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Varicose Veins

Varicose veins are dilated, enlarged or swollen, tortuous, twisted veins that usually appears raised and swollen and typically appearing dark purple or bluish color.  Varicose veins are also known as varicosities.  The most commonly affected areas are the lower limbs (legs) because of the increased pressure in the veins of the lower body due to standing or walking.   

Varicose veins can just be simply a cosmetic concern for some people, but for others it can be a cause of aching pain and discomfort.  They can also lead to very serious problems. 

Symptoms may include:

Varicose veins in a majority of cases may not cause any pain, though in some cases it can cause severe pain. 

  • Aching legs or heavy feeling in the legs
  • Swelling in the lower legs
  • Itching around the veins
  • Skin discoloration surrounding the vein that is varicosed
  • Spider veins or telangiectasia on the leg that is affected.  Spider veins are similar to varicose veins, but they’re smaller.  They are often red or blue and can be found closer to the skin surface. 

Signs of varicose veins 

  • Dark purple or bluish colored veins.
  • Bulging veins appearing twisted
  • Skin discoloration
  • Healed or active ulcers

Arteries have the role to carry blood from the heart to the rest of the body, whereas veins carry blood from the rest of the body to the heart.  The veins of the lower legs need to work against gravity to carry the blood back to the heart.  Muscle contractions act as pumps to aid this job of pumping blood back to the heart.

The veins of the lower legs have valves that permit blood flow only on one way.  It prevents the blood from flowing backwards due to gravity.  Due to weakness in the valves, it may not function properly and the blood can flow backwards and get collected in the veins instead of getting back to the heart.  This causes the veins to enlarge, stretch or twist. 

Some of the major risk factors of varicose veins are:

  • Age:  Risk for varicose veins is increased as age advances.  As we grow older and usually after the 40s, the valves in our veins get weaker due to wear and tear.  Due to the weakness in the valves, some blood doesn’t flow back to the heart and it gets collected in the leg veins.
  • Gender:  Women are more likely than men to develop the condition.  This could be the result of the hormonal changes during pregnancy, premenstruation or menopause.  Female hormones have a tendency of relaxing the vein walls.  
  • Pregnancy:  During pregnancy, because of the growing fetus in the body, there is an increase in the volume of blood in the body.  This puts more pressure in the veins of the lower body causing the veins to get enlarged.  The enlarged uterus press on the veins and prevent good flow to the heart.
  • Obesity and overweight:  Being obese can add pressure on the veins of the lower legs.  Increased abdominal fat compresses the veins causing strain on the walls of the vein and valves.
  • Genetic factors may have some role.
  • Damage in the veins:  Having suffered trauma in the past can causes weakness in the veins and they may not function properly.
  • Blood clot:  People having a history of blood clots or deep vein thrombosis are at high risk of developing varicose veins.  
  • Standing or sitting for long duration:  Being in the same position for long periods result in incomplete emptying of veins.

Varicose veins can cause complications, which include:

  • Formation of ulcers.  Due to increased venous pressure on the lower legs, painful ulcers may form on the skin near the varicose veins, especially near the ankles.  It is advisable to see your doctor if there is any discoloration of the skin near the varicose veins, because the discoloration could be an indication of an ulcer forming.
  • Blood clots.  Persistent pain in the legs or swelling may be indicative of blood clot.  This condition is medically known as thrombophlebitis.   The development of blood clots in superficial veins may progress to deep vein of the legs and this condition is called Deep Vein Thrombosis or DVT.  It is important for the patient to seek immediate medical attention in case a DVT is suspected as it can lead to further complications like pulmonary embolism.
  • Bleeding.  Occasionally, the veins very close to the skin may burst.  Urgent medical attention is necessary in such cases.

Prevention of varicose veins may not be completely possible.  But some possible measures can be taken which include reducing your weight, exercising, changing your sitting or standing position regularly, keeping the legs elevated.

Ultrasound of abdomen to check for any block or pressure on veins.

Venous Doppler to

  • assess the extent of varicosity
  • look for the presence of perforator vein problems
  • to detect inefficiency of valves
  • to look for DVT

Conservative

  • Drugs
    • Calcium ______
    • Vitamin E
  • Stockings

Surgery

  1.  Radiofrequency Ablation (RFA)
  2. LASER
  3. Sclerotherapy
  4. Ligation and excision of varicose veins

Generally, all these procedures are done under spinal or general anesthetics.  Two days of hospitalization and a few more days of rest may be necessary to recover.

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