Varicose veins

Varicose veins are abnormally and permanently enlarged superficial veins typically 3mm or more in diameter. Any vein may become varicose, but veins most commonly affected are those in legs and feet. They may occur alone or with chronic venous insufficiency. The word “varicose” comes from the Latin root “varix,” which means “twisted.

Etiology

Etiology is usually unknown. Most people have no obvious risk factors. Primary varicose veins occur because of congenitally defective valves (primary venous valvular insufficiency) or primary dilatation of the vein wall due to structural weakness, or without a known cause. Secondary varicose veins occur because of another condition, for example they are very often in pregnancy because of increased pelvic and leg venous pressure. In some cases they result from chronic venous insufficiency and venous hypertension. Less commonly, varicose veins are caused by such diseases as phlebitis (inflammation of the veins).

Risk factors

Age. Aging causes wear and tear on the valves in veins, eventually, that wear causes the valves to malfunction. They are most common in people aged 30 to 70.
Sex. Women are more likely than men are to develop the condition (2-3xmore likely). Hormonal changes during premenstruation, pregnancy or menopause may be a factor. Taking hormone replacement therapy or birth control pills may increase the risk of varicose veins. Female hormones tend to relax vein walls, estrogen affects venous structure.
Genetics. Varicose veins are common within family suggesting genetic component. Having a family member with varicose veins may increase the risk for developing them. Approximately half of the people who get varicose veins have a family history of them.
The increased pressure on veins. Varicose veins may also result from conditions that increase pressure on the leg veins, such as being overweight or pregnant.
Standing for long periods of time. A blood doesn’t flow as well if man is in the same position (standing or sitting with legs bent or crossed) for long periods.
Cloths. Wearing clothing that interferes with the normal flow of the blood through the veins.

Pathophysiology

Veins are blood vessels that carry blood from the tissues of the body to the heart. Leg muscles pump the veins to help them in their function, because they must work against gravity. Veins have one-way leaflet valves to prevent blood from flowing backwards (retrograde). They open as blood flows toward the heart then close to stop blood from flowing backward. When the valves are weakened, damaged or don’t work properly, blood backs up and pools in the veins. This causes them to swell and enlarge. When veins become enlarged, the leaflets of the valves no longer meet properly, and the valves don’t work. The blood collects in the veins and they enlarge even more. During aging veins lose elasticity, they become weak allowing blood to flow backward. Pregnancy increases the volume of blood in the body and decreases the flow of blood from legs to the pelvis because of growing uterus, which exerts higher pressure on veins in pelvis.

Symptoms and signs

Varicose veins are common and usually are not a sign of a serious medical problem. They may initially be tense and palpable but are not necessarily visible. Later they may progressively enlarged and become obvious. They are dark purple or blue in color and may appear twisted and bulging — like cords. They commonly appear on the backs of the calves or on the inside of the leg. However, they can form anywhere on legs, from your groin to ankle.They can cause a sense of fullness (heavy legs), throbbing or cramping in legs, fatique, presure and superficial pain (especially when standing or walking), ankle swelling or hyperesthesia in legs. Restless leg syndrom appears to be a common overlapping clinical syndrome in patients with varicose veins. Stasis dermatitis (the darken skin) and venous stasis ulcer are uncommon. When skin changes occur they typically affect the medial malleolar region. Itching can occur around one or more varicose veins. Ulcers may develop after minimal trauma and are small, superficial and painfull. Varicose veins occasionally thrombose (thrombophlebitis), causing pain. They may also produce thin bullae in the skin, which may rupture and bleed after minimal trauma. Serious complications are rare. In some cases, varicose veins can signal a blockage in the deeper veins (deep vein thrombosis).

Diagnosis

Diagnosis is usually obvious from the physical examination in standing and seating position. They are easy to see. Additional technics are used especially before surgery or other vein treatment. Doppler Ultrasound can be ordered to evaluate the flow of blood in veins and to rule out complications (blood clots). Rarely an angiogram can be ordered (the procedure involves injecting a dye into veins that can be seen using x-ray).  The angiogram can help to rule out other disorders of the legs besides varicose veins.

