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Varicose Veins

Varices

Varicose veins are markedly dilated and tortuous veins, which are usually found on the leg.


Presentation

In the legs, varicosities are common along the inner side of the leg, near the ankles and posterior calf region. The dilated veins appear blue, distended or elongated, looped or curled. Those suffering from varicose veins can experience any of the following symptoms:

In more severe cases of chronic venous insufficiency, the sluggishness of blood flow through the veins can cause localized skin changes like excessive dryness, itching, throw a erythematous rash or brownish discoloration and ulcers. The sluggish blood flow can also produce a clot in the vein. This clotting is known as thrombosis and is a common complication of varicose veins.

Generally, the symptoms of varicose veins worsen at the end of the day, especially due to prolonged standing throughout the day. Occasionally, women find that their symptoms are exaggerated before their menstrual periods, and during pregnancy.

Fatigue
  • Clinical presentation includes lower extremity pain, fatigue, itching and/or heaviness, which often worsen with prolonged standing, associated with dilated tortuous veins. Underlying venous insufficiency can be documented by duplex ultrasound.[bestpractice.bmj.com]
  • Later, they may progressively enlarge, protrude, and become obvious; they can cause a sense of fullness, fatigue, pressure, and superficial pain or hyperesthesia in the legs. Varicose veins are most visible when the patient stands.[merckmanuals.com]
  • Common sypmtoms of superficial venous reflux: Pain Swelling Leg heaviness and fatigue Varicose veins in your legs Highlights of the Closure Procedure Relief of symptoms Short recovery Same day procedure Local or regional anesthesia Resume normal activities[lubbockvvc.com]
  • Varicose veins can cause leg pain, discomfort and fatigue. So it’s important to know your options. At Park Nicollet, treatment is minimally invasive. That means less time missed at work and home.[parknicollet.com]
Inguinal Mass
  • Contrast enhanced multislice-CT showed round and oval shaped inguinal and retroperitoneal masses in one patient and inguinal mass lesions in the other patient. The mass lesions were suspicious of lymphadenopathy related to cancer recurrence.[ncbi.nlm.nih.gov]
  • Typically, they manifest as an inguinal mass that mimics a complicated hernia during pregnancy or the postpartum period.[dx.doi.org]
Lower Extremity Pain
  • Clinical presentation includes lower extremity pain, fatigue, itching and/or heaviness, which often worsen with prolonged standing, associated with dilated tortuous veins. Underlying venous insufficiency can be documented by duplex ultrasound.[bestpractice.bmj.com]
Chronic Cough
  • See a health care professional if the person has health problems such as chronic constipation, urinary retention, or chronic cough. Relieving conditions that are causes straining may help with the varicose veins.[emedicinehealth.com]
Vein Disorder
  • Jump to search Vedi anche la categoria : Venous stasis. varicosi dilatazione patologica permanente di una vena associata a una modificazione di tipo regressivo delle pareti venose Carica un file multimediale Wikipedia Istanza di malattia Sottoclasse di vein[commons.wikimedia.org]
  • According to The National Women's Health Information Center, as many as 60% of all American women and men suffer from some form of vein disorder.[footsmart.com]
  • At the time of your consultation, the severity of your vein disorder will be evaluated to determine if EVLT treatment is considered "medically necessary."[theskincentermd.com]
  • In fact, more peopleare unable to work due to vein disorders than due to arterial disease. (Vascular Disease Foundation Newsletter, Spring 2005). Visible tortuous varicose veins are located in the subcutaneous fatty tissue.[sigvaris.com]
  • In the past it has been tricky for phlebologists and health professionals to define vein disorders because of the range and severity of symptoms.[veinhealth.com.au]
Calf Pain
  • Thirty patients with no experience of elastic stockings, presenting with primary varicose veins causing calf pain or aching were randomised to a GECS (18-21 mmHg at the ankle level, n 15) or a placebo stocking (0 mmHg, n 15).[ncbi.nlm.nih.gov]
  • Thigh or calf cramps (often at night) Mild swelling of feet or ankles Itching If flow of blood through the veins becomes worse, symptoms may include: Leg swelling Leg or calf pain after sitting or standing for long periods Skin color changes of the legs[mountsinai.org]
  • Swelling and calf pain after you sit or stand for long periods of time. Skin changes, such as: Color changes. Dry, thinned skin. Inflammation. Scaling. Open sores, or you may bleed after a minor injury.[uofmhealth.org]
Radiculopathy
  • Spinal epidural varicosities have been reported as an etiological factor in lumbar and sacral radiculopathies. This is the first reported case of spinal cord compression in association with spinal epidural varices.[ncbi.nlm.nih.gov]
Dyspareunia
  • Pelvic congestion syndrome is a not-well-known clinical entity that affects mainly multiparous women of reproductive age, causing emotional disturbances; pelvic pain; dyspareunia; and gluteal, vulvar, and lower limb varices (, 3 –, 6 ).[dx.doi.org]

Workup

Varicose veins can be diagnosed easily on physical examination due to their characteristic presentation. But to know the extent of affection, various other tests have to be performed as follows:

The most useful techniques are contrast venography, color-flow duplex ultrasonography and magnetic resonance imaging (MRI).

