May 18, 2008

-Varicose veins

Introduction

Varicose veins are gnarled, enlarged veins. The word "varicose" comes from the Latin root "varix," which means "twisted." Any vein may become varicose, but the veins most commonly affected are those in your legs and feet. That's because standing and walking upright increases the pressure in the veins in your lower body.

For many people, varicose veins and spider veins — a common, mild and medically insignificant variation of varicose veins — are simply a cosmetic concern. For other people, varicose veins can cause aching pain and discomfort. Sometimes the condition leads to more serious problems. Varicose veins may also signal a higher risk of other disorders of the circulatory system.

Varicose veins are a common condition in the United States, affecting up to 15 percent of men and up to 25 percent of women. Treatment may involve self-help measures or procedures by your doctor to close or remove veins.

Signs and symptoms

Some people with varicose veins don't experience any discomfort from the condition. When painful signs and symptoms do occur, they may include:

  • An achy or heavy feeling in your legs, and burning, throbbing, muscle cramping and swelling in your lower legs. Prolonged sitting or standing tends to make your legs feel worse.
  • Itching around one or more of your veins.
  • Skin ulcers near your ankle, which represent a severe form of vascular disease and require immediate attention.

Varicose veins are dark purple or blue in color and may appear twisted and bulging — like cords. They commonly appear on the backs of the calves or on the inside of the leg. However, they can form anywhere on your legs, from your groin to your ankle.

Spider veins are similar to varicose veins, but they're smaller. Spider veins are found closer to the skin's surface and are often red or blue. They occur on the legs, but can also be found on the face. Spider veins vary in size and often look like a spider's web or a tree branch.


Causes

Arteries carry blood from your heart to the rest of your tissues. Veins return blood from the rest of your body to your heart, so the blood can be recirculated. To return blood to your heart, the veins in your legs must work against gravity. Muscle contractions in your lower legs act as pumps, while toned, elastic vein walls help blood return to your heart. Tiny one-way valves in your veins open as blood flows toward your heart then close to stop blood from flowing backward.

As you get older your veins can lose elasticity, causing them to stretch. The valves in your veins may become weak, allowing blood that should be moving toward your heart to flow backward. Blood pools in your veins, and your veins enlarge and become varicose. The veins appear blue because they contain deoxygenated blood, which is in the process of being recirculated.

Some pregnant women develop varicose veins. Pregnancy increases the volume of blood in your body, but decreases the flow of blood from your legs to your pelvis. This circulatory change is designed to support the growing fetus, but it can produce an unfortunate side effect — enlarged veins in your legs. Varicose veins may surface for the first time or may worsen during late pregnancy, when your uterus exerts greater pressure on the veins in your legs. Hemorrhoids are varicose veins located in and around the anus.


Risk factors

These factors increase your risk of developing varicose veins:

  • Age. Aging causes wear and tear on the valves in your veins that help regulate blood flow. Eventually, that wear causes the valves to malfunction.
  • Sex. Women are more likely than men are to develop the condition. Hormonal changes during pregnancy, premenstruation or menopause may be a factor. Female hormones tend to relax vein walls. Taking hormone replacement therapy or birth control pills may increase your risk of varicose veins.
  • Genetics. If other family members had varicose veins, there's a greater chance you will too.
  • Obesity. Being overweight puts added pressure on your veins.
  • Standing for long periods of time. Your blood doesn't flow as well if you're in the same position for long periods.

Screening and diagnosis

In making a diagnosis, your doctor will examine your legs while you're standing and will look for swelling. He or she may also ask you to describe the pain and aching in your legs. Finally, your doctor may perform an ultrasound test to see if the valves in your veins are functioning normally or if there's any evidence of a blood clot. Your primary care doctor may recommend that you see a doctor who specializes in vein conditions (phlebologist) or a doctor who treats skin conditions (dermatologist or dermatology surgeon).


Complications

Extremely painful ulcers may form on the skin near varicose veins, particularly near the ankles. Ulcers are the result of long-term "water logging" of these tissues, caused by increased pressure of blood within affected veins. Brownish pigmentation usually precedes the development of an ulcer. See your doctor immediately if you suspect you've developed an ulcer.

Occasionally, veins deep within the legs become enlarged. In such cases, the affected leg may swell considerably. Any sudden leg swelling warrants urgent medical attention because it may indicate a blood clot — a condition known medically as thrombophlebitis.


Treatment

Fortunately, treatment usually doesn't mean a hospital stay or a long, uncomfortable recovery. Less invasive techniques generally allow varicose veins to be dealt with on an outpatient basis. Self-help measures — such as exercising, losing weight, not wearing tight clothes, elevating your legs and avoiding long periods of standing or sitting — can ease pain and prevent varicose veins from getting worse. Varicose veins that develop during pregnancy generally improve without medical treatment within three months after delivery.

If you don't respond to self-help or if your condition is more severe, your doctor may advise one of these varicose vein treatments:

  • Sclerotherapy. In this procedure, your doctor injects small- and medium-sized varicose veins with a solution that scars and closes those veins. In a few weeks, treated varicose veins should fade. Although the same vein may need to be injected more than once, sclerotherapy is effective if done correctly. Sclerotherapy doesn't require anesthesia and can be done in your doctor's office.
  • Laser surgeries. Doctors are using new technology in laser treatments to close off smaller varicose veins and spider veins. Laser surgery works by sending strong bursts of light onto the vein, which makes the vein slowly fade and disappear. No incisions or needles are used.
  • Catheter-assisted procedures. In one of these treatments, your doctor inserts a thin tube (catheter) into an enlarged vein and heats the tip of the catheter. As the catheter is pulled out, the heat destroys the vein by causing it to collapse and seal shut. This procedure is usually done for larger varicose veins.
  • Vein stripping. This procedure involves removing a long vein through small incisions. This is an outpatient procedure for most people. Removing the vein won't affect circulation in your leg because veins deeper in the leg take care of the larger volumes of blood.
  • Ambulatory phlebectomy (fluh-BEK-to-me). Your doctor removes smaller varicose veins through a series of tiny skin punctures. Local anesthesia is used in this outpatient procedure. Scarring is generally minimal.
  • Endoscopic vein surgery. You might need this operation only in an advanced case involving leg ulcers. Your surgeon uses a thin video camera inserted in your leg to visualize and close varicose veins, and then removes the veins through small incisions.

Be a cautious consumer
When it comes to treatment options for varicose veins, it pays to be a cautious health consumer. Advertisements claiming "unique," "permanent" or "painless" methods to remove varicose veins may be appealing, but they may not actually measure up to those claims. Before undergoing any procedure, ask your doctor about any health risks and possible side effects.

You may want to inquire about treatment costs, as well. Most insurance policies don't cover the expense of elective cosmetic surgery for varicose veins. However, in many cases, if you have signs or symptoms such as swelling and bleeding, insurance may cover the treatment.

Current treatments for varicose veins and spider veins are highly successful. However, it's possible that varicose veins can recur.


Prevention

There's no way to completely prevent varicose veins. But improving your circulation and muscle tone can reduce your risk of developing varicose veins or getting additional ones. Traditional, common-sense approaches include:

  • Exercise. Get your legs moving. Walking is a great way to encourage blood circulation in your legs. Your doctor can recommend an appropriate activity level for you.
  • Watch your weight, and your diet. Shedding excess pounds takes unnecessary pressure off your veins. What you eat makes a difference, too. Follow a low-salt, high-fiber diet to prevent the swelling that may result from water retention and constipation.
  • Watch what you wear. Avoid high heels. Low-heeled shoes work calf muscles more, which is better for your veins. Don't wear tight clothes around your waist, legs or groin. Tight panty-leg girdles, for instance, can restrict circulation.
  • Elevate your legs. To improve venous circulation, take several short breaks daily to elevate your legs above the level of your heart. For example, lie down with your legs resting on three or four pillows.
  • Avoid long periods of sitting or standing. Make a point of changing your position frequently to encourage blood flow. Try to move around at least every 30 minutes.
  • Don't sit with your legs crossed. This position can aggravate circulation problems.

Self-care

Wearing compression stockings is often the first approach to try before moving on to other treatments. Compression stockings are worn all day. They steadily squeeze your legs, helping veins and leg muscles move blood more efficiently. The amount of compression varies by type and brand.

Stockings today come in a variety of strengths, styles and colors. With the variety offered, you're likely to find a stocking that you're comfortable wearing.

You can buy compression stockings at most pharmacies and medical supply stores. Prices vary. Prescription-strength stockings also are available.

When purchasing compression stockings, make sure that they fit properly. Using a tape measure, you or your pharmacist can measure your legs to ensure you get the right size and fit according to the size chart found on the stocking package. Compression stockings should be strong but not necessarily tight. If you have weak hands or arthritis, getting these stockings on may be difficult. There are devices to make putting them on easier.


Complementary and alternative medicine

Evidence suggests that horse chestnut seed extract may be an effective treatment for chronic venous insufficiency (CVI), a condition associated with varicose veins in which leg veins have problems returning blood to the heart. The herb may help improve swelling and discomfort caused by varicose veins. Talk with your doctor before trying horse chestnut seed extract or any other herb or dietary supplement.


(source mayo clinic)

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