Our body is composed of an intricate network of blood vessels that are broadly classified as arteries and veins. Arteries carry oxygen-rich blood from the heart to the rest of the body, while veins carry oxygen-poor blood from the entire body to the heart. In the legs, the veins are classified as superficial veins and deep veins.
The superficial veins have valves within them that allow blood to travel against gravity up from the legs towards the heart. Sometimes, these valves can fail, resulting in engorgement of these veins. These veins are called varicose veins.
But dilated veins are not necessarily an occurrence just in the legs. Veins within the esophagus, pelvis, vagina and rectum can also become varicose, though varicose veins in the legs are a lot more common.
The normal veins
Before delving into varicose veins, it is worthwhile noting what normal is. The leg veins are primarily of 2 types – superficial veins that are seen just under the skin, and deep veins that are deeper in the leg within the muscles. Between these two systems are communicating veins.
Varicose veins are superficial veins that are dilated as the valves within them fail to keep the blood moving up towards the heart, resulting in pooling of blood within the veins. On the surface, the veins appear knobby and irregular, and are fairly obvious on inspection of the leg in thin individuals. Obese individuals can also suffer from the condition, though the veins may not be that evident as they are covered in fat tissue.
The video below offers an overview of varicose veins –
Causes of varicose veins
We have briefly mentioned this above. In essence, within the veins are valves that allow flow of blood in one direction only. This is called unidirectional flow. However, sometimes the valves can become weaker and may not function as well as they should. This can result in result in backflow of blood in the direction opposite to the way it should be. Over time, this results in accumulation of blood within the veins, causing them to enlarge and become distended. These enlarged veins are called varicose veins.
While the above discusses the underlying anatomical cause for varicose veins, it is worthwhile knowing the conditions that can cause varicose veins. The common conditions include pregnancy, obesity, advancing age and remaining stood for a long period of time (as a choice or as a part of a job). Patients who have previously suffered from deep vein thrombosis (blood clots in the deep veins of the leg) are also at risk of developing varicose veins. Inherent problems with the vessel wall can also result in varicose veins.
This video below should make things a little clearer –
Other that these causes, there appears to be a genetic link to the development of varicose veins as well – patients with close family members who suffer from varicose veins are at a greater risk of developing the condition. Tumours in the abdomen can sometimes increase the risk.
Symptoms and signs
Patients who suffer from varicose veins rarely experience any symptoms. The commonest complaint is the cosmetic appearance that accompanies varicose veins – many tend to find the look rather unpleasant. In advanced stages, the veins can feel rather heavy and may ache a lot. Some patients complain of swollen feet, a throbbing sensation in the legs and sometimes muscle cramps. Long standing varicose veins can be accompanied by skin changes, with the skin becoming itchy and dry. These symptoms are more pronounced in individuals who are overweight and have large varicose veins.
Diagnosing varicose veins
The best way to diagnose varicose veins is from a clinical examination. Specialist tests are unnecessary, though a detailed clinical examination will help demonstrate the failure of the valves to perform their normal function. On some occasions, using an ultrasound device can help assess the veins a bit better if required.
Treatment of varicose veins
Most cases of varicose veins do not require treatment as they rarely cause any symptoms of concern. However, in patients who have symptoms, have very large varicose veins and are finding the appearance of the unsightly veins distressing, treatments may be offered. Below are some of the common treatments that are given to patients who suffer from varicose veins.
1. Home remedies
Simple elevation of the legs at night using pillows can help reduce the size of the veins and relieve any symptoms the patient may be experiencing. People whose job requires them to stand for long hours should make sure they move around and even rest their legs often. Losing weight is essential. Compression stockings are also useful.
2. Radiofrequency ablation
This procedure involves using a tiny catheter that is inserted into the veins under ultrasound guidance to expose the veins to radiofrequency energy. This causes thermal injury to the vessel wall, and the heat promotes vessel wall collapse, eventually resulting in it shutting close. The procedure is conducted under local anesthesia.
3. Laser treatment
This procedure is similar to radiofrequency ablation, but uses a laser instead of radiofrequency waves.
This procedure involves the injection of a particular substance into the vein that seals it shut. This material is called a sclerosant. It is also performed under local anesthesia and ultrasound guidance, and has some good results. Effects can be seen a few weeks after treatment, and can last for a long time. However, a small number of patients may experience side effects such as back pain and blood clots in the leg, but these are rare.
5. Surgical ligation and stripping
This involves tying up the veins and removing them completely as a surgical procedure. This has good results, and does not affect the flow of blood within the leg as the deeper veins still allow for blood flow.
This video explains it further –
Varicose veins are a fairly common condition, and are often related to a number of different risk factors. Treatments are many, and sometimes surgery may be required.
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