Varicose veins
Varicose veins are swollen, twisted veins that often appear near the surface of the skin, primarily in the legs. They occur when the one-way valves in the veins fail, leading to blood pooling and increased pressure. Factors contributing to this condition include congenital defects, damage from blood clots, and the natural aging process. Symptoms may include an aching sensation, heaviness in the legs, and visible bulging veins that often worsen with prolonged standing or sitting. While varicose veins are typically not serious, they can lead to complications like blood clots and venous ulcers if left untreated.
Management options for varicose veins range from wearing compression stockings to surgical interventions that remove or shrink the affected veins. Lifestyle changes, such as regular movement, weight management, and avoiding long periods of sitting or standing, can help prevent the development or worsening of varicose veins. Although they are common, especially in older adults, proactive measures can significantly alleviate symptoms and prevent complications.
Varicose veins
Disease/Disorder
Anatomy or system affected: Blood vessels, circulatory system
Definition: The distension of superficial veins, usually affecting the legs and causing the appearance of twisted, swollen, blue veins, especially on the backs of the calves.
Information on Varicose Veins
Causes: Aging process; damage from venous thrombosis; long periods of standing, sitting, or straining; pregnancy; congenital valve or vessel defects; obesity
Symptoms: Twisted, swollen, blue, or bulging veins; achiness or heaviness in legs; swollen feet and legs
Duration: Short-term to chronic
Treatments: Compression stockings, surgery, sclerotherapy
Causes and Symptoms
The main task of normal leg veins is to return blood to the heart and lungs. This is difficult because the blood must be pushed upward, against the constant force of gravity. The force that propels the blood up the leg comes from the contraction of the calf muscles surrounding the deep veins that occurs during the act of walking. This forward momentum is quickly lost as gravity pulls the blood back down; however, one-way valves attached to the inside of the vein wall allow blood to pass up the leg freely, then close before the blood can be pulled back down. With each step taken, the column of blood moves up the leg until it eventually reaches the heart.
The system works well until one of the valves fails. Valves may fail because of congenital defect or because of damage from venous thrombosis (blood clots in the veins of the leg). As one ages, long periods of sitting or straining eventually cause even normal veins to become stretched and dilated, causing the valve leaflets to close improperly. When a vein valve does not close correctly, blood leaks backward, placing extra pressure on the valve beneath it. This increased pressure causes the vein to become dilated and twisted. Such veins are said to be “varicose.” If this vein is near the skin, it will bulge out and become visible. These unsightly veins become more pronounced while standing and disappear or become less noticeable when lying down.
Once damaged, the valve cannot repair itself. The increased pressure continues to damage valve after valve until the small bump eventually becomes a large, bluish rope. Varicose veins are frequently accompanied by an aching sensation or a feeling of heaviness in the legs. These symptoms are aggravated by sitting or standing. People who must be on their feet all day usually experience severe discomfort. As the condition worsens, the legs and feet swell. These symptoms, which are often absent upon arising from bed in the morning, usually become more severe as the day progresses.
Although varicose veins are sometimes painful, they are not always a serious condition. Most people experience only minor inconvenience from them. If allowed to progress, however, varicose veins lead to more serious conditions. One of the most common—and most serious—of these complications is a blood clot within the varicose vein. As long as blood is moving quickly in a vessel, it is very difficult for it to clot. When a vein becomes varicose, the dilated portion of the vein allows blood to pool. If blood stagnates, it can become a solid mass of blood called a thrombus, or a blood clot. This blood clot may continue to grow up the vein. It can fill the entire vein from the foot to the groin and enter the deep veins of the leg.
Deep vein thrombosis, a clot in a deep vein is a potentially life-threatening condition, as it may break loose, pass through the heart, and lodge in the arteries that take blood to the lungs. This condition is referred to as a pulmonary embolism. If this happens, and the blood clot is small, the patient experiences shortness of breath and chest pain. If the clot that breaks loose is big and lodges in a larger lung artery, it can result in sudden death. Blood clots limited to the superficial veins (near the skin) are far less likely to break loose and result in a major pulmonary embolism. The symptoms of clot in the superficial veins are pain and redness directly over the vein involved. The varicose vein may also become hard. This is called a superficial cord. As the clot grows, the redness, pain, and cord move up the leg. This is a serious condition and requires immediate medical attention.
Other complications associated with varicose veins relate to the impact of having increased venous pressure in the legs over a long period of time. When the valves are working, the pressure in the tissue at the ankle is kept at a low level. When varicose veins are severe, the pressure in the tissue becomes so high that blood flow to the skin decreases. If this occurs over a long period of time, the skin becomes discolored and hardens. Ultimately, the skin breaks down, and venous ulcers occur. These open, weeping sores can become infected and become a chronic problem.
Treatment and Therapy
Minor varicose veins are managed quite effectively—if caught early—with well-fitting elastic compression stockings. These place pressure over the superficial veins, giving them support and preventing additional damage to them. This also forces blood into the deep veins. Assuming the deep veins have functioning valves in them, this provides relief and slows progression of the problem. Another popular approach is to surgically remove the damaged vein. This operation, called stripping, removes the veins with damaged valves, forcing blood to go through healthy veins. This can resolve the symptoms of varicose veins altogether. However, other veins may eventually become varicose.
Another varicose vein removal intervention is injection therapy, or sclerotherapy, in which the patient is injected with a material that irritates the varicose vein, causing a clot to form in it. The clot is carefully controlled so that it stays only in the vein being treated. The clot attaches to the vein wall, causing the vein to shrink. This shrinking of the vein makes it seem to disappear. Sclerotherapy is not appropriate in more serious cases of varicose veins.
Perspective and Prospects
Although varicose veins can occur at any time, they are particularly predominant among the elderly; 50 percent of all individuals can expect to develop varicose veins by the age of fifty.
Nothing can be done to change congenital or inherited factors that cause varicose veins. Simple measures, however, can prevent the development of varicose veins before they occur or can slow their progression once they have developed. These preventive measures all have a common theme: avoiding long periods of sitting or standing and keeping the calf muscle active. Doctors advise people who must sit or stand for any length of time to flex and relax their calf muscles by pulling their feet up and pushing them back down. This keeps the blood moving and keeps it from pooling. Other measures include breaking up long periods of inactivity by walking a few minutes every hour, elevating the legs from time to time, wearing loose clothing that does not restrict blood flow, and avoiding high-heeled shoes. Some doctors also recommend eating a high-fiber diet since some varicose vein problems result from straining during difficult bowel movements. Patients with varicose veins who are overweight or obese will ease the symptoms of the varicose veins with weight loss. Strength-training exercises for the muscles of the leg, especially the calf, can also help to relieve some of the symptoms of varicose veins.
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