The Sievering Surgical Clinic

Sieveringer St 9, A-1190 Vienna Tel: 328 8777

The Vein Clinic

Varicose veins

Diagnosis & Treatment

Understanding Varicose Veins

General Information

This information sheet is for people who have varicose veins and want to learn more about them.

Mild forms of venous insufficiency are merely uncomfortable, annoying, or cosmetically disfiguring, but severe venous disease can produce serious systemic consequences and can lead to loss of life or limb. Most patients with venous insufficiency have subjective symptoms that may include pain, soreness, burning, aching, throbbing, cramping, muscle fatigue, and restless legs. Over time, chronic venous insufficiency leads to cutaneous and soft tissue breakdown that can be debilitating.

Varicose veins are very common ailment. They affect around 60% of the population at some time in their lives. They are swollen veins (usually on the legs) that look lumpy and bluish through the skin.

How does blood flow from your legs?

Blood is pumped from your heart to your legs through arteries. Once it has supplied oxygen and nutrients to the legs, blood returns to your heart through your veins. To do th Varicose veinsis from your legs, blood in your veins must flow upwards, against gravity. The muscles in your legs help this flow. Each time your calf and thigh muscles contract when you are walking, veins deep inside your leg are squeezed. One-way valves inside your veins help prevent the blood from flowing backwards.ialls become weak and swell, causing blood to back up and pool inside the vein. Varicose veins are also related to increased pressure in the leg veins or defective valves in the veins. They may appear as swollen, twisted clusters of blue or purple veins and are sometimes surrounded by thin red capillaries known as spider veins.  

What causes varicose veins?

The reason varicose veins develop is not fully understood. One of the basic problems is not only a damage to the valves but a lost of vein wall elasticity. In time the vein will dilate and the valves are no longer effective in hindering a back-flow of blood. This means that blood can't travel up the veins as easily, and is more likely to pool.   It is possible that people inherit a tendency for weak venous walls and valves. Alternatively, the vein walls may become weak following an inflammation or theombosis which will cause bulging of the vein with time and so damage to the valves.

There is a greater risk of getting varicose veins during pregnancy, because of the higher pressure exercised on the pelvic venous veins and increased in hormonal activity. Adding to this if one re overweight this will further increase the pressure in the abdomen and so in the veins. Many other factors have been blamed for varicose veins, such as standing for long periods, crossing your legs while sitting, smoking and poor diet. However, there isn't reliable scientific evidence to support these theories.


What are the symptoms ?

 
The symptoms from varicose veins don't necessarily match their size, and sometimes there are no symptoms at all apart from the veins being unsightly. Most people will not have symptoms but may be concerned about the appearance of the veins. If symptoms occur, they may include:  

. aching or discomfort in your legs  
. itching of the skin of your legs  
. swelling of your ankles

More severe symptoms are usually associated with the complications of varicose veins. These can include the following.

In some cases, varicose veins can be harmful to your health because they may be associated with the development of:

 

.    Chronic venous insufficiency   - the poor flow of blood in the veins ca interfere with the way the skin exchanges oxygen, nutrients and waste products with the blood. When this happens over a long period of time, it is called venous insufficiency, which can cause a number of problems including the following:


. varicose eczema - brown or purple discolouration of the skin that can become permanent  


.    Venous stasis ulcers   - ulcers (open sores) that result when the enlarged vein does not provide enough drainage of fluid from the skin. As a result, an ulcer may form.

 

.  Fungal and bacterial infections - may occur as the result of skin problems caused by fluid retention (edema) in the leg. These infections also increase the risk of tissue infection (cellulitis).

 

.    Phlebitis   - veins close to the surface of the skin can become painful and reddened due to inflammation or blockage of the vein. This is different to the more dangerous blockage of the deeper veins, known as deep vein thrombosis (DVT).

 

.    Thrombosis   - blood clots that form in the dilated vein

 

.    Bleeding   - varicose veins near to the surface can bleed if the leg is cut or bumped. This bleeding might become a medical emergency if it can't be stopped. If a varicose vein in your leg is bleeding, you need to lie down, raise your leg and apply pressure directly to the bleeding area. Then seek medical help.

