Varicose Veins

What are varicose veins?

Varicose veins are veins close to the skin that are swollen or stretched. Veins in the legs and pelvic area are most often affected. Varicose veins are more common in women. They can appear at any time in adulthood, especially during or after pregnancy. They may worsen as you get older.

Spider veins are similar to varicose veins, but they are smaller. They often look red or blue and are closer to the surface of the skin than varicose veins. They may look like a spider web or tree branch. Spider veins are most often found on the legs or the face.

What is the cause?

Unlike the arteries, the veins have no muscle tissue. Veins use the muscles in our feet and legs to return blood, against gravity, to the heart. To help this process, the veins have a series of valves in them that prevent blood from flowing backward. When these valves stop working properly, the blood has trouble moving upward. The blood backs up in the veins where the valves no longer are working. These swollen veins are varicose veins.

Factors that may contribute to this condition are pregnancy, excess weight, and standing on your feet for long periods of time. Constipation may cause varicose veins in the rectal area (hemorrhoids). Varicose veins tend to run in families, so heredity is a factor also.

What are the symptoms?

Varicose veins in your legs are enlarged and may look blue, twisted, or ropelike. You may have no other symptoms, or you may have:

• swelling in the legs, ankles, or feet
• cramps or general aching in the legs or aching in the area where the veins are swollen
• feeling of heaviness in legs, or leg muscles that tire easily
• itching of the skin around the veins
• discoloration or sores on your skin, especially near the ankle, from poor circulation

How is it diagnosed?

Your healthcare provider will examine you and check your legs while you are standing. If you are having symptoms, your provider may also order tests, such as an ultrasound exam.

How is it treated?

There are many ways to treat varicose veins. A combination of treatments often produces the best results.

The main treatment is wearing elastic stockings for support during daily activities. If you have leg swelling along with varicose veins, these stockings are especially important for preventing skin sores. To keep varicose veins from getting worse, try:

• walking often (to help the muscles move the blood upward, out of the legs)
• elevating your feet
• avoiding sitting or standing for a long time

If you have to sit for a long time, such as with traveling, raise your heels repeatedly off the floor to exercise your feet and calf muscles.

A medical treatment called sclerotherapy involves injecting a chemical solution into spider veins and small varicose veins. The chemical causes the veins to close and forces the blood to flow through healthier veins. Injections are done with little discomfort and without anesthesia in a healthcare provider's office. Several treatment sessions may be needed. This procedure makes your legs look better, but it may cause worse problems later. Some possible complications of sclerotherapy are:

• darkening of the skin where the vein was removed (this usually goes away in a few months)
• temporary redness and tenderness of the vein that was treated
• reopening of the vein after treatment
• development of new enlarged veins in the area where a vein was treated

Duplex ultrasound-guided sclerotherapy is a newer technique used to treat more severe varicose veins. Duplex guidance is used to position a catheter in the desired location, and then a strong irritating solution is injected into the veins.

Another treatment uses a laser to treat varicose veins. It eliminates the need for injections and may reach veins that are too small for the needle on the guidance catheter to pass through easily. Laser treatment works by sending very strong bursts of light onto the vein. The light makes the vein slowly fade and disappear. Two or three treatment sessions are usually needed.

Surgery may be needed to remove large varicose veins. One method that leaves only very small scars is called ambulatory phlebectomy. This procedure can be done in the healthcare provider's office. Tiny cuts are made in the vein, and then with surgical hooks, the vein is pulled out of the leg.

How long will the effects last?

The symptoms will last as long as you have varicose veins. They may get worse without treatment.

How can I take care of myself?

• Raise your legs to a level higher than your heart as often as you can.
• Rest often.
• Raise your feet when you sleep by propping them on a pillow. Avoid crossing your legs when you are sitting.
• Avoid wearing girdles, control-top pantyhose, or garters.
• Wear support hose. Ask your healthcare provider to recommend the right stockings for you.
• To increase circulation, exercise regularly according to your healthcare provider's recommendations.
• Lose weight if you are overweight.
• Avoid constipation.

How can I help prevent varicose veins?

• Avoid sitting or standing in one position for a long time.
• When you are sitting, exercise your calf muscles (for example, by raising your heels up and down) to promote normal blood flow.
• Exercise regularly to maintain good muscle tone, good circulation, and normal weight.