| |
Varicose veins are enlarged veins that may
take a straight or twisted path along the surface of the skin. They
may be various shades of blue or purple. Patients often complain
of aching, throbbing, itching and general discomfort with standing
or dependency. However, some rather large varicose veins remain
asymptomatic. The varicose veins are often a symptom of an underlying
condition called venous insufficiency.
The normal direction of blood flow in the veins of the leg is from
the bottom to the top and from the superficial (skin level) to the
deep (muscle level) veins. Blood is propelled in these directions
by the muscles in the calf and thigh as well as by the thin valves
in the veins.
When the valves become damaged, reflux occurs. Gravity then acts
on the column of blood in the veins leading to a backwards flow
and abnormal pressures which gives rise to varicose veins. The stretching
and bulging of the veins lead to the various symptoms described
above.
If left untreated, some patients go on to develop skin discoloration
or rash at the calves and ankles with eventual ulceration of the
skin. This is due to the elevated pressure at the skin level veins
in the lower leg. Some enlarged varicose veins are prone to develop
a superficial phlebitis which is a painful, firm clot.
Some causes of valve damage my be an injury to the leg, an episode
of phlebitis (clot in the leg), prolonged standing position, a strong
family history, and repeated pregnancies.
Please use the drop down menu to find the
answers to the questions on Varicose Veins
QUESTIONS & ANSWERS: Venous Disease:
What are varicose veins?
Varicose veins--which afflict 10% to 20% of all adults but serve
no useful purpose in the body--are swollen, twisted, blue veins
that are close to the surface of the skin. Because valves in them
are damaged, they hold more blood at higher pressure than normal.
That forces fluid into the surrounding tissue, making the affected
leg swell and feel heavy.
Unsightly and uncomfortable, varicose leg veins can promote swelling
in the ankles and feet and itching of the skin. They may occur in
almost any part of the body but are most often seen in the back
of the calf or on the inside of the leg between the groin and the
ankle. Left untreated, patient symptoms are likely to worsen with
some possibly leading to venous ulceration.
Back to Top
What causes varicose veins?
The normal function of leg veins - both the deep veins in the leg
and the superficial veins which feed them - is to carry blood back
to the heart. During walking, for instance, the calf muscle acts
as a pump, contracting veins and forcing blood back to the heart.
To prevent blood from flowing in the wrong direction, veins have
numerous valves. If the valves fail (a cause of venous reflux),
blood flows back into superficial veins and back down the leg. This
results in veins enlarging and becoming varicose. The process is
like blowing air into a balloon without letting the air flow out
again- the balloon swells.
To succeed, treatment must stop this reverse flow at the highest
site or sites of valve failure. In the legs, veins close to the
surface of the skin drain into larger veins, such as the saphenous
vein, which run up to the groin. Damaged valves in the saphenous
vein are often the cause of reversed blood flow back down into the
surface veins.
Back to Top
Why does it occur more in the legs?
Gravity is the culprit. The distance from the feet to the heart
is the furthest blood has to travel in the body. Consequently, those
vessels experience a great deal of pressure. If vein valves can't
handle it, the backflow of blood can cause the surface veins to
become swollen and distorted.
Back to Top
Who is at risk for varicose
veins?
Conditions contributing to varicose veins include genetics, obesity,
pregnancy, hormonal changes at menopause, work or hobbies requiring
extended standing, and past vein diseases such as thrombophlebitis
(i.e. inflammation of a vein as a blood clot forms.) Women suffer
from varicose veins more than men, and the incidence increases to
50% of people over age 50.
Back to Top
What are the symptoms?
Varicose veins may ache, and feet and ankles may swell towards day's
end, especially in hot weather. Varicose veins can get sore and
inflamed, causing redness of the skin around them. In some cases,
patients may develop venous ulcerations.
Back to Top
What are venous leg ulcers?
Venous ulcers are areas of the lower leg where the skin has died
and exposed the flesh beneath. Ulcers can range from the size of
a penny to completely encircling the leg. They are painful, odorous
open wounds which weep fluid and can last for months or even years.
Most leg ulcers occur when vein disease is left untreated. They
are most common among older people but can also affect individuals
as young as 18.
Back to Top
What is the short term treatment
for varicose veins?
ESES (pronounced SS) is an easy way to remember the conservative
approach. It stands for Exercise Stockings Elevation and Still.
Exercising, wearing compression hose, elevating and resting the
legs will not make the veins go away or necessarily prevent them
from worsening because the underlying disease (venous reflux) has
not been addressed. However, it may provide some symptomatic relief.
Weight reduction is also helpful.
If there are inflamed areas or an infection, topical antibiotics
may be prescribed. If ulcers develop, medication and dressings should
be changed regularly.
There are also potentially longer-term treatment alternatives for
visible varicose veins, such as sclerotherapy and phlebectomy.
Back to Top
What is sclerotherapy?
A chemical injection, such as a saline or detergent solution, is
injected into a vein causing it to “spasm” or close
up. Other veins then take over its work. This may bring only temporary
success and varicose veins frequently recur. It is most effective
on smaller surface veins, less than 1-2mm in diameter.
Back to Top
What is ambulatory phlebectomy?
As with sclerotherapy, ambulatory phlebectomy is a surgical procedure
for treating surface veins in which multiple small incisions are
made along a varicose vein and it is "fished out" of the
leg using surgical hooks or forceps. The procedure is done under
local or regional anesthesia, in an operating room or an office
"procedure room."
Back to Top
What is vein stripping?
If the source of the reverse blood flow is due to damaged valves
in the saphenous vein, the vein may be removed by a surgical procedure
known as vein stripping. Under general anesthesia, all or part of
the vein is tied off and pulled out. The legs are bandaged after
the surgery but swelling and bruising may last for weeks.
Back to Top
When is Closure used?
VNUS Closure is used to treat reflux in veins that would otherwise
require stripping. Closure, in contrast to vein stripping, is done
in the office under local anesthesia. A small catheter is passed
into the vein which leads to the closing off of the vein with removing
it from the leg. The body then turns this into scar tissue months
later. Recovery is instantaneous as is return to normal activity.
Back to Top
What is the main difference
between arteries and veins?
In simplest terms, arteries pump oxygen-rich blood FROM the heart,
veins return
oxygen-depleted blood TO the heart.
Back to Top
What are the three main categories
of veins?
Deep leg veins return blood directly to the heart and are in the
center of the leg, near the bones. Superficial leg veins are just
beneath the skin. They have less support from surrounding muscles
and bones than the deep veins and may thus develop an area of weakness
in the wall. When ballooning of the vein occurs, the vein becomes
varicose. Perforator veins serve as connections between the superficial
system and the deep system of leg veins.
Back to Top |
|
