Varicose veins are abnormal, dilated veins which are usually seen under the skin of the legs. The condition is more common in women, and it tends to run in families. These dilated veins sometimes cause discomfort such as aching or burning pain after standing. Occasionally, there can be other problems such as superficial phlebitis, dermatitis, or bleeding from the veins. In most cases, varicose veins are not dangerous, so treatment is aimed at relieving the symptoms and preventing the problem from getting worse. Surgical treatment is only necessary in a few cases.
There are two systems of veins in the leg: the deep system is made up of large veins within the muscles of the leg; the superficial system is a network of smaller veins located just under the skin. The two systems are connected in a few places by short perforating veins. The function of veins is to carry blood from the leg back to the heart. In the leg, the deep veins do most of this work, forcing the blood uphill when the leg muscles contract. The blood is kept from running back down to the leg by valves inside the veins. Both the deep and superficial systems have valves. Both systems empty into one large vein (the femoral vein) in the groin. The superficial system has two main veins (called saphenous veins); one on the back of the calf, and the other along the inner side of the leg from the ankle to the groin. These veins can be removed without any side effects; they are the veins often used for heart and arterial bypasses.
In some people, the valves in the superficial veins leak, causing the blood to collect in the lower legs. The weight of the blood causes very high pressures in the veins in the lower leg. The stretching of the vein wall causes pain. Elevating the legs empties the veins and relieves the pain. Wearing medical compression stockings keeps the veins empty, relieving the discomfort, and preventing further dilation of the veins.
Superficial phlebitis is an uncomfortable but not serious condition in which a blood clot forms in a superficial varicose vein. The clot causes inflammation, with pain,heat, redness, and a lump developing at that location. Treatment includes aspirin or ibuprofen, rest, elevation, and warm compresses. The pain should improve within a few days, although the lump may be present for several weeks. Superficial clots do not move, and there is no danger from them. Occasionally,
superficial phlebitis can occur together with deep vein thrombosis, which is a dangerous condition because of the possibility that clots in the deep vein can move to the heart and block blood flow to the lungs. If there is any sign of deep vein thrombosis, tests should be done to see if treatment is necessary.
Dermatitis (skin irritation) can occur if the pressure in the veins is very high; usually this only occurs if the valves in the deep veins are scarred, but sometimes it happens in people with severe superficial vein problems alone. The dermatitis first shows up as reddened, itching areas of skin; later, the skin can become brownish and discolored. If severe, the condition can lead to ulceration (skin breakdown and sores). Again, the treatment is elevation of the legs and compression stockings. If the problem is limited to the superficial veins, removing them may provide a cure.
Treatment of varicose veins:
Before starting treatment, it is important to know the cause of the varicose veins. A simple test using ultrasound and measurement of the blood flow in the veins can show abnormalities in the superficial, perforating, and deep veins, and can indicate how successful various types of treatment are likely to be.
There are three main methods of treating varicose veins. Often, all three are used :
Compression therapy is all that is necessary in most cases. Special stockings are worn which are designed to apply more pressure on the lower part of the leg, encouraging the blood to flow upward. Although these stockings do not improve the appearance of the leg, they relieve discomfort caused by the veins, prevent further dilation of the veins, and reduce the chances of phlebitis or dermatitis.
Sclerotherapy involves injecting a chemical into the veins which causes inflammation and scarring of the vein. There is some risk of damage to the skin, allergic reaction to the chemical, and recurrence of the varicosity. This treatment works best on smaller varicose veins and "spiders". Multiple treatments are necessary. Insurance does not cover this type of treatment. However, sclerotherapy can be very successful in improving the cosmetic appearance of some varicose veins.
Surgical excision or "vein stripping" is an operation which is usually done under anesthesia, in which the varicose veins are pulled from underneath the skin through a number of small skin incisions. The extent of the operation depends on how extensive the varicose veins are, and the results of the tests mentioned above. The operation is quite successful, and the result is lasting; any small varicose veins remaining may later be treated with sclerotherapy if necessary. The risks of the operation are small aside from the need for anesthesia.