 

.    Skin changes   - The first sign of venous insufficiency is the formation of oedema and bothersom skin alteration.

 

Complications are more common when varicose veins are the result of a problem or disease in the deep veins or in the perforating veins which connect the deep and superficial veins. These underlying conditions may include deep vein thrombosis or chronic venous insufficiency.  

Having varicose veins does not mean that you will definitely get complications or chronic venous insufficiency. And although they won't usually get better without treatment, varicose veins only get worse slowly.


Diagnosis

Varicose veins are easily visible. To work out the position and extent of valve weakness, there are a number of tests a doctor might do.


. A Doppler test is a technique that uses sound waves (ultrasound) to give information about the direction of blood flow in a vein and whether valves are working properly.  


. Colour duplex ultrasound imaging is used to look for any abnormalities in the vein structure.  


. The Trendelenburg test involves lying down and lifting one leg up in the air. The doctor uses a hand or a tourniquet to temporarily block off the blood flow in your veins. When you stand up again, the doctor can watch your varicose veins refilling with blood; this gives an indication of which part of the leg veins have faulty valves.

 

Treatments

Compression stockings

These may relieve the swelling and aching of your legs but do not prevent more varicose veins from developing. They need to be worn during the day and are taken off at night. Graduated compression stockings are tightest at the ankle and get gradually looser further up the leg. These help the blood to flow up towards the heart.

Compression stockings are available in various sizes and pressures and it is very important that they fit you properly. They are made to fit your calf diameter, not foot size. Your GP or pharmacist can provide advice.

Some people find compression stockings difficult to put on. There are tools available to help, or you could ask for help from a partner or friend. Stockings can be uncomfortable, especially in hot weather. But there is no point in wearing them rolled down.

Injection sclerotherapy

Small varicose veins can be injected with a chemical that damages the vein walls. As a result, scar tissue forms which closes off the affected vein. Other stronger veins take over and the treated vein, which is no longer filled with blood, becomes less visible.

For larger veins, a foam is sometimes injected instead of a liquid (this is called foam sclerotherapy), using ultrasound to guide the injection. Foam sclerotherapy is a new technique, and in a small number of people it can cause complications including blood clots in other leg veins, temporary vision problems, headaches and fainting. Your doctor will give you more information and advise whether foam sclerotherapy is a suitable treatment for you.

For best results, you should wear a compression bandage for between three and six weeks after injection sclerotherapy.  
Injection sclerotherapy can be an alternative to surgery, but varicose veins may come back and nearby veins may become varicose. Often, several injections are needed. One possible side-effect of this treatment is skin discolouration. Your doctor will give you more information.

Varicose vein surgery

This involves removing the affected superficial veins. There are many variations of operation, depending on which veins need treatment. The most common is called ligation and stripping. For more information, please see the separate BUPA health fact sheet, Varicose vein surgery.
New approaches

Minimally invasive techniques such as laser, microwave and radiofrequency treatments are being provided at some hospitals. One of these is endovenous ligation treatment (EVLT), where a fine laser probe is passed inside a vein. This heats the vein and causes it to close up.

Prevention

Anyone can develop varicose veins, so it may not always be possible to prevent them. Although there are no scientifically proven ways to prevent varicose veins, the following suggestions may be useful:
. avoid standing still for long periods of time  
. take regular exercise, such as walking  
. maintain a healthy weight  
. wear properly fitted compression stockings to prevent further deterioration of existing varicose veins

Further information

. TheVeinClinic.Info
. www.dr-bull.com
. The Circulation Foundation
www.circulationfoundation.org.uk  
Sources
. Varicose Veins. Clinical Evidence.
www.clinicalevidence.com
. Surgical treatments of varicose veins. Royal College of Surgeons.
www.edu.rcsed.ac.uk

 

More information on functional testing for venous disease Venous Disease

 

 

| 25.01.2011 | Read more | Print |

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