoms and signs of varicose veins

• Bulging dark blue or purple blood vessels, visible on calf and the thigh
• Tender, aching, sore or heavy legs, often associated with swelling in the feet or ankles after standing for a long time

Complication of varicose veins

• Skin over the varicose veins may become ulcerated, flaky, discoloured or prone to bleeding, or symptoms may become incapacitating – a person with varicose veins can also be developing stasis dermatitis. Stasis dermatitis, if left untreated can cause skin infections and chronic leg ulcers. · Red, tender and warm varicose veins could be a sign of phlebitis that is by a blood clot in the vein.
• Injured varicose vein needs care. Burst of blood flow due to leg elevation and direct compression needs to be controlled. Individuals suffering from varicose veins should have their veins evaluated by a vein specialist as this can potentially be a serious complication.

Treatment of varicose veins

In some cases, no treatment is required as the main problem is cosmetic, but the person may feel embarrassed exposing that area so seeks medical help.

Treatment options include medical and surgical depending on the patient’s weight, treatment history, history of allergies and ability to withstand surgery and anaesthesia.

Leg elevation is recommended for mild cases.

The patient may be advised to use compression stockings which reduce blood and pressure in the veins of the lower limb.

• Sclerotherapy: This is a method by which a liquid is injected into the vein causing it to shrink and disintegrate. This forces the blood to go through the remaining healthy veins. The liquid is called sclerosing agent. This technique cannot be used in pregnant women, obese people and those with an allergy to the sclerosing agent. After this treatment dark discolouration of the skin in that area may appear but it completely disappears within 6 months.
• Laser therapy: This technique is useful when small varicose veins are near the surface of the skin but it may cause skin discolouration. For deep varicose veins, laser surgery is recommended. A device inserted through a catheter in the vein transmits intense heat and causes scarring of the vein.
• Stripping of veins: This is an old surgical technique by which a flexible device is inserted into the vein and then the vein is `stripped off’ through a small incision at the groin. Any tributaries of the vein are also tied off through separate small incisions. It has been in use since 1950. After the anaesthesia wears off, there may be some pain at the incision site.

Prevention of varicose veins

Varicose veins can be prevented by avoiding prolonged standing, keeping legs elevated from time to time and wearing elastic support hose. Controlling weight and exercising regularly will also help slow down the progression of this condition.