Varicose Veins

What are varicose veins?

Varicose veins normally do not create any pain. The signs and symptoms that indicate that an individual might have varicose veins are:

Veins known as spider veins are identical to varicose veins, except for the size which is smaller. They are usually located near the skin surface. Normally they are blue or red. They not only develop on the legs but also can occur on the face. Spider veins can differ in sizes as well as resembling spider webs.
There are self-care methods which can help with these veins – such as elevating the legs, exercise the legs or wear compression stockings which can help with any pain of varicose veins as well as stop them from becoming worse. If an individual is worried about how the veins feel and look, and the self-care help have not stopped the problems from becoming worse, a visit to the primary care physician is advised.

Varicose Veins Causes
Blood is moved from the heart to all the rest of the tissues thru arteries. This blood is returned from the body tissues to the heart by veins, so that this blood can be recirculated. In order to return this blood to the heart, these veins in the leg need to work against the gravity. Contractions in the muscle in the lower legs propel the blood and the elastic walls in the veins help to return the blood to the heart. There are miniature valves in the veins that open as the blood flows to the heart and then close in order to prevent blood from going backwards.
Reasons for varicose veins may include:

Age
As individuals get older, the veins may lose elasticity that causes the walls to stretch. The veins and the walls can become very weak, which allows the blood that needs to be moving in the direction of the heart to flow backwards. This causes blood to pool in the veins and the veins enlarge becoming varicose. The veins appear blue since they hold deoxygenated blood that is in the process of being recirculated thru the lungs.

Pregnancy
Many women who are pregnant develop varicose veins. Pregnancy raises the blood volume in the body, but decreases the blood flow from the legs to the pelvis. This change in the circulatory system is created in order to support the fetus that is growing, but it can cause a side effect which is unfortunate – veins in the legs enlarge. Varicose veins can surface for the very first time or can worsen during later pregnancies, when the uterus exerts pressure on the veins in the legs. Hormone changes during pregnancy may also play a role. These varicose veins which start during pregnancy normally improve without any treatment medically within 3 months after delivery.

There are rare complications of varicose veins but they can happen, and they can include:

Blood clots
Infrequently, the veins which are deep in the legs become enlarged. In these incidents, the leg which is affected can considerably swell. Any sudden swelling of the leg deserves medical attention which is urgent as it can be an indication of a blood clot – a condition referred to by the medical term thrombophlebitis.

Ulcers
Ulcers which are extremely painful can form on the skin near varicose veins, especially near the ankles. Long-term fluid buildup in the tissues can cause these ulcers by increased pressure of the blood within the affected veins. Any discolored spot on the skin is the usually sign before an ulcer forms. See a primary care physician if there is a suspicion that an ulcer is developing.


Treatment of varicose veins
Self-Care Measures
Medical and Surgical Treatments
Sclerotherapy
Thermal Ablation:

(radiofrequency and laser)
Surgical Ligation and Stripping
Ambulatory Phlebectomy
Endoscopic Vein Surgery
Recurrence of varicose veins



How are varicose veins treated?
Besides a physical exam, your doctor may take x-rays or ultrasound pictures of the vein to find the cause and severity of the problem. Your doctor can help you to determine what treatment options are best for your condition and lifestyle. Not all cases of spider veins and varicose veins are the same, and not all vein treatments are the same.
Available vein treatments include those listed below:

Self-Care Measures

Self-care measures are a common option for treating varicose veins. If self-care measures are called for, your doctor may ask you to:




Medical and surgical treatments
are used to
either remove varicose veins or close them. Removing or closing varicose veins usually doesn’t create circulation problems because the blood reroutes itself through other veins. These therapies range from approaches that don’t involve incisions or injections to those that are surgical procedures. It may be necessary to combine therapies, depending on your condition and lifestyle.

Sclerotherapy

This is the most common treatment for both spider veins and varicose veins. The doctor injects a solution of liquid or foam into the vein that causes the vein walls to swell, stick together, and seal shut. This stops the flow of blood and the vein turns into scar tissue. In a few weeks, the vein should fade. The same vein may need to be treated more than once.
This treatment is very effective if done the right way. Most patients can expect a 50% to 90% improvement. Sclerotherapy does not require anesthesia, and can be done in the doctor's office.

Microsclerotherapy uses special solutions and injection techniques that increase the success rate for removal of spider veins and other very small varicose veins. It involves injection of small amounts of a liquid or foam chemical using a very fine needle. The chemical causes scarring in the inner lining of the veins, causing them to close off.

The treated vein can also become inflamed or develop lumps of clotted blood. This is not dangerous. Applying heat and taking aspirin or antibiotics can relieve inflammation. Lumps of coagulated blood can be drained.


Endovenous Techniques (radiofrequency and laser)
These methods for treating the deeper varicose veins of the legs (the saphenous veins) have been a huge breakthrough. They have replaced surgery for the vast majority of patients with severe varicose veins. This technique is not very invasive and can be done in a doctor’s office. The patient is awake during the procedure, but the doctor numbs the area of the vein. The patient usually goes home on the same day.
The doctor puts a very small tube called a catheter into the vein. Once inside, the catheter sends out radiofrequency or laser energy that shrinks and seals the vein wall. Healthy veins around the closed vein restore the normal f low of blood. As this happens, symptoms from the varicose vein improve. Veins on the surface of the skin that are connected to the treated varicose vein will also usually shrink after treatment. When needed, these connected varicose veins can be treated with sclerotherapy or other techniques.
Possible side effect:


Surgical Ligation and Stripping
With this treatment, problematic veins are tied shut and completely removed from the leg. Removing the veins does not affect the circulation of blood in the leg. Veins deeper in the leg take care of the larger volumes of blood. Most varicose veins removed by surgery are surface veins and collect blood only from the skin. This surgery requires either local or general anesthesia and must be done in an operating room on an outpatient basis.
Possible side effects: Serious side effects or problems from this surgery are uncommon.


Ambulatory Phlebectomy
With this surgery, a special light source marks the location of the vein. Tiny cuts are made in the skin, and surgical hooks pull the vein out of the leg. This surgery requires local or regional anesthesia. The vein usually is removed in one treatment. Very large varicose veins can be removed with this treatment while leaving only very small scars. Patients can return to normal activity the day after treatment.
Possible Side Effects:


Endoscopic vein surgery
This procedure uses a tiny camera at the end of a thin tube to move through the varicose veins. A surgical instrument at the end of the camera is used to close the veins. Endoscopic vein surgery is currently only used in severe cases in which there are skin ulcers due to the varicose veins. Only small incisions are required for this procedure. People who have this surgery must have some kind of anesthesia including epidural, spinal, or general anesthesia. Patients can return to normal activity within a few weeks.


Can varicose veins return even after treatment?
Current treatments for varicose veins have very high success rates compared to traditional surgical treatments. Over a period of years, however, more abnormal veins can develop. The major reason for this is that there is no cure for weak vein valves. So with time, pressure gradually builds up in the leg veins. Ultrasound can be used to keep track of how badly the valves are leaking (venous insufficiency). Ongoing treatment can help keep this problem under control.

The single most important thing a person can do to slow down the development of new varicose veins is to wear graduated compression support stockings as much as possible during the day.