Varicose veins

Varicose veins are veins in your legs that are enlarged, clearly visible under your skin, and twisted or bulging. Varicose veins are usually painless. Sometimes they can hurt, itch, or burn. If you experience one of these symptoms, it is recommended that you see your doctor. It is important to diagnose varicose veins as early as possible to prevent the disease from progressing and to avoid more serious complications. With varicose veins, compression wear can help.

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What are varicose veins?

Varicose veins (medical terms: varices, varicosis, or varicosity) are dilated and tortuous veins (3 mm in diameter or larger) that appear as convoluted swellings. Sometimes varicose veins protrude as knot-like bulges on the surface of the skin. Nearly 30% of the world’s population develop varicose veins. The risk for developing varicose veins is higher for women and increases with age, obesity, lack of exercise, pregnancy, or a genetic predisposition.

Varicose veins can form in any superficial vein in your body, but the veins in the lower extremities (foot, calf, thigh, or entire leg) are most commonly affected. Varicose veins can be painful or, on the contrary, completely painless. When symptoms are present, they can include ankle and leg swelling, heaviness, fullness, aching, restlessness, fatigue, pain, cramps, and itching. After sitting or standing for a long time these symptoms can worsen due to increased blood levels and pressure in the veins of your lower body. Also, high temperatures can aggravate these symptoms – varicose veins can trouble you more in the summer.

Why is early diagnosis of varicose veins important?

Early and correct diagnosis of varicose veins is essential to prevent further worsening of this venous disease. If varicose veins are left untreated, your quality of life can be negatively affected through discomfort and pain, swelling of your legs (edema), and skin changes.

In addition, varicose veins increase the risk for further severe complications such as thrombophlebitis (inflammatory process causing a blood clot to form), deep vein thrombosis (DVT), variceal bleeding, ulceration, and more.

Varicose veins are damaged veins in which the venous valves do not close properly.

Nearly 30% of the world’s population develop varicose veins. The risk for developing varicose veins is higher for women and increases with age, obesity, lack of exercise, pregnancy, or a genetic predisposition.  

What causes varicose veins?

In varicose veins, the internal walls of the veins are changed or damaged, causing the veins to dilate. The venous valves do not close properly anymore, the blood flows backwards towards the feet and, as a result, pools in the veins.

This blood pooling causes the veins to stretch or twist, leading to the typical appearance of convoluted swellings and/or knot-like bulges on the surface of the skin.

Varicose veins are not only a sign of aging

It’s possible for younger individuals with a genetic predisposition to acquire them. Risk factors, such as an occupation that involves extensive standing or sitting or being overweight, can further lead to the development of varicose veins. Typically, varicose veins often appear during pregnancy due to the hormonal changes and the higher blood pressure linked to pregnancy

What can I do about varicose veins?

If you have observed varicose veins in your legs, you should visit a doctor to check for underlying causes, particularly if the varicose veins cause pain. By means of ultrasound, the doctor visualizes the blood flow and checks if the superficial veins or the system of deep veins in your legs is affected.

Non-invasive treatment: Compression therapy

To help with varicose veins, compression therapy with medical compression garments is the basic treatment.

If you are diagnosed with varicose veins, your doctor can prescribe compression garments like medical compression stockings. The elastic material of the medical compression stocking provides controlled pressure to the leg, with the strongest pressure at the ankle and decreasing pressure going up the leg that gently squeezes the vein walls together. This eases blood flow back towards the heart, reducing venous pressure, and improving overall circulation.

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Other treatments of varicose veins

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Injection of a liquid, foam, or glue (e.g. cyanoacrylate) under ultrasound guidance, that causes the veins to shrink and collapse.

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Surgical removal of varicose veins. Superficial veins are removed through small incisions (Micro-incision Phlebectomy), deep veins via vein stripping.

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Closing varicose veins with thermal energy (laser or radiofrequency)

Summary

Varicose veins (medical terms: varices, varicosis, or varicosity) are dilated and tortuous veins (3 mm in diameter or larger) that appear as convoluted swellings.

Basic medical knowledge on venous disorders

  • With the term Chronic Venous Disorder (CVD) we describe a long-standing condition involving impaired venous return.
  • If vein valves don’t close properly, a reflux results: the blood leaks downwards and stagnates in the vein, thereby leading to venous hypertension. This condition is known as chronic venous insufficiency (CVI) which may cause edema, skin change, and, in some cases, ulcerations.
  • If left untreated, chronic venous insufficiency can result in the formation of serious disorders, including phlebitis and pulmonary embolism. To distinguish the different manifestations of CVD, the CEAP classification system is used.
  • Acute venous disorders usually occur without pre-existing conditions, but they can also be triggered by chronic venous disorders. In any case, medical treatment is immediately required. Acute venous disorders include superficial thrombophlebitis, deep vein thrombosis (DVT), pulmonary embolism, post-thrombotic syndrome, and variceal bleeding.

 

 

Further reading