Varicose Veins

Do these images look familiar?

 
Varicose veins

Read on to find out more about varicose veins…

What are Varicose Veins?

 
Varicose veins

Varicose veins are abnormal or ‘incompetent’ blood vessels that have become engorged and distended due to the back flow and pooling of blood. These veins are not normally visible to the eye, but once they become varicose they can become very apparent and raised above the surrounding skin.

Varicose veins are larger than spider and reticular veins, measuring from around 3mm up to more than 2cm in diameter, and are most commonly found on the legs between the ankle and thigh.

In some cases, varicose veins may have no obvious complications and may appear to be simply a cosmetic problem.  In other cases, a range of complications can be involved. In either case, they are a form of venous disease and should be taken seriously.

Over time, they may become more extensive across the legs, and may begin to cause more symptoms and potentially serious complications.

In the CEAP clinical classification system, varicose veins are categorised as C2 and are generally considered as a medical condition which should be assessed and possibly treated before the condition progresses further and more serious complications develop.

How common are they?

 

Varicose veins are a common condition, particularly among middle-aged and older people. Studies have shown a range of 10% to 39% of men with the condition, and 30% to 39% of women. It is generally accepted that women are more commonly effected, and these rates can be even higher amongst the over 50 population. Varicose veins are not always visible to the eye.

Who is more at risk?

 
A number of factors make you more likely to develop varicose veins:

  • Age; the elasticity of your veins weakens as you get older
  • Your genes; if you have a strong family history of varicose veins the chances are that you will have them too
  • Conditions that cause increased abdominal pressure such as chronic constipation, abdominal tumours or wearing tight girdles
  • Excess weight; being obese (and especially belly fat) increases pressure on the leg veins
  • Standing or sitting for long periods of time
  • Immobility; such as being confined to bed
  • A medical history of blood clots or injury to your veins
In addition, simply being female can increase your risk of developing varicose veins:

  • Hormonal changes during puberty, pregnancy and menopause dilate the veins
  • Taking contraceptive pills and hormone replacement therapy have a similar effect in dilating veins
  • Pregnancy; the pressure of the growing uterus and the increased volume of blood causes veins to enlarge

What causes them?

 

Your veins and arteries are part of your circulatory system. Arteries pump blood around your body. Once oxygen and nutrients are delivered, your blood flows into your veins, some of which are just below the skin. The forward flow of blood is ensured through:

  • One way valves in the veins, preventing back flow
  • Your calf muscles squeezing the blood toward your heart when you move about
  • Your arteries transmitting energy to the veins to propel blood towards the heart
  • Elasticity, veins stretch and contract to help with upward blood flow
Varicose veins develop when:

  • Your veins walls become weak and lose their elasticity
  • The valves in your veins become ineffective, leading to backward flow of blood
  • Rarely, when the larger veins closer to your heart are obstructed or fail

When this happens, blood pools in those veins making them varicose.

What are the signs and symptoms?

 

In the majority of cases varicose veins are visible to the eye and may appear in one or more of the following ways:

  • Knobby
  • Like twisted ropes
  • Bulgy and protruding above the surrounding skin
  • Skin colour, blue, dark blue or purple in color

Initially, they may not cause any symptoms. Although in some cases symptoms develop before the varicose veins become prominent. The symptoms that may be associated with varicose veins include:

  • Aching in your legs
  • Pressure and heaviness in your legs
  • Burning and throbbing pain
  • Weakness in your legs
  • Muscle cramping (with or without swelling) in your feet or lower legs
  • Worsening pain after sitting for a long period or after being on your feet all day
  • Skin ulcers (usually near your ankle)
  • Dry, red, scaly or itchy skin around the varicose veins
  • A rash or skin discoloration around the varicose veins (due to blood leaking into skin tissue)
  • Skin thickening over the varicose veins
  • Painful muscle spasms in your calves at night
  • Restless legs

What are the potential complications?

 

Varicose veins can cause serious complications such as:

  • Leg ulcers or sores: When fluid builds up in your ankle over a prolonged period due to pooled blood (known as venous stasis) this leads to discolouration. Over time, painful ulcers or sores develop which are difficult to heal.
  • Bleeding: The skin over the veins can get damaged, tearing the fragile varicose vein, causing bleeding which can be difficult to stop.
  • Serous infection: Chronic swelling of the feet and ankles due to varicose veins increases the risk of cellulitis, a serious bacterial infection of tissue under the skin.
  • Blood clots: A thrombosis can form in either the superficial or deep vein system as a result of pooled blood. A superficial vein thrombosis (SVT) forms in the veins just below the skin, and may be firm, tender and warm with pain and swelling. A deep vein thrombosis (DVT) forms in the deeper veins and may cause pain in the calf muscle along with warmth, redness and swelling.

Varicose veins are not only a cosmetic problem but can give rise to a range of uncomfortable complications that can have a major effect on your health and quality of life. It is therefore important to see a medical practitioner who specialises in veins to have your legs assessed.

What treatments are available?

 

Fortunately there are painless and minimally invasive procedures to treat and manage varicose veins. Such treatment can dramatically ease discomfort or pain, avert complications, improve appearance and stop disease progression.