Varicose veins (varicose veins)

Varicose veins are a disease that leads to varicose veins, thinning of their walls, the formation of venous nodules and disruption of blood flow in them.

With varicose veins of the lower extremities - varicose veins of the legs - the saphenous veins on the legs thicken, become clearly visible, sinuous, acquire a blue or dark purple color, and form convex nodes. Varicose veins can also affect other organs in which similar changes occur.

There are several types of varicose veins:

  • Superficial varicose veins, in which veins close to the surface of the skin become thick and nodular. As a rule, they are clearly visible, they are rather long, winding and cause significant cosmetic discomfort.
  • Reticular varicose veins are small veins that form a thin blue network under the skin.
  • Telangiectasia - "stars" or "spiders" on the skin, which often appear on the face and décolleté, as well as on the legs. They are harmless and, unlike superficial veins, do not protrude above the surface of the skin.
The scheme of development of varicose veins

Varicose veins are a common condition that affects about three out of ten adults. Women are more prone to the disease than men.

Varicose veins can form in any part of the body, but most often it develops in the veins in the legs and feet, especially in the ankles, since a lot of stress is placed on the lower body while standing and walking.

For most people, varicose veins do not pose a great threat to health, have only a cosmetic defect and do not require treatment. If varicose veins cause you pain, discomfort, or increase the risk of complications, it needs to be treated.

Unfortunately, free surgical treatment for varicose veins is not always available (this depends on the regional health insurance program), so you may have to pay for the treatment yourself.

If you require treatment, you may need to print out a description of the treatments for varicose veins and discuss them with your doctor.

Prevention of varicose veins

So far, there is no evidence that varicose veins can be prevented for sure. However, there are ways to slow the progression of the disease, for example:

  • do not stand or sit for too long, try to move every half hour;
  • taking regular rest breaks during the day, raising your feet on a pillow, this helps to relieve discomfort;
  • exercising regularly can improve blood circulation and help maintain a healthy weight.

Symptoms of varicose veins

As a rule, varicose veins are dark purple or blue in color, they are twisting or protruding from the surface of the skin.The appearance of varicose veinsIn addition to the characteristic appearance, the symptoms of varicose veins include:

  • pain, heaviness and discomfort in the legs;
  • swelling of the feet and ankles;
  • burning or throbbing in the legs;
  • muscle cramps in the legs, especially at night;
  • dryness, itching, and thinning of the skin over the affected vein.

These symptoms tend to get worse in warm weather or if you have been standing for a long time. You may feel better if you walk or sit with your legs raised higher. It is comfortable to put your feet on the pillow.

Varicose veins usually form in the legs, either on the back of the ankles or on the inside of the leg. But varicose veins can develop in any other part of your body, for example:

  • in the esophagus;
  • uterus;
  • vagina;
  • pelvic area;
  • rectum (anus).

If you are worried about the appearance of your veins, contact a vascular surgeon or, if there is no way to get to a specialist, a general practitioner.

The causes of varicose veins

The most common cause of varicose veins is thinning of the vein walls and weakening of the valves.

Inside the veins are tiny valves that open to one side to allow blood to pass through and then close again to prevent blood from flowing in the opposite direction. Sometimes the walls of the veins can stretch and lose their elasticity, which leads to weakening of the valves. If the valves do not work properly, it can cause blood to ooze or flow in the opposite direction. In this case, the blood will stagnate in the veins, which will lead to their swelling and stretching.

It is not yet completely clear what is the root cause of the stretching of the walls of the veins and the weakening of the valves. Some people develop varicose veins for no apparent reason.

