One of the most common problems I see in practice is varicose veins.
Today, I will be giving you an overview of this condition, and will touch up on common treatments used. I will also answer some of the most common questions patients ask me about this problem.
What Are Varicose Veins?
Veins are blood vessels responsible for bringing unhealthy blood from all the parts of the body back to the heart. The blood travels through the lungs, where it gets enriched with oxygen and nutrients.
Inside the veins are valves that allow for flow of blood in one direction alone – towards the heart. These valves are more prominent in the leg, and play a more important role there.
This is because blood that travels from the leg to the heart does so against gravity. The valves prevent blood from flowing back to the legs.
However, if the valves are incompetent, and do not work properly, the blood from the legs fails to return back to the lungs and heart. It pools in the veins, engorging them and making them look all ‘twisty and bendy’.
These twisted engorged veins filled with blood are called varicose veins.
Are They Seen Only In The Leg?
While they are seen most commonly in the leg, varicose veins can be seen in other parts of the body as well. The superficial saphenous vein is the most commonly involved vein.
For example, when the valves in the veins of the testes fail to work, the veins engorge, leading to a condition called varicocele.
Similarly, varicosities may be seen in the veins of the food pipe and stomach. Hemorrhoids, or piles, are also a variant of this condition.
What Are The Causes Of Varicose Veins?
Older women are more commonly affected than men. The table below lists the common risk factors for varicose veins.
The exact cause for varicose veins remains unclear. It involves a combination of multiple physiological and structural abnormalities that leads to weakening of the valves within the veins. The walls of the veins also become weak.
It is possible all this is because there is a loss of elasticity of the wall of the veins. A genetic predisposition has been cited as the possible underlying reason.
In pregnancy, varicose veins occur due to hormonal changes.
Clinical Features Of Varicose Veins
So what does a patient with varicose veins experience?
Given the veins are engorged, they are fairly visible from a distance, making it a cosmetic issue primarily.
However, common symptoms include itching, heaviness in the legs, cramping pain, leg fatigue and swelling in the affected leg. These are worse at the end of the day.
Over time, there can be darkening of the skin as well. Advanced cases can develop ulcers on the skin that do not heal easily.
Those with varicose veins are prone to developing skin infections. The thickening and darkening of the skin can make the lower legs and ankles look thin – a condition called lipodermatosclerosis.
In rare cases, the veins can rupture and bleed.
Diagnosis clinically is fairly easy. Confirmation of the diagnosis is usually done with an ultrasound scan of the leg.
An ultrasound is a painless test that help clearly determine the location of the incompetent valves. It also helps find out if there is any deeper vein involvement, such as deep vein thrombosis. The presence of inflammation can also be noted.
During the study, the doctor may squeeze your calf muscle to determine the extent of blood reflux through the incompetent valves.
Treatment Of Varicose Veins
There are numerous treatment options for varicose veins.
Simple lifestyle measures such as weight loss and regular exercise can all help in the management.
More complex interventions are rarely necessary.
In those patients who have painful varicose veins, medications may be prescribed to help alleviate the pain. These may or may not work for everyone though.
Graduated Compression Stockings
These are one type of treatment that helps. It consists of tight socks that can extend from the foot to either the knee or the middle of the thigh.
However, not everyone likes these stockings as they can be quite tight. Furthermore, the right size must be given to the patient, as those that are too tight can cause skin ulceration from the pressure.
I recommend buying graduated compression stockings from a hospital or a trained professional rather than online.
Surgical vein stripping is a procedure that is sometimes offered to patients with varicose veins. It involves removing the vein completely under general anaesthesia.
More recently however, surgical stripping is going out of fashion. It has been replaced by a procedure called catheter based endovenous thermal ablation, or EVTL.
Here, a catheter is passed through the affected vein using ultrasound guidance and under local anaesthesia. The catheter uses radiofrequency waves or lasers to generate heat, which in turn cauterizes the vein. This technique can effectively help treat varicose veins.
Following the procedure, doppler ultrasound tests may be recommended at varying intervals to assess procedural success. Complications such as deep vein thrombosis are seen in less than 1% of patients.
Are Varicose Veins Bad?
Varicose veins are generally harmless. They are not a threat to your life. However, if they are fairly large, they might affect your quality of life as they can cause a little pain and may hinder your mobility.
Is Walking Good For Varicose Veins?
Walking is generally a very good exercise. (insert link). However, whether it helps relieve varicose veins over time is unclear.
It is prolonged standing that is associated with varicose veins. Walking does not seem to be a causative factor.
Varicose veins are a common problem. They are a nuisance, but fortunately not life-threatening. If you are concerned, make sure you visit your doctor.
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