The body’s vascular system is made up of arteries and veins. Arteries carry the blood away from the heart to the tissues, supplying them with oxygen and nutrients. Veins return the blood to the heart. Unlike arteries, veins have no pumping ability in their walls. Instead, veins rely on the contraction of the muscles around them to push the blood back to the heart and contain one-way valves that prevent the blood to flow backwards (known as reflux). When these valves become damaged and fail to open or close properly, blood flow becomes affected and pressure increases inside the veins. This phenomenon leads to gradual enlargement and elongation of the vein. The result of this process is a varicose vein.
What are the risk factors for varicose veins?
Family history of varicose veins is the number one risk factor. Varicose veins are also much more common (2x) in women then in men. Pregnancy and hormonal changes during the life span are believed to play a significant role in the development of varicose veins. Some studies say as many as 70% of pregnant women develop some degree of varicose veins.
Gravity also plays a significant role in the development of varicose veins. This problem is often seen in people whose occupation requires prolonged standing such as nurses, flight attendants, teachers, waitresses, and of coures surgeons.
Trauma to the vein can also lead to the development of varicose veins.
Varicose veins may have no symptoms at all. However, the most common symptoms are aching, tired or heavy legs, especially at the end of the day. Dry, scaly skin and swelling of the lower legs are commonly seen in late stages. The process may progress to chronic venous insufficiency.
First your physician asks you questions about your general health, medical history, and symptoms. In addition, your physician conducts a physical exam. Together these are known as a patient history and exam. Your physician will examine the texture and color of any prominent veins. He or she may apply a tourniquet or direct hand pressure to observe how your veins fill with blood. To confirm a diagnosis of varicose veins, your physician may order a duplex ultrasound test.
Duplex ultrasound uses high-frequency waves higher than human hearing can detect. Your physician uses duplex ultrasound to measure the speed of blood flow and to see the structure of your leg veins. The test can take approximately 20 minutes for each leg. Besides showing varicose veins, duplex ultrasound may help your physician decide whether your varicose veins are related to some other condition rather than the veins themselves.
How are varicose veins treated?
Varicose veins may sometimes worsen without treatment. Your physician will first try methods that don't require surgery to relieve your symptoms. If you have mild to moderate varicose veins, elevating your legs can help reduce leg swelling and relieve other symptoms. Your physician may instruct you to prop your feet up above the level of your heart 3 or 4 times a day for about 15 minutes at a time. When you need to stand for a long period of time, you can flex your legs occasionally to allow the venous pump to keep blood moving toward your heart.
Compression Stockings
For more severe varicose veins, your physician may prescribe compression stockings. Compression stockings are elastic stockings that squeeze your veins and stop excess blood from flowing backward. Compression stockings can also help heal skin sores and prevent them from returning. You may be required to wear compression stockings daily for the rest of your life. For many patients, compression stockings effectively treat varicose veins and may be all that are needed to relieve pain and swelling and prevent future problems.
When these kinds of treatments alone do not relieve your varicose veins, you may require a surgical or minimally invasive treatment, depending upon the extent and severity of the varicose veins. These treatments include sclerotherapy, ablation, vein stripping, and laser treatment.
Sclerotherapy
In sclerotherapy, a solution is injected directly into a superficial vein via a very small needle. The sclerosing agent injures the vein from within, causing it to collapse. At UVA, we use a detergent solution that is not painful. We offer sclerotherapy for unsightly and often uncomfortable “spider” veins. Foamed sclerosant solution can also be used for larger varicosities, particularly in patients who have already undergone saphenous vein ablation or stripping. Patients with medical conditions that make surgical vein treatments less desirable may be excellent candidates for foam sclerotherapy for chronic venous insufficiency.
Ablation
Ablation uses a thin, flexible tube called a catheter inserted into a varicose vein. Tiny electrodes at the tip of the catheter heat the walls of your varicose vein and destroy the vein tissue. As with chemical sclerotherapy, your vein is then no longer able to carry blood, breaks up naturally, and is absorbed by your body. Click here for more information about endovenous ablation.
Vein Stripping
To perform vein stripping, your physician disconnects and ties off all major varicose vein branches associated with the saphenous vein, the main superficial vein in your leg. Your physician then removes the saphenous vein from your leg. A procedure, called small incision avulsion, can be done alone or together with vein stripping. Small incision avulsion allows your physician to remove varicose veins from your leg using hooks passed through small incisions. In a similar procedure called TIPP, your physician shines an intense light on your leg to show your veins. Once your physician locates a varicose vein, he or she passes a suction device through a tiny incision and suctions out the vein. Although these procedures sound painful, they cause relatively little pain and are generally well tolerated. Your vascular surgeon will advise you regarding which procedure is the best for your particular situation.