Varicose Veins

What are varicose veins?

Arteries are high pressure systems that take oxygen rich blood to various parts of the body; veins are capacity drainage vessels that carry the blood back to the heart.

The veins in the legs have to pump blood to the heart against gravity, they do that by the support of contracting calf muscles (acting peripheral heart) and the presence of one way valves to prevent blood form falling back to the leg (reflux).

There are two sets of veins in the legs: the main ones that lie in the middle of the leg (deep veins that transport >90% of the venous blood) and ones that run close to the surface (superficial veins that transport <10% of the blood).

Varicose veins are dilated, enlarged veins that are present usually in the subcutaneous layer and are often tortuous in nature. They are generally greater than 3mm in diameter, with severe cases being 15mm or greater in size. Generally speaking, they are found in around 20% of the population, with women often being more affected than men.

Spider veins are very small-dilated veins that are present within the skin. These are the most common and are present in a large percentage of the population. These do not necessarily need treatment; in so much as they present more of a cosmetic problem.

What causes varicose veins?

Incompetent veins are malfunctioning dilated veins (usually superficial) that have abnormal reverse flow known as venous reflux. If reflux is left to occur over a significant period of time, it will cause increased blood pressure in the veins, resulting in them becoming distended, swollen and varicose – a process that usually takes many years.

What are the risk factors?

• Increasing age
• Family history
• Obesity
• Pregnancy
• Injury to the leg veins
• Hormonal factors (e.g. puberty)
• Occupation requiring prolonged standing
• Gender (usually more common in women)

What symptoms do they cause?

The most common problems encountered by those who have varicose veins include:

• Aching legs (ranging from mild to severe)
• Swelling of the leg/s
• Itchiness and dry skin (eczema)
• Clots and inflammation in the veins (thrombophlebitis)
• Skin discolouration (lipodematosclerosis)
• Skin ulcers

How are varicose veins diagnosed?

In the majority of cases, diagnosing varicose veins is usually relatively straightforward. They are often easily visible and the distribution and direction of the varicose veins will usually suggest which vein in the leg is most affected.

What a physical examination cannot always confidently diagnose is where the highest point of reflux (abnormal functioning valve) occurs. Most of the time, it is located in the groin but occasionally it can be in the thigh or in the pelvis.

As well as the distribution of veins, the leg is examined for signs of other tissue damage that can be cause by the condition, such as skin discolouration, ulceration and eczema.

All varicose veins require an ultrasound to check the deep and superficial veins, get an exact diagnosis of the highest reflux point and provides a ‘map’ showing the surgeon exactly where the problems are in the veins.

The scan also shows whether the veins contain clots or are blocked due to inflammation, both of which help determine the best treatment option.

Prevention

Suggested measures to control venous pressure and slow the progression of varicose veins:

• Maintain a healthy weight
• Wearing compression stockings
• Leg elevation when no walking
• Be as active as possible.