Calf muscle - deep vein pump

However, there are a number of factors that can increase the risk of varicose veins:

  1. Floor. Women are more prone to the disease than men. Research results suggest that hormones produced by the female body tend to weaken the venous walls, allowing the valves to leak blood.
  2. Genetics. The risk of developing varicose veins increases if your close relative has this disease. This suggests that part of your varicose veins may be caused by your genes (units of genetic material that you inherit from your parents).
  3. With age, the veins begin to lose their elasticity, and the valves in them also cease to function.
  4. Being overweight puts additional strain on the veins, which means they have to work harder to get blood back to the heart. This puts more stress on the valves, which can cause them to stretch. The influence of excess weight on the development of varicose veins is increased in women.
  5. Stand-up work. Some studies suggest that long-standing work may increase the risk of varicose veins. This is because a standing person has increased pressure in the veins of the legs.
  6. During pregnancy, blood volume increases to help the development of the fetus. This adds stress to the veins. Increased hormone levels during pregnancy also lead to relaxation of the muscle walls of the blood vessels, which increases the risk of varicose veins. An additional risk factor for varicose veins is the uterus, which increases in size during pregnancy and constricts the blood vessels in the pelvic region. Despite the fact that pregnancy increases the risk of developing varicose veins, most women find that their veins have improved significantly after giving birth.

In rare cases, varicose veins can be caused by another medical condition, including:

  • a previously formed blood clot;
  • swelling or swelling in the pelvic area;
  • pathology of blood vessels.

Diagnosis of varicose veins

If you have varicose veins, but this does not give you any inconvenience, you do not need to see a doctor. Varicose veins are rarely serious and usually do not require treatment.

However, you should see your doctor if:

  • Varicose veins cause pain or discomfort.
  • The skin over your veins is sore or irritated.
  • Leg pain at night is irritating and interferes with sleep.

Varicose veins are diagnosed by their appearance. The doctor will examine your legs while you are standing. You may also be asked if you are in pain or if there are situations where your varicose veins are getting worse. For example, some women report that their menstrual cycle (periods) affects the condition of their varicose veins.

To find out how dangerous varicose veins are for you, your doctor should find out:

  • do you have a close relative with varicose veins;
  • whether there is pregnancy;
  • what is your body mass index (BMI);
  • Have you ever had a deep vein thrombosis (a blood clot in one of your body's deep veins)?
  • whether there was a leg injury (such as a fracture).

Additional examination for varicose veins

If the doctor decides that you need additional testing, you will be referred to a vascular surgeon who will deal with further diagnosis and treatment.

In most cases, a duplex ultrasound of the blood vessels is prescribed. This type of scan is done using high frequency sound waves that produce an image of the veins in your legs. The image shows blood flow and helps the vascular surgeon identify damaged valves that may be causing the veins to dilate.

Varicose Veins Treatment

Treatment of varicose veins is usually necessary in the following cases:

  • to relieve symptoms if the illness causes pain and discomfort;
  • to treat complications such as leg ulcers, edema, or changes in skin pigmentation;
  • for aesthetic reasons, however, this is rarely covered by insurance, so you will most likely have to pay for the treatment yourself.

Treatment will depend on your general health and the size, position, and severity of your varicose veins. The vascular surgeon will recommend the most appropriate treatment for you.

In some cases, varicose veins can be treated at home. There are simple ways to relieve symptoms. To do this, you need:

  • exercise;
  • do not stand for a long time;
  • rest, giving the legs an elevated position.

Endothermic ablation for varicose veins

Endothermic ablation is usually the first treatment you will be offered. This procedure uses either high-frequency radio waves (radiofrequency ablation) or a laser (intravenous laser therapy) to block the affected veins. These operations are described in more detail below.

Radiofrequency ablationconsists in heating the walls of the veins using radio frequency energy. The vein is accessed through a small incision above or below the knee. Under ultrasound guidance, a narrow tube called a catheter is directed to the vein. A probe is inserted into the catheter and emits radio frequency energy. She heats the vein until its walls collapse, closing and blocking its lumen. After the vein has been blocked, your blood will naturally be redirected to one of your healthy veins.

Radiofrequency ablation is performed under a local anesthetic. The procedure can cause short-term side effects, such as a tingling sensation (paresthesia). After the procedure, you may need to wear compression stockings for a maximum of one week.

