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Varicose Veins Explained

Swollen and enlarged, dark purple varicose veins on the inside of the leg or the backs of the calves are more than just a cosmetic problem. Left untreated, varicose veins can progress to cause discoloration of the skin, inflammatory dermatitis, the bacterial infection known as cellulitis, ulceration, and worse.

Who Gets Varicose Veins. Varicose veins are found more often in older people than in younger people, and in more women than men. In the Tecumseh Health Study, varicose veins were diagnosed in 72% of all women aged 60 to 69, and even in 1% of all men in their 20's. In the adult population as a whole, about 50 to 55% of women and 40 to 50% of men have vascular changes that can lead to varicose veins, and about 20 to 25% of women and 10 to 15% of men have already-visible varicose veins. The vascular damage that causes varicose veins, however, often originates in childhood and can begin causing all the symptoms of varicose veins except their characteristic purplish blue bulges as early as the age of 10.

Not Just a Cosmetic Problem. Varicose veins are unsightly, but they are not just a cosmetic problem. A varicose vein may cause troubling symptoms even it is entirely invisible to the naked eye. The legs may ache and feel itchy even though the skin is still smooth. There may be leg cramps at night, worse after long days spent standing. The skin of the leg may feel ropey before the varicose veins begin to bulge under the skin.

Varicose veins may cause:

  • Pain or tenderness along the course of a vein.
  • Heaviness, itching, burning sensations, numbness, swelling, restless legs, and leg cramps. These symptoms are worse when the condition is producing spider veins (telangiectasia) and are less severe as the veins become varicose, then severe again when the varicose veins become numerous and large.
  • Dull pain that is worse after standing, especially after varicose veins become noticeable.
  • Pain that is improved by walking or elevating the legs. Pain that is worse after walking or elevating the legs is associate with arteries inside the leg, not veins on the surface of the leg.
  • In women, symptoms that change with the menstrual cycle, during pregnancy, or after hormone replacement therapy. Treatment of existing varicose veins prior to pregnancy has been shown to prevent the progression of the condition to other veins during pregnancy.

Because varicose veins develop over so many years, many people become so accustomed to these symptoms they do not even notice them by the time varicose veins are evident on the skin.

What Causes Varicose Veins. Some experts describe varicose veins as the result of a high-pressure flow into a low-pressure system. To understand how this can happen, first it is necessary to understand the difference between arteries and veins.

Arteries can oxygenated blood away from the heart, and veins carry oxygen-depleted blood back to the heart. When we are standing, the veins in the legs have to transport blood back to the heart against the force of gravity. The blood in these veins in the outer layers of leg tissue has to be compressed to about five times atmospheric pressure to make sure it does not flow backwards.

Years of localized high blood pressure can wear out the "leaflets" on the valves in these veins that keep blood flowing back towards the heart, so that blood vessels eventually become chronically overfilled and begin to bulge. The strain on one vein causes strain on its neighbors, and more and more veins in the leg from the thighs down to the ankles become varicose. The muscles and skin around varicose veins suffer because they are only fed by oxygen-poor, acid-laden blood that squeezes them against the fascia and tendons that hold them in place.

Surgical Treatment. Doctors have used surgery to treat varicose veins at least since the time of Hippocrates around 400 BC. Surgical technique has improved over the centuries so that less and less invasive procedures are used to "strip" the veins. Doctors also use endovenous (EV) laser and radiofrequency (RF) ablation to collapse varicose veins. Sclerotherapy involves injecting the vein with various soap-like chemicals that dissolve its proteins and leave a cord of fiber in its place; accidental injection of these chemicals into an unidentified artery can cause profound injury to the leg.

Surgical treatment usually results in major changes to the appearance of the leg in just a few weeks. Sometimes, however, surgery can actually make varicose veins worse, by removing a bypass pathway that was protecting veins that had not yet developed the twisting, bulging, bluish appearance on the surface of the legs.

Treatment with Compression Stockings. Compression stockings are a kindler, gentler approach to treating varicose veins. They compensate for the damage to the valves in the veins that keep blood flowing upward to the heart by applying gentle pressure to the leg. Unlike a tourniquet or a long bandage, compression stockings are designed to provide more pressure lower on the leg and less pressure higher on the leg, allowing the veins to do as much of their own work as possible.

There have been extensive studies of the usefulness of compression stockings in treating varicose veins with and without surgery in the UK. Studies find that the outward manifestations of varicose veins heal as well after the use of compression stockings as after surgery, which is always followed by the use compression stockings during recovery. Of course, the earlier in the course of the condition compression stockings are used—preferably as soon as symptoms are noticed—the better the results.

What You Can Do to Help Heal Varicose Veins. Surgery, sclerotherapy, and compression stockings are not the only ways to control varicose veins. You can help heal yourself by simple changes in daily habits:

  • Wear support stockings.
  • Don't cross your legs.
  • Avoid socks and stockings that restrict circulation, especially if they have a tight band at the top.
  • Take walks on a regular basis to improve circulation. If you do not have time to leave your home of work to take a walk, try rotating your feet at the ankles while you are seated in a chair. Alternate clockwise and counterclockwise motion. Raise your legs parallel to the floor, and then point your toes up and down. Ideally, some kind of exercise should be performed about once an hour when you cannot get up to walk.
  • If you have to stand for a long time, shift your weight to one leg and then the other.
  • When you fly, ask for an aisle seat so you can stretch your legs as often as possible.
  • Pain in the calf that won't go away can be caused by a blood clot, and requires immediate medical attention. A hot feeling in the chest or arms combined with a cold feeling in the legs is also a symptom of a clot. Chest pain after vein stripping is a medical emergency.
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