Varicose veins
Varicose veins affect three in ten people worldwide. Women are affected more than men due to hormonal changes and pregnancy. Any vein in the body has the potential of swelling and enlarging due to a number of reasons, and may therefore be classified as “varicose”. Typically, varicose veins are present in the legs, thighs and feet from body pressure, however the uterus, vagina, pelvis, anus and gullet may also be affected.
What are varicose veins?
The function of arteries and veins is to allow blood flow through the body to and from the heart to supply the body with nutrients and oxygen. The leg muscles particularly help to push the blood back up the veins to the heart as part of the body’s blood circulation process. Veins become thick, swollen, and even knotted in appearance (varicose) because the valves in the vein degenerate from damage causing blood to buildup and clot. When the valves weaken, the blood cannot freely pump back through the valves to circulate, and this can seriously impact overall health.
Types of varicose veins
The veins nearer the outer skin layers are called superficial veins, and deeper veins are named perforator veins. Usually, the varicose effect impacts superficial veins. Varicose veins differ from C1 type spider veins and blue veins (telangiectasias) due to location and size.
Varicose veins are usually identified in type through the developmental stages that range from C0, meaning no visible sign of venous disease, to C6 where the skin is covered with active ulcers. C2 is the classification for varicose veins and thereafter to classification increases as the venous disorder takes effect changing the skin (C3 is edema, C4 is pigmentation, eczema and lipodermatosclerosis, C5 is the presence of ulcers). Leaving varicose veins untreated can lead to a number of types of associated conditions, such as Thrombophlebitis (inflammation from blocked veins); Bleeding (from excess pressure or injury); Varicose eczema (permanent brown or purple skin discolouration); and Venous ulcers (fluid leaks from the varicose vein into surrounding tissue).
Causes of varicose veins
Generally, the cause of varicose veins is thought to be vascular degeneration of the valves (weakened valves) causing blood pooling in superficial veins. However, there are a number of contributing factors, such as:
- Standing for long periods of time without resting or raising the legs (occupations)
- Remaining inactive without doing exercise for long durations (occupations or lifestyle)
- Aging causes veins to lose elasticity and impede circulation
- Female hormones which relax the vein walls causing the valves to leak (gender)
- Obesity places pressure on vein valves that can also result in leaking
- Pregnancy due to hormonal changes relaxing blood vessels, pressure from increased blood flow for the fetus and the birth process, and the increased size of the uterus
- Genetics – runs in families
Diagnosing varicose veins
Varicose veins can be physically identified, especially in the leg, by a physician or through the following symptoms:
- protruding purple veins causing dry and itchy skin patches
- swollen legs, feet or ankles with burning, aching and throbbing
- heavy discomfort in the legs with muscle cramps at night particularly
Patients are referred to a vascular surgeon or phlebologist for further diagnosis to identify the location and severity of the valve damage, and for treatment. Some diagnostic tests include:
- Trendelenburg test where the blood flow in the leg is temporarily restricted to observe the potential varicose vein and valve function when the restriction (such as with tourniquet) is lifted
- Ultrasound Doppler test to check circulation
- Ultrasound Colour duplex scan to check vein structure
Treatments for varicose veins
Some people who have varicose veins and are not symptomatic choose not to have treatment, however this is not recommended due to associated health risks. Treatments for varicose veins may be non-surgical, such as wearing compression stockings to assist upward blood flow. Surgery is also an option, such as Sclerotherapy, Varicose Vein Surgery, Radiofrequency Ablation, and Endovenous Laser Treatment:
- Sclerotherapy (liquid or foam)
Under local anaesthetic operation, the varicose vein is injected with liquid or foam sclerotherapy to close off the vein.
- Varicose Vein Surgery
Through operation under general anaesthetic, the vein is stripped. Phlebectomy applies a similar process of pulling out the vein with hooks through small holes made in the leg. In Transilluminated Powered Phlebectomy (TIPP), a suction is used to remove the vein.
- Radiofrequency Ablation
Electric current is used to close off the vein by destroying the varicose vein wall using heat under general anaesthetic.
- Endovenous Laser Treatment
A laser is used to close off the vein by destroying the vein wall under general anaesthetic.
Venous health can be improved through nutrition, weight reduction and regulation, regular exercise, not standing for long periods without rest, and wearing compression socks. Most people opt for treatment to soothe uncomfortable symptoms, to avoid further unhealthy complications, and for better aesthetics (to improve the look of the body).