Intravenous laser therapy.As with radiofrequency ablation, with intravenous laser therapy, a catheter is inserted into your vein and monitored by ultrasound. A tiny laser is inserted through the catheter and placed at the beginning of the varicose vein. The laser emits short bursts of energy that heats the vein, causing it to become blocked. The laser is slowly pulled along the vein, controlling its movement using ultrasound, so that the affected vein is closed along its entire length.

Intravenous laser therapy is performed under local anesthetic. After the procedure, you may feel a tightening sensation in your legs, and the affected areas may be bruised and sore. Nerve damage is also possible, but this is usually temporary.

Sclerotherapy for the treatment of varicose veins

If endothermic ablation is not an option for you, you will most likely be offered sclerotherapy instead. This procedure consists in injecting special foam into the veins. Foam causes scarring that clogs the vessel. This treatment may not work for you if you have previously had deep vein thrombosis.

The foam is injected into a vein using an ultrasound-guided injection. Several veins can be treated in one session. Sclerotherapy is usually done under local anesthetic, which means you will be given a pain reliever to freeze the area to be treated.

After sclerotherapy, the manifestations of varicose veins should disappear in a few weeks, when healthier veins will take over the work of the damaged ones, which will no longer be filled with blood. You may need multiple sclerotherapy sessions to turn a vein pale, and there is a chance that the varicose veins will reappear.

Although sclerotherapy has been proven to be effective, the long-term effectiveness of foam therapy is unknown. According to the National Institute of Health and Welfare in the UK, this type of treatment is effective in 84 cases out of 100. However, according to the results of another study, in more than half of cases, varicose veins reappear after treatment.

Sclerotherapy can also cause the following side effects:

  • blood clots in other veins in the legs;
  • headache;
  • back pain;
  • discoloration of the skin, such as brown spots over the veins where the procedure was performed;
  • fainting;
  • temporary vision problems.

After the procedure, you will be able to walk and will be able to return home immediately. You may need to wear compression stockings for a maximum of one week.

In rare cases, sclerotherapy can cause serious potential complications such as stroke or transient ischemic attacks (TIAs).

Surgery for varicose veins: phlebectomy

If endothermic ablation and sclerotherapy are not suitable for you, you will most likely be offered a surgery called phlebectomy to remove any affected veins. Varicose vein surgery is usually performed under general anesthesia, meaning you will be unconscious during the surgery. You will most likely be able to return home the same day. However, in some cases it may be necessary to stay in the hospital overnight, especially if the surgery was performed on both legs.

Most surgeons use an operation called ligation, which involves ligating the veins in the affected leg. Two incisions are made with a diameter of about 5 cm. The first incision is made in the area of your groin, at the beginning of the varicose vein. A second incision is made below, usually in the knee or ankle area. The upper end of the vein (in the groin area) is tied and closed. A thin flexible wire is pulled through the lower end of the vein, which is then gently pulled through the lower incision in your leg.

With this operation, blood circulation in the leg is not disturbed, since the veins located deep in the leg will take over the work of the remote ones. The surgery can cause pain, bruising, and bleeding. More serious complications are rare but may include nerve damage or deep vein thrombosis.

Recovery from surgery takes one to three weeks before you can return to work, but this will depend on your general health and the nature of your job. You may need to wear compression stockings for a maximum of one week.

Transillumination phlebectomy.During a transillumination phlebectomy, one or two incisions are made in your leg. The surgeon will place a special light bulb called an endoscopic transilluminator under the skin to see which veins need to be removed. Before removal, the affected veins are cut and then removed with a special aspirator through incisions in the skin.

Transillumination phlebectomy can be performed under local or general anesthesia. You may have bruising or bleeding after the procedure.

This is a relatively new method of treatment, therefore, there are certain doubts about its effectiveness, and therefore, transillumination phlebectomy has not yet become widespread.

Compression stockings for varicose veins

Compression stockings for the treatment of varicose veins of the lower extremities

Compression stockings have been specially designed to compress the legs evenly to improve circulation. The pressure is often especially increased in the ankle area and decreases higher up the leg. This stimulates blood flow upward to the heart.

