What are varicose veins?
A varicose vein is a larger, sometimes bulging vein. The condition is usually the result of problems with valves within the veins of the leg. When one or more of the valves fails to close properly, the veins allow blood to flow backwards into the leg instead of up to the heart. As blood accumulates, abnormal pressures swell the superficial vein system, causing the veins to bulge and become visible- hence the creation of varicose veins! The most common factors in the development of varicose veins are heredity, pregnancy and hormones. Other factors include leg injury, sedentary lifestyle, prolonged standing, obesity and hot weather. Varicose veins are typically chronic and progressive.
Approximately 25 percent of women and 15 percent of men in the United States have varicose veins. The tendency to get varicose veins is commonly hereditary and occurs more commonly in women than men.
How do I know if I have varicose veins?
Varicose veins can cause painful, heavy, and/or swollen legs- these are just a few of the symptoms common in varicose vein disease. Many people complain of itching and soreness in the thighs and legs. In more severe cases, leg ulcers, skin thickening and skin discoloration are seen.
About Varicose Veins
Varicose veins can cause symptoms or be entirely asymptomatic. Prior to determining a course of action for your legs, we will conduct a careful examination including your history designed to elicit symptoms commonly associated with varicose veins and to identify any signs of advanced venous pathology.
Common symptoms associated with varicose veins include:
- Spider Veins
- Protruding, Swollen, Visible Veins
Less common signs or symptoms may appear and persist. These include:
- Superficial blood clotting (thrombophlebitis, manifesting with pain)
- Restless legs at night
- Leg cramps at night
Severe symptoms are a red flag!
If you are experiencing any of the following, you should seek a full venous evaluation soon. These include:
- Discoloration of the skin above your ankle (hyper pigmentation)
- Hardening of the tissues above your ankle (dermatofibrosclerosis)
- Bleeding from a superficial vein after minor trauma
- Unusual rashes or areas of dermatitis
- Skin ulceration (open sores)
Varicose Vein Risks
Many patients will try to ignore varicose veins; however, treatment is important to prevent dilated, twisted veins, episodes of aching pain, and leg ulcers on the surface of the skin. If left untreated, varicose veins can lead to more serious complications. Early treatment is highly recommended to help prevent the varicose veins from becoming advanced and more difficult to manage.
Old Varicose Vein Treatments
The old technique for Varicose Vein treatment was known as vein stripping, a painful but effective method that is still in practice in some areas. There are several new techniques such as radio frequency “Closure” and laser based “EVLT” that address these problems more effectively with less pain, with a much shorter recovery time, and more safely due to reduced chance for infection or post-op complications. There is also sclero or injection therapy, foam sclerosants, and ambulatory phlebectomy or Trivex. Most are used with special light devices to make vein treatment more accurate. At AVVC we have used virtually all methods available, and will choose the treatments most suitable for your personal condition.
The cause of varicose veins are either weakened vein walls and broken valves in the main superficial vein system or the veins communicating with deep veins in the leg. It is critical to properly diagnose and discern the source of your problems, because the treatment for varicose veins is different for each. It is important that your venous studies that will determine your condition be done by a registered vascular technician in combination with a board certified professional.
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Depending on the severity of the condition, initial treatment is usually a compression stocking worn while the patient is up and about. The stocking may relieve the symptoms and delay the progression of the condition somewhat, but does not cure the underlying problem. The definitive treatment is to stop the flow of blood back into the legs by surgically destroying the varicose vein.
Causes of Varicose Veins:
Varicose veins are not something that happen overnight. Usually it takes several to many years for them to develop to a stage where symptoms occur. Occasionally we will see a young person in their 20’s with severe varicose vein issues – these are commonly believed to be inherited. Varicose veins are commonly inherited although its important to note that anyone can get them. Often times varicose veins are common in people who have had certain types of injury to the leg or an episode of deep vein clots. Varicose veins are seen more frequently in today’s society with many standing and sitting professions, which in turn deprive veins of regular circulatory flow of the leg “calf-pump” muscles. Lack of exercise, restrictive clothing, smoking, pregnancy, and weight gain can add to the strain on your veins.
The following are sources of Varicose Veins:
1. Incompetent saphenous veins (greater or lesser)
2. Incompetent perforator veins
3. Incompetent branches of the saphenous veins
In the first two categories it is important to treat the source of the problem otherwise varicose veins will recur. For incompetent saphenous veins the procedure of choice for many years was ligation (tying off the veins) or ligation and stripping (tying off and removing) from the groin to the knee. Though stripping is still done in some places, multiple studies over the past 6 years have shown equal or greater effectiveness with minimally invasive treatments (Closure RF, EVLT) and with considerably less recovery time, pain and bruising, (Closure RF). For the incompetent perforators the more recently introduced procedure using RF (radio frequency) is proving to be effective and so much simpler than what was previously performed (a SEPS pr Linton procedure). All these procedures are performed on an outpatient basis!
Please Note: The main superficial vein in the leg is the Saphenous vein. Communicating or “connector” veins between the Saphenous vein and the deep vein system, are called “Perforatoring” veins.
Traditional varicose vein surgeries are “blind procedures” requiring long operative times and multiple incisions. In vein stripping, for instance, a long wire is threaded into the vein from the groin to the ankle and secured to an acorn-shaped head attached to the wire. Traction on the wire at the groin is used to pull the vein out, with the remnants of the vein removed through incisions in the leg.
Varicose Veins During Pregnancy:
It is common for women to develop varicose veins during their pregnancy. The main cause of this is due to the hormone changes in the woman’s body, and to a lesser extent, weight gain. There are increased levels of progesterone which cause the blood vessels to relax. This problem can be increased due to the fact that the enlarged womb may pressure the major veins that pass through the pelvis which results on pressure in the veins of the legs. Varicose veins during pregnancy are more likely to affect women who have an inherited tendency of varicose veins in their family.
Its important to note that varicose veins may disappear after pregnancy however after each subsequent pregnancy varicose veins are more likely to appear and become more visible. For women who had varicose veins in previous pregnancies its important you take precautions if you become pregnant again.