Computerised Thermographic Imaging

CTI is absolutely safe for patient and has excellent diagnostic informativeness. There are no limitations to use infrared thermography as a method of primary diagnostic (screening) procedure and as a method to follow-up control after treatment. At the early stage of varicose disease, where there are no visual clinical signs of venous insufficiency, on thermograph image hyperthermia above the affected veins is detected. The reason of increasing temperature above the superficial vein is the retrograde blood flow from the deep vein, where temperature is higher. It is important to emphasize that the first thermographic signs of the venous disorder appears a long time before the first visual detection of the veins enlarging. That is the reason why infrared thermography may be applied as a method of early, pre-clinical diagnostic of varicose vein disease allowing to start preventive support much earlier.

Complications

Most varicose veins are relatively benign, only  a small percentage of people have complications. In some cases severe varicosities can lead to major complications. Basic complications may include dermatitis and thrombophlebitis (inflammation of the wall of the vein with blood clot in superficial vein). More dangerous are ulcer, development of carcinoma or sarcoma in longstanding venous ulcers (more than 100 reported cases of malignannt transformation) and bleeding from varicose vein’s injury.

Treatment

Treatment aims to relieve symptoms, improve the leg’s appearance (varicose veins may be primarily a cosmetic problem, some people may choose to have treatment just for improving the cosmetic appearance)and prevent complications. Although treatment can target existing varicose veins, it can’t keep new varicose veins from forming. Varicose veins that cause few signs and symptoms usually don’t need to be treated. Instead, it may be recommended self-care measures. Varicose veins causing more severe signs and symptoms such as skin ulcers, serious skin conditions, blood clots, significant pain, or disruption of daily life activities may need medical or surgical treatment.

Types of Treatment

Self-Care Measures

Self-care measures are a common option for treating varicose veins (avoid excess amounts of standing, frequent breaks during prolonged periods of standing,  elevating legs when sitting, resting or sleeping above the level of the heart, wearing compression stockings all day long, exercising, losing weight, avoid wearing tight clothes). Self-care measures may relieve symptoms and keep varicose veins from getting worse.

Non-surgical and surgical treatment

Medical and surgical treatments are used to either remove varicose veins or close them. Removing or closing varicose veins usually doesn’t create circulation problems because the blood reroutes itself through other veins.
Sclerotherapy

This procedure uses a liquid chemical to close off the vein.
Microsclerotherapy

This procedure is used to treat spider veins and other very small varicose veins. It involves injection of small amounts of a liquid chemical.
Laser surgery

This procedure uses no incisions or injections. Light energy from a laser is used to make the vein fade away.
Endovenous ablation therapy

This procedure uses an energy source (either laser or radiowave) to create heat to close off the vein.
Endoscopic vein surgery

This procedure uses a tiny camera at the end of a thin tube to move through the varicose veins. A surgical instrument at the end of the camera is used to close the veins.
Vein stripping and ligation

In this procedure, veins are tied shut (ligation) and removed (stripping) through small incisions.
Catheter-assisted procedures

This procedure uses a thin tube (catheter) put into an vein and heats the tip of the catheter. As the catheter is pulled out, the heat destroys the vein.
Ambulatory phlebectomy

In this procedure, small varicose veins are removed through small incisions in your skin.

Prognosis

Varicose veins are typically progressive disease, they tend to worsen over time without treatment.
Treatment procedures provide good short-term symptom relief, but long-term efficacy is poor.

Prevention

There are no apparent ways to completely prevent varicose veins. Improving circulation and muscle tone can reduce risk of developing varicose veins, getting additional ones or getting worse of existing varicose veins. This can be done by simple self-care measures (mentioned earlier).

ICIM Medics offers a comprehensive screening program for varicose veins using most sophisticated equipment and technology.

For more information on this topic please call ICIM Medics on +353 45 844 819 or email us at info@icim.ie

Tags: Veins