Compression stockings can help you relieve pain, discomfort, and leg swelling caused by varicose veins. However, it is not known whether stockings help stop the progression of existing varicose veins or whether they prevent new varicose veins from emerging.

Wearing compression stockings as a long-term treatment for varicose veins is recommended only if none of the above treatment methods are suitable for you. If you are pregnant and have varicose veins, you may be advised to wear compression stockings during pregnancy instead of the above treatments.

Compression stockings vary in size and pressure. Most people with varicose veins will be prescribed class 1 (light pressure) or class 2 (moderate pressure) stockings. Stockings are also available:

  • different colors;
  • various lengths: some reach the knee, and some cover the thigh;
  • with different foot shapes: some cover the foot completely, while others reach to the toes.

Compression stockings can be purchased over the counter or directly from the manufacturers.

If you have deep vein insufficiency, you may need to wear compression stockings your entire life. A lack of deep veins means that you have valve problems or deep veins in your legs are blocked. In this case, you will need to wear stockings, even if you have had surgery to remove some of your varicose veins.

You need to put on compression stockings in the morning, immediately when you wake up and take them off before going to bed. They can be uncomfortable, especially in hot weather, but it is very important to wear them correctly in order to get the best results.

Pull them all the way to the top so that the pressure is properly distributed throughout the leg. Do not let the stocking roll down, otherwise it may dig into your skin, gathering in a tight roller around your leg. See your doctor if the stockings are uncomfortable or if they don't seem to fit you. You may be able to make matching custom-made stockings. To do this, the leg will be measured in several places to make sure that the stockings fit exactly. If your legs are often swollen, your measurements should be taken in the morning when the swelling is minimal.

If compression stockings are drying out your skin, apply a moisturizer (emollient) to your legs before bed. You should also watch for sores, blisters, or discoloration of the skin.

As a general rule, new stockings should be purchased every three to six months. It is advisable to purchase two pairs of stockings so that you can wear one while the other is in the wash and dry. Stockings should be hand washed in warm water and dried away from direct heat.

Complications of varicose veins

Varicose veins can cause complications as it interferes with the normal flow of blood. This rarely happens, usually several years after the first varicose veins appear under the skin.

Bleeding.Varicose veins close to the surface of your skin can sometimes bleed if you cut or hit your leg. Bleeding can be difficult to stop. You should lie down, lift your leg and press on the wound. Seek medical attention immediately if bleeding persists.

Varicose veins and deep venous thrombosis

Thrombophlebitis- This is an inflammation of the veins caused by the formation of blood clots in them. Blood clots can cause pain, redness, and a rise in skin temperature over the damaged vein.

If thrombophlebitis develops in one of the superficial veins of your leg, it is called superficial thrombophlebitis. Like varicose veins, thrombophlebitis can be treated with compression stockings. In some cases, non-steroidal anti-inflammatory drugs may be prescribed. Deep venous thrombosis is more severe and requires urgent medical attention.

Chronic venous insufficiency.Due to improper blood flow in the tissues, metabolism is disturbed. If the metabolic process is disturbed for a long time, this is called chronic venous insufficiency. Chronic venous insufficiency can sometimes lead to the development of other diseases, including:

  • Varicose eczema is a condition that causes skin redness, flaking, blistering and flaking. In many cases, the disease is irreversible.
  • Lipodermatosclerosis causes hardening and thickening of the skin, which can also turn red or brown. Usually, the disease affects the ankle area.
  • Varicose ulcers form when pressure builds up in the veins of the lower leg. This causes fluid to leak from the vein and accumulate under the skin. This fluid can cause skin hardening, swelling, and eventually skin destruction and ulceration. Most often, varicose ulcers form in the ankle area.

If you find any unusual skin changes, such as those described above, you should see your doctor immediately. These conditions tend to respond well to treatment, but it is important to seek medical attention early on.

Which doctor should I contact for varicose veins?

You should contact a vascular surgeon or phlebologist (a more highly specialized doctor) who can give you competent advice on the treatment of varicose veins.