Varicose veins

What are varicose veins?

Varicose veins is a condition in which the veins get enlarged and become visible. Veins contain valves, which prevent the blood from flowing backward. When these valves do not function properly, blood either flows backward or starts collecting in the veins, instead of returning to the heart. Blood also collects in the veins if there is pressure on the veins from outside. These enlarged veins, due to accumulation of blood, are called varicose veins.

Women are more likely to have varicose veins, especially during pregnancy. In some cases, these veins may rupture and cause ulcers and blood clots.

Varicose veins mostly occur on the thigh or calf, where they are close enough to the skin to be seen. However, they can occur in other parts of the body as well.

What are the causes of varicose veins?

The basic cause of varicose veins is failure of valves to prevent the backward flow of blood. Other causes include defective valves since birth, obesity, hormonal changes occurring during puberty or pregnancy, ageing, leg injury and a family history for the disease. Prolonged standing or sitting and poor posture also increase the risk.

What are the symptoms?

Varicose veins can be seen near the skin as swollen, enlarged, tortuous, bluish veins that are most noticeable while standing. Other symptoms include:

• Pain in the legs
  
• Muscle cramps of the legs
  
• Swelling of ankles
  
• Discoloured brown skin at the ankles
  
• Skin ulcers on the legs or above the ankles

How are they diagnosed?

The diagnosis is based primarily on the appearance of the veins. The doctor may advise an ultrasound examination of the leg to check the blood flow and valve defects.

What is the treatment?

Treatment may not be required unless the condition is painful or is causing skin ulcers. Frequent rest periods and raising the legs whenever possible to increase the blood flow, avoiding prolonged standing or sitting, and regular exercise help with leg swelling and pain. Compression bandages and stockings are available that help minimize the symptoms.

If symptoms are severe or a person finds the appearance of the veins unacceptable, varicose veins surgery may be an option. In this the dilated, tortuous veins are removed after tying their connection with the normal veins. In the most common operation the larger veins in the thigh are removed by the use of a 'stripper' device inserted into the veins. The many smaller veins in the leg below the knee are removed through a number of very small cuts, which leave only tiny wounds.

There is a new device available which a surgeon can insert into the veins, which obliterates the veins from the inside; they then do not need to be removed. The results of this new treatment are being studied, and it looks very promising. At the moment this treatment is only available in few hospitals in some countries.

If the main problem is the formation of leg ulcers, then skilful application of pressure bandages will almost always lead to complete healing, though this takes a long time.