Varicose Veins - June 1, 2009 - Dr. Paul Fleser - NewsChannel5.com | Nashville News, Weather & Sports

Varicose Veins - June 1, 2009 - Dr. Paul Fleser

Varicose Veins

Varicose veins are swollen, twisted veins you can see just under the surface of the skin. These veins usually occur in the legs, but they also can form in other parts of the body. Varicose veins are common and usually cause few signs or symptoms. In some cases, varicose veins may cause complications, such as mild to moderate pain, blood clots or skin ulcers.

Problems related to varicose veins

A number of vein problems are related to varicose veins, such as telangiectasias, spider veins, varicoceles, and other vein problems.

• Telangiectasias are small clusters of blood vessels. They're usually found on the upper body, including the face, and appear red. They may form during pregnancy and often are found in people who have certain genetic disorders, viral infections or other medical conditions such as liver disease. Because telangiectasias can be a sign of a more serious condition, see your doctor if you think you have them.
• Spider veins are a smaller version of varicose veins and a less serious type of telangiectasias. Spider veins involve the capillaries, the smallest blood vessels in the body, and they often show up on the legs and face. They usually look like a spider web or tree branch and can be red or blue. They usually aren't a medical concern.
• Varicoceles are varicose veins in the scrotum. Varicoceles may be linked to male infertility. If you think you have varicoceles, see your doctor.

Other types of varicose veins include venous lakes, reticular veins and hemorrhoids. Venous lakes are varicose veins that appear on the face and neck. Reticular veins are flat blue veins often seen behind the knees. Hemorrhoids are varicose veins in and around the anus.

Causes

Weak or damaged valves in the veins can cause varicose veins. After your arteries deliver oxygen-rich blood to your body, your veins return the blood to your heart. The veins in your legs must work against gravity to do this. One-way valves inside the veins open to let blood flow through and then shut to keep blood from flowing backward. If the valves are weak or damaged, blood can back up and pool in your veins. This causes the veins to swell.

Weak valves may be due to weak vein walls. When the walls of the veins are weak, they lose their normal elasticity. They become like an overstretched rubber band. This makes the walls of the veins longer and wider and causes the flaps of the valves to separate. When the valve flaps separate, blood can flow backward through the valves. The backflow of blood fills the veins and stretches the walls even more. As a result, the veins get bigger, swell and often get twisted as they try to squeeze into their normal space. These are varicose veins.

Risk factors

• Having family members who have varicose veins may raise your risk for the condition. About half of all people who have varicose veins have a family history of them.
• Getting older may put you at higher risk for varicose veins. The normal wear and tear of aging may cause the valves in your veins to weaken and not work as well.
• Women tend to get varicose veins more often than men. Hormonal changes that occur during puberty, pregnancy, menopause, or with the use of birth control pills may raise a woman's chances of getting varicose veins. During pregnancy, the growing fetus puts pressure on the veins in the legs. Varicose veins that occur during pregnancy usually get better within three to 12 months of delivery.
• Being overweight or obese can put extra pressure on your veins. This can lead to varicose veins.
• Standing or sitting for a long time, especially with your legs bent or crossed, may raise your risk for varicose veins. This is because staying in one position for a long time may force your veins to work harder to pump blood to your heart.

Signs and symptoms

The signs and symptoms of varicose veins include:

• Large veins that you can see on your skin.
• Mild swelling of your ankles and feet.
• Painful, achy or "heavy" legs.
• Throbbing or cramping in your legs.
• Itchy legs, especially on the lower leg and ankle. This is sometimes incorrectly diagnosed as dry skin.
• Discolored skin in the area around the varicose vein.

Signs of telangiectasias are red clusters of veins that you can see on your skin. They are usually found on the upper body, including the face. Signs of spider veins are red or blue veins in a web pattern that often show up on the legs and face. See your doctor if you have these signs and symptoms. They also may be signs of other, sometimes more serious conditions.

Complications

Sometimes varicose veins can lead to dermatitis, an itchy rash. If you have varicose veins in your legs, dermatitis may affect your lower leg or ankle. Dermatitis can cause bleeding or skin ulcers if the skin is scratched or irritated.

Varicose veins also may lead to a condition called superficial thrombophlebitis. Thrombophlebitis is a blood clot in a vein. Superficial thrombophlebitis means that the blood clot occurs in a vein close to the surface of the skin. This type of blood clot may cause pain and other problems in the affected area.

