Varicose Veins

Varicose veins are swollen, twisted, tortuous and abnormally dialted superficial veins that usually occur in the legs and feet. They develop when the valves inside veins weaken or malfunction, causing blood to flow backward and pool in the vein. This results in the veins becoming enlarged, raised, and visible under the skin.

Varicose veins are a manifestation of chronic venous insufficiency, which has multiple causes and aggravating factors.

🔹 Causes and Risk Factors

Varicose veins are typically caused by increased pressure in the veins, which can occur due to a number of factors:

1. Age: As we age, veins lose elasticity, and valves weaken, making it harder for blood to flow properly.
2. Gender: Women are more likely to develop varicose veins, due to hormonal changes during pregnancy, menopause, or the use of birth control pills, which can relax vein walls.
3. Pregnancy: Increased blood volume and pressure from the growing uterus can lead to varicose veins.
4. Family history: A family history of varicose veins increases the risk.
5. Obesity: Extra weight puts additional pressure on the veins in the lower body.
6. Standing or sitting for long periods: Occupations that require prolonged standing or sitting (e.g., nurses, teachers) can increase the likelihood of developing varicose veins.
7. Previous blood clots or deep vein thrombosis (DVT): Damage to vein walls and valves after a clot can lead to varicose veins.
8. Hormonal changes: Pregnancy, puberty, or menopause can alter blood flow and increase the risk of varicose veins.

🔸 Symptoms of Varicose Veins

While some people with varicose veins are asymptomatic, others experience the following:

1. Visible, twisted veins: Typically on the legs, often appearing blue or dark purple.
2. Pain or aching: Especially after prolonged sitting or standing.
3. Swelling in the feet or ankles.
4. Heavy or fatigued legs: Especially after standing for long periods.
5. Itching or a sensation of burning around the affected veins.
6. Skin changes: Over time, varicose veins can lead to thickening of the skin or ulcer formation in more severe cases.
7. Restless legs: An uncomfortable sensation, often at night.
8. Pelvic congestion syndrome. Some female patients have associated pelvic varicosities. This a separate condition and needs appropriate testing, diagnosis and treatment.

🔹 Diagnosis

A doctor will typically diagnose varicose veins through:

1. Physical Exam: Observing the veins in the affected area.
2. Duplex Ultrasound: This non-invasive test helps assess blood flow and detect venous reflux (backward blood flow) and clotting.
3. Venography: Rarely used, this is a more invasive test involving injecting a contrast dye into the veins to create X-ray images of the veins.

🔸 Treatment Options for Varicose Veins

Treatment for varicose veins depends on the severity of the condition and symptoms. Options include:

1. Conservative Measures (Non-surgical)

• Compression stockings: Helps reduce swelling, pain, and discomfort by promoting blood flow.
• Lifestyle changes: Weight loss, regular exercise, elevating legs, avoiding prolonged standing or sitting.
• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and swelling.

2. Minimally Invasive Procedures

• Sclerotherapy: A solution is injected into the vein, causing it to collapse and eventually fade. It’s effective for smaller veins.
• Endovenous Laser Therapy (EVLT): A laser fiber is inserted into the vein to close it off by using heat. This is commonly used for larger varicose veins.
• Endovenous Radiofrequency Ablation (RFA): Similar to EVLT, but uses radiofrequency energy to close off the vein.
• Micro stab Phlebectomy: Small incisions are made to remove varicose veins directly. This is typically used for smaller veins that can’t be treated with sclerotherapy or ablation.
• Venography with intravascular guided stenting if there is central venous obstruction or compression in selected patients [especially those with ulcers and severely symptomatic chronic venous insufficiency.

3. Surgical Options

• Vein stripping: A procedure where the problematic vein is surgically removed. This is less commonly performed today due to the availability of less invasive treatments. Surgical vein striping is associated with a very long recovery and risk of surgical wound complications. Often needing hospitalization and further treatment. 

🔹 Prevention of Varicose Veins

While not all cases can be prevented, certain lifestyle changes can reduce the risk of developing varicose veins:

1. Regular exercise: Improves circulation and helps maintain a healthy weight.
2. Maintain a healthy weight: Reduces pressure on the veins.
3. Avoid prolonged sitting or standing: If your job or lifestyle requires long hours of standing or sitting, take regular breaks and stretch.
4. Elevate your legs: Especially if you’re prone to varicose veins, elevating your legs can help reduce pressure on the veins.
5. Wear compression stockings: Especially if you have a family history of varicose veins or work in occupations requiring prolonged standing.

🔸 Complications of Varicose Veins

Though often considered a cosmetic issue, untreated varicose veins can lead to complications such as:

• Venous ulcers: Painful sores on the skin, particularly near the ankles.
• Deep vein thrombosis (DVT): A blood clot in the deep veins can form if the veins are severely damaged. Very rarely caused by varicose veins of the superficial veins. Often an untreated or sub optimally treated DVT leads to varicose veins.
• Bleeding: Varicose veins, especially near the surface, may be more prone to bleeding from minor injury.
• Chronic venous insufficiency (CVI): In severe cases, the veins may not effectively return blood to the heart, leading to swelling, skin changes, and ulcers.

🔹 Prognosis

Varicose veins are typically not life-threatening, but they can significantly affect quality of life. With proper treatment and lifestyle modifications, symptoms can be managed, and the risk of complications reduced. In some cases, varicose veins may return over time, even after treatment.