Veins – Varicose – Symptoms & Treatments
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What are veins?
To get a clear understanding, first we have to picturize the heart or the pump sitting in the centre of chest, and arteries that carry oxygen rich blood from the heart to the rest of the body. Veins are present throughout the body as tubes that carry blood back to the heart. There are valves in most veins to prevent back flow. As opposed to arteries, veins bring oxygen deficient blood from the tissues to the heart. The return of blood to the heart is assisted by the action of the leg muscle pump, and by the pump action of our rib cage during breathing. The difference between veins and arteries is their direction of flow (out of the heart by arteries, returning to the heart for veins).
What are varicose veins?
Varicose veins are veins that have become enlarged and twisted. The term commonly refers to the veins on the legs. Veins have pairs of leaflet valves to prevent blood from flowing backwards (retrograde flow or venous reflux). Leg muscles pump the veins to return blood to the heart, against the effect of gravity. When veins become varicose, the leaflets no longer meet properly, and the valves do not work. This allows blood to flow backwards and the veins enlarge even more. This is also referred to as Chronic Venous Insufficiency. Varicose veins are most common in the superficial veins of the legs, which are subject to high pressure when standing.
Signs and symptoms of varicose veins
- Aching, heavy legs (often worse at night and after exercise).
- Appearance of spider veins (telangiectasia) in the affected leg.
- Ankle swelling, especially in the evening.
- A brownish-yellow shiny skin discoloration near the affected veins.
- Redness, dryness, and itchiness of areas of skin, termed stasis dermatitis or venous eczema, because of waste products building up in the leg.
- Cramps may develop especially when making a sudden move as standing up.
- Minor injuries to the area may bleed more than normal or take a long time to heal.
- In some people the skin above the ankle may shrink (lipodermatosclerosis) because the fat underneath the skin becomes hard.
- Restless legs syndrome appears to be a common overlapping clinical syndrome in people with varicose veins and other chronic venous insufficiency.
- Whitened, irregular scar-like patches can appear at the ankles. This is known as atrophie blanche.
Complications from varicose veins
- Most of the varicose veins are usually benign, however potential complications that can develop are:
- Pain, tenderness, heaviness, inability to walk or stand for long hours, thus hindering work.
- Skin conditions / dermatitis which could predispose skin loss.
- Skin ulcers especially near the ankle, usually referred to as venous ulcers.
- Development of carcinoma or sarcoma in long standing venous ulcers. Over 100 reported cases of malignant transformation have been reported at a rate reported as 0.4% to 1%.
- Severe bleeding from minor trauma, of particular concern in the elderly.
- Blood clotting within affected veins, termed superficial thrombophlebitis . These are frequently isolated to the superficial veins, but can extend into deep veins, becoming a more serious problem.
- Acute fat necrosis can occur, especially at the ankle of overweight people with varicose veins. Females are more frequently affected than males.
Ultrasound is the test of choice, if chronic venous insufficiency is suspected. It is a risk-free and a non invasive procedure. It gives information about the anatomy, physiology and pathology of the veins. It confirms varicose veins disease, making an assessment of the hemodynamics, and charting the progression of the disease and its response to treatment. It allows the examiner to evaluate the gross anatomy of the venous networks as well as blood flow direction, which is crucial in determining vein pathology. The normal physiological blood flow is antegrade, flowing from the periphery towards the heart, so the evidence of an opposite, etrograde flow might indicate a pathology.
Stages of veinous insufficiency
C-0 : no visible or palpable signs of venous disease
C-1: telangiectasia or reticular veins
C-2: varicose veins
C-3: edema C-4a: pigmentation or eczema
C-4b: lipodermatosclerosis, atrophie blanche
C-5: healed ulcer C-6: active ulcer
Varicose veins are more common in women, and are also linked to heredity. Other related causes are pregnancy, obesity, menopause, aging, prolonged standing, leg injury and abdominal straining. They don’t happen just you crossed your legs or ankles. It is often caused by venous reflux. Chronic alcohol consumption is also a known cause
Treating Varicose Veins
For the majority of cases, a physical examination will be necessary in order to determine the presence of varicose veins. Your vein specialist will also ask you to describe your pain, be vocal if you’ve been feeling sensations of achiness. For more serious cases, ultrasound could be administered in order to get a better look at the interior of the veins.
For treatment, sclerotherapy is often a primary consideration. This involves your vein specialist injecting you with a solution that will scar and seal the vein. After a few days, the varicose veins should begin to dissipate. Another option includes VenaCure EVLT (Endovenous Laser Treatment), which is when strong bursts of light are shone onto the vein, causing it to fade and vanish. This is non-invasive and no needles are involved. The final option could include the phlebectomy that we mentioned above.