Diagnosis

Doctors often diagnose varicose veins based on a physical exam alone. Sometimes tests or procedures are done to find out the extent of the problem and to rule out other disorders. If you have varicose veins, you may see a vascular medicine specialist or vascular surgeon. These are doctors who specialize in blood vessel conditions.

Your doctor may recommend a Doppler ultrasound to check blood flow in your veins and to look for blood clots. A Doppler ultrasound uses sound waves to create pictures of structures in your body. During this test, a handheld device will be placed on your body and passed back and forth over the affected area. A computer will convert the sound waves into a picture of the blood flow in your arteries and veins.

Although rare, your doctor may order an angiogram to get a more detailed look at the blood flow through your blood vessels. For this procedure, dye is injected into your veins. The dye outlines your veins on x-ray images. An angiogram can help your doctor confirm whether you have varicose veins or another problem.

Treatment

Varicose veins are treated with lifestyle changes and medical procedures. The goals of treatment are to relieve symptoms, prevent complications and improve appearance. If varicose veins cause few symptoms, your doctor may suggest simply making lifestyle changes. If your symptoms are more severe, your doctor may recommend one or more medical procedures. For example, you may need a medical procedure if you have significant pain, blood clots or skin disorders as a result of your varicose veins.

Lifestyle changes often are the first treatment for varicose veins. These changes can prevent varicose veins from getting worse, reduce pain and delay other varicose veins from forming. Lifestyle changes include the following:

• Avoid standing or sitting for long periods without taking a break. When sitting, avoid crossing your legs. Raise your legs when sitting, resting, or sleeping. When you can, raise your legs above the level of your heart.
• Do physical activities to get your legs moving and improve muscle tone. This helps blood move through your veins.
• If you are overweight or obese, lose weight. This will improve blood flow and ease the pressure on your veins.
• Avoid wearing tight clothes, especially those that are tight around your waist, groin (upper thighs) and legs. Tight clothes can make varicose veins worse.
• Avoid wearing high heels for long periods. Lower heeled shoes can help tone your calf muscles. Toned muscles help blood move through the veins.

Your doctor may recommend compression stockings. These stockings create gentle pressure up the leg. This pressure keeps blood from pooling and decreases swelling in the legs.

Medical procedures are done either to remove varicose veins or to close them. Removing or closing varicose veins usually doesn't cause problems with blood flow because the blood starts moving through other veins.

You may be treated with one or more of the procedures listed below. Common side effects after most of these procedures include bruising, swelling, skin discoloration and slight pain. Side effects are most severe with vein stripping and ligation. Although rare, this procedure can cause severe pain, infection, blood clots and scarring.

• Sclerotherapy uses a liquid chemical to close off a varicose vein. The chemical is injected into the vein to cause irritation and scarring inside the vein. The irritation and scarring cause the vein to close off, and it fades away. This procedure often is used to treat smaller varicose veins and spider veins. It can be done in your doctor's office, while you stand. You may need several treatments to completely close off a vein.
• Microsclerotherapy is used to treat spider veins and other very small varicose veins. A small amount of liquid chemical is injected into a vein using a very fine needle. The chemical scars the inner lining of the vein, causing it to close off.
• Laser Surgery applies light energy from a laser onto a varicose vein. The laser light makes the vein fade away. Laser surgery is mostly used to treat smaller varicose veins. No cutting or injection of chemicals is involved.
• Endovenous ablation therapy uses lasers or radiowaves to create heat to close off a varicose vein.
• Your doctor makes a tiny cut in your skin near the varicose vein. He or she then inserts a small tube called a catheter into the vein. A device at the tip of the tube heats up the inside of the vein and closes it off.
• For endoscopic vein surgery, your doctor will make a small cut in your skin near a varicose vein. He or she then uses a tiny camera at the end of a thin tube to move through the vein. A surgical device at the end of the camera is used to close the vein.
• For ambulatory phlebectomy, your doctor will make small cuts in your skin to remove small varicose veins. This procedure usually is done to remove the varicose veins closest to the surface of your skin.
• Vein stripping and ligation typically is done only for severe cases of varicose veins. The procedure involves tying shut and removing the veins through small cuts in your skin.

-National Institutes of Health