Varicose veins are veins that have lost their elasticity and no longer work efficiently. They become more visible when standing, doing heavy lifting, and during pregnancy and menstruation. Temperature affects these veins, and in hot weather they are more obvious than when it is cool.
In industrialized countries like Canada, up to one in seven men and one in four women over the age of 15 have venous disease. Varicose veins are the leading cause of leg discomfort among healthy young adults.
Ninety per cent of patients visiting varicose vein clinics say the condition runs in the family. Both men and women are equally likely to inherit it. However, varicose veins appear two to three times more often in women than men. It may be that the many hormonal changes a woman has in her lifetime encourage the development of these veins. Varicose veins that develop during pregnancy often improve without treatment after the baby is born.
Those who stand or sit for long periods at work are at risk. Varicose veins can also develop after trauma to the legs or a deep vein thrombosis (a blood clot in the deep veins of the leg).
Surprisingly, the size of varicose veins does not always match the seriousness of the symptoms or the pain. Very small varicose veins may cause discomfort, a burning feeling, cramps at night, and restless legs. On the other hand, some large varicose veins may cause no symptoms at all.
Most symptoms of varicose veins appear at the end of the day. Itchiness of the skin overlying a varicose vein is a very common complaint.
Varicose veins have bothered people since the beginning of recorded history. More than 2000 years ago, Hippocrates, the father of medicine, treated them with bandages and extract of willow trees. Henry VIII suffered from varicose veins.
We now live longer and are less active. Many jobs require sitting at a desk for hours or standing all day. More varicose vein problems are the result. Knowing that varicose veins can be treated, and the fact that we now dress in a way that shows our legs, makes people more inclined to seek help.
To lessen the development of varicose veins, maintain an ideal weight and do regular physical activity. Regularly changing your sitting or standing position will help, as will elevating your legs while sitting. Women should avoid shoes with high heels.
If your job is not active, wear light compression support stockings to help prevent varicose veins. Support stockings are made of fine material, and the colours and textures are beautiful. They look more like something from high fashion than the medical world. No one will notice if you are wearing prescribed support stockings.
Over time, your legs will become more disfigured, and symptoms will get worse. The first sign of complication from varicose veins is swelling in the ankles and calves. When the legs are often swollen, the skin breaks down. This can lead to skin inflammation (dermatitis), varicose eczema (after long bouts of dermatitis), and dark discoloration (pigmentation). Finally, ulcers (open sores) of the skin may occur, especially around the inner ankle.
Varicose veins can bleed all of a sudden. This complication requires immediate attention! A lot of blood can be lost from a varicose vein. Apply pressure on the area, elevate your leg, and get help right away.
Compression stockings can prevent symptoms, stop the condition from getting worse, and treat swelling after surgery or when sitting for a long time.
They help prevent deep vein thrombosis. Wear compression stockings (travel socks) when travelling for long hours by plane or car. Many airlines recommend a series of exercises and measures to prevent deep vein thrombosis.
Compression stockings come in different pressures and weights. Lightweight support stockings are similar to ordinary socks or pantyhose. They blend easily with different fashions.
The most commonly prescribed stockings are light support (eight to 20 mm Hg). If your legs are swelling or you have large varicose veins, medium compression stockings are recommended (20 to 30 mm Hg). After deep vein thrombosis, complications of varicose veins, or edema (swelling) that is difficult to treat, a high pressure (30 to 40 mm Hg) stocking is recommended.
Sclerotherapy is an injection technique used by qualified doctors and health care providers to treat varicose veins. It is only slightly invasive. A solution is injected into the affected varicose or spider vein to irritate the lining. Once irritated, the vein will collapse and change into fibrous tissue (sclerosed vein). The body slowly absorbs the tissue.
This treatment has been available in Canada from trained doctors since the early 1960s. It was developed in Europe. Medications used to sclerose the veins have a long track record of safety.
The outpatient procedure takes between 15 to 45 minutes, depending on the veins treated. Some doctors recommend using support stockings after the injections. Patients are advised to remain active.
Foam sclerotherapy, a new variation, is very effective in treating large varicose veins and those appearing after surgical treatment.
Echosclerotherapy or ultrasound guided sclerotherapy uses an ultrasound machine to see large varicose veins that are not visible to the naked eye. It has revolutionized the treatment of varicose veins, making it more accurate, effective and safe. It has been used since the 1990s.
As with any treatment that uses medications, there is a risk of allergic reaction. The doctor's office is equipped to manage medical emergencies.
Other risks related to sclerotherapy include bruising, injection site irritation, pain and itchiness. It is possible that new variscosities (neovascularization) may develop at the treatment site. Thrombosis (a blood clot in the blood vessel) may occur at the injection site. However, the more experienced the practitioner is in treating varicose veins, the lower the risk.
Asclera® (polidocanol) was recently approved in the United States but is not yet available in Canada. It has been available in Europe and other countries for more than 30 years. It is also the medication most used worldwide for this purpose.
Saline solution is known as a treatment for varicose veins. However, it is only effective for very small reticular veins (blue veins) and telangiectasias (spider veins).
If the major vein in the leg (the greater saphenous vein trunk) is varicose, surgery is the preferred treatment. It is only recommended for a small number of people. Varicose vein surgery is simpler and safer than it was many years ago. It is usually a day surgery, can be done under local anesthesia, and normally requires two small incisions.
Any remaining varicose veins can be treated with sclerotherapy, usually six weeks after surgery.
Less traumatic and less invasive methods that allow a faster return to normal function are being studied. Alternatives to surgery for treating varicose veins include endovenous laser and radio frequency resistive heating. Both procedures are done in an operating room, either in a private clinic or hospital.
Endovenous laser, done under local anesthesia, is used to treat large varicose veins. A laser filament is introduced into the vein. Laser energy is then applied to destroy the vein. Recovery time is less than with surgery. Radio frequency resistive heating is similar. However, these treatments are not covered by health care plans in many provinces.
Many medication combinations of bioflavonoids and venotonic herbs, which help veins to drain, are available worldwide as creams, gels, or for oral use. In Canada, some medication combinations contain horse chestnut seed extract, as well as bioflavonoid (diosmin, oligomeric proanthocyanidin and hesperidin). They are not recommended for long-term oral use. These are most popular in the summer, when higher temperatures make wearing support stockings uncomfortable.
Varicose veins are a common health problem. The condition is ongoing and chronic. Prevention and timely treatment of varicose veins help to avoid dramatic complications. Preventive measures like regular exercise, compression stockings and ideal weight maintenance can make a difference. Still, from time to time, these veins do require medical treatment.