Duplex ultrasonography is the ideal imaging modality for diagnosing varicose insufficiency syndromes, planning out a treatment plan and pre-operative vein mapping.

Magnetic resonance venography (MRV) can reach and diagnose varicosities in the deepest veins in the pelvis and calves, and is thus the most specific and sensitive test available.

Direct contrast venography is a very labor-intensive imaging technique. Being invasive, it has been replaced by duplex ultrasonography for routine evaluation of venous disease, at a number of centres, but the technique is very useful in remains extremely useful in tough cases [5].

Color-flow ultrasound imaging has become accepted as the standard for evaluation of venous anatomy and dense physiology. In many patients, color-flow imaging itself is sufficient.

Blood (laboratory) tests are not helpful in making a diagnosis of varicose veins.

Treatment

Majority of people with mild symptoms of varicose veins are treated by use of compression stockings and leg elevations intermittently all day.

For varicose veins lying closer to skin, sclerotherapy or laser therapy may be useful. Sclerotherapy involves injecting a sclerosing agent into the affected vein, which leads to scarring of the vein and permanently shuts it down. Laser therapy is effective in tiny varicosities.

People with severe insufficiency may have recurrent thrombi and varicose ulcers. The conventional surgery known as vein stripping and ligation can be useful. During this procedure, the abnormal veins are tied and removed from the body through a series of small cuts in the skin. A similar surgical procedure, known as ambulatory phlebectomy, also rips out veins via small skin incisions, but it is not as invasive as the actual stripping and ligation.

Cryosurgery is a variant of stripping. The only agenda of this technique is to prevent a distal incision to remove the stripper [6].

Newer therapies include transilluminated power phlebotomy (a modified form of ambulatory phlebotomy) and endovenous thermal ablation. Endovenous thermal ablation uses a laser fiber placed inside the vein [7]. These newer procedures are less invasive and are associated with lesser complications, with comparable efficacy [8] [9].

External laser therapy is used basically for cosmetic removal of the smaller spidery veins that are visible.

Recently FDA has approved a polidocanol foam (Varithena) which is a pharmaceutical-grade low nitrogen foam that is used in treatment of incompetent veins and varicosities affecting the great saphenous vein. It has been found to be effective in reducing the manifestations of the visible varicosities and the superficial venous incompetence [10].

Prognosis

Varicose veins are a chronic condition whose symptoms can be controlled with the help of leg elevation and therapeutic stockings.

Varicose veins can be treated permanently by various surgical procedures but they cannot prevent development of new varicose veins.

Etiology

Varicose veins can be linked to genetics [1]. Factors that affect the varicose veins are pregnancy, menopause, prolonged standing, obesity, ageing, injury to the leg, abdominal straining, prior surgery or trauma to the leg.

Increased homocysteine levels in the body can also cause varicose veins, as it leads to degradation and inhibits the formation of 3 important structures of the artery i.e. collagen, elastin and proteoglycans.

Epidemiology

Varicose veins are more common in females as compared to their male counterparts [2]. It is due to hormonal factors that varicosities are more frequent in women than men of any age group [3].

Death can take place as a result of bleeding from fragile varicose veins [4], but mortality rates reported with varicose veins is chiefly due to the combination of this condition with venous thromboembolism.

Sex distribution
Age distribution

Pathophysiology

Varicose veins are normal veins that have dilated due to increased venous pressure. Blood collects in superficial venous capillaries, which then flows into bigger superficial veins, and ultimately through valves, empties into deep veins. Then it is carried back to the heart. Superficial veins are situated superficially in the skin, whereas deep veins are embedded in the muscle fascia. Blood passes from superficial veins to the deep system via perforating veins.

Chronic exposure to high pressure will cause any superficial vein to dilate and eventually varicose. Normal veins too dilate and become tortuous under continued high pressure, which might be due to dialysis shunts, spontaneous arteriovenous malformations, and hereditary vein wall weakness. Occasionally, even normal venous pressures produce varicose changes and venous insufficiency, for reasons unknown.

Prolonged high pressure in veins might be caused by an outflow obstruction, either from extrinsic compression or intravascular thrombosis.

Most commonly, superficial venous valve failure results from excessive dilatation of a vein from high pressure of reverse flow within the superficial venous system. Failure of valves can be an outcome of direct trauma or from thrombotic valve injury. When unveiled to high pressure chronically, superficial veins dilate to an extent, such that their fragile valve leaflets loose the contact.
When multiple valves fail in a series, the affected vein cannot efficiently pump the blood upwards. Venous blood then just flows along the pressure gradients i.e. downwards due to gravity and outwards to a congested and swollen leg. With passage of more time, many more superficial veins become dilated and tortuous.
During pregnancy due to hormonal changes that render the vein wall and the valves more pliable, varicose veins develop.

Prevention

There's no way to completely prevent varicose veins. A person cannot change his or her genes, but they can take measures to avoid it as far as possible by pursuing the following regimen:

Exercising regularly to improve the circulation and muscle tone helps in keeping obesity at bay by maintaining healthy weight; obesity is a major risk factor for varicose veins.

Do not remain in the same position for long periods of time i.e. if you are sitting continuously, take a break and move around and if you are standing continuously, sit down for some time and relax.

Avoid wearing high heels everyday and binding clