Varicose Veins: Causes, Symptoms and Treatment
Blood vessels in the human body mainly comprise of the arteries and the veins. Arteries bring the oxygenated blood to the organs while veins carry deoxygenated blood back towards the heart. Veins have valves in them. These valves help in preventing the backward flow of blood against gravity. Thus blood continues to have a unidirectional movement towards the heart. Varicose veins are a result of increased tortuosity and dilatation of the venous system.
Veins have a less muscular vessel wall. As a result, they are unable to propel the blood forward towards the heart. Peripheral muscles (e.g. the muscles of the calf) help in propelling the blood forward. This is especially for the deep veins. However, it is the superficial veins (which lie beneath the skin) that are more prone to develop sluggish blood flow and develop varicosities.
Varicose veins mainly result from faulty valves or venous obstruction. As a result, blood backs up in the veins. They become dilated, enlarged and wavy/ tortuous. While they do not cause significant symptoms in the majority of the people, they may lead to pain, discomfort in others. They may rupture leading to hemorrhages.
The most common sites are the lower extremities (gravity-dependent parts of the body). However, they can also develop in the anal region (piles or hemorrhoid) in the abdomen ( in patients with portal hypertension and liver failure) or in the testis (known as varicocoele).
Causes and Risk Factors
Various conditions increase one’s risk of developing varicose veins. They include:
- Venous pooling of blood due to prolonged inactivity, or long hours of standing as in bus conductors, cooks.
- Increased back pressure due to venous obstruction. It may be due to clots in the veins or external venous compression by tumours/ masses.
- Pregnancy is a hyper-coagulable state. There are increased risks of developing hypertension and blood clots. Moreover, an expanding uterus compresses the veins. These may eventually lead to the development of varicose veins. (Know about Medical Problems During Pregnancy)
- Non-modifiable risk factors like increasing age, family history also predispose to the same.
Signs and Symptoms
As mentioned earlier, varicose veins have an unsightly appearance. However, they may be non-symptomatic. In some individuals, they may lead to dull aching leg pain, heaviness in the legs along with ankle oedema. Patients also experience muscle cramps at night and develop dry, itchy skin. They may develop eczematous skin rashes or may further lead to haemorrhage and ulceration. (Know about Eczema or itchy red rashes)
- Thrombophlebitis: It refers to a generalised inflammation of the affected veins. The skin over it may be tender, warm and flushed. It is associated with some form of clotting in the veins.
- Haemorrhage: Very rarely back pressure may cause a disproportionate increase in venous pressure leading to a haemorrhage beneath the skin or in the muscles.
- Deep Vein Thrombosis: A DVT increases the risk of varicosities and conversely, varicosities may precipitate a thrombus formation.
A wave Doppler may be used to determine the direction of blood flow in the veins. They help to determine the location of the faulty valves in the superficial or deep veins.
Duplex ultrasound is the diagnostic modality of choice. Recurrent varicose veins, veins behind the knees, patients with a history of deep venous thrombosis benefit from this scan.
The first line of treatment is conservative management. A pressure stocking, raising one’s legs during sleeping at night and regular exercise is advised in the early stage. Complications of the varicose veins require one amongst the following treatments:
- Radiofrequency ablation – Where heat is used to seal affected veins.
- Sclerotherapy – A specialized foam is used to close the veins
- Ligation and stripping – It is the most common operation. The affected vein is tied/ligated and removed surgically.
- Small Incision Avulsion: Avulsion requires many tiny incisions and removal of the varicose veins that have been outlined on the skin.