Varicose Veins

Summary for patients:

Varicose Veins occur when the veins in your legs become weakened or damaged, causing them to become swollen or distorted. For most people, they are not a serious health problem but their appearance can cause embarrassment. The most common way to treat Varicose Veins is through regular exercise and by elevating your legs when resting. Wearing compression stockings also helps as these are specially designed to improve your circulation.

For healthcare practitioners:

“Varicose veins” is the commonly used term for the superficial veins in the leg when they have become swollen and distorted. Although these can be unsightly, they are not generally symptomatic and do not cause complications. However, in some cases they can become painful and lead to varicose eczema, thickening of the skin (lipodermatosclerosis) and eventually venous leg ulceration.

In normal healthy legs, the calf muscle helps to pump blood back to the heart and valves in the veins stop backflow due to gravity. If these veins become damaged or weakened in any way (e.g. due to smoking, obesity, pregnancy or age) the valves can become incompetent allowing backflow (reflux) and the pooling of blood in the weakened veins causes them to enlarge and look unsightly as they are just below the skin.

Signs and symptoms include a feeling of “heaviness” in the legs, often worse at night, spider veins (telangiectasia) in the affected leg, ankle swelling (especially in the evening) and dry itchy skin in the area of the varicose veins.

There are various treatments, both invasive (surgical) or non-invasive. Traditional surgery involves stripping or removing either part or all of the long saphenous vein, though there is a 5.3% risk of DVT from this1 and a potential risk or recurrence.

Sclerotherapy1 is the injection of a chemical into the veins which seals them. Newer techniques include Endovenous and Radiotherapy Ablation, which use heat to seal the veins.

Regular exercise and elevating the legs when resting, and compression hosiery (Class 2 or 3) help to improve the micro-circulation and reduce swelling.3

Secondary varicose veins can occur following stenosis or a Deep Venous Thrombosis (DVT) and are usually treated by wearing compression hosiery.

References
  1. van Rij AM, Chai J, Hill GB, Christie RA (December 2004). “Incidence of deep vein thrombosis after varicose vein surgery”. Br J Surg 91 (12): 1582–5.
  2. Weiss RA, Weiss MA (1993). “Doppler ultrasound findings in reticular veins of the thigh subdermic lateral venous system and implications for sclerotherapy”. J Dermatol Surg Oncol 19 (10): 947–51
  3. Campbell B (2006). “Varicose veins and their management”. BMJ 333 (7562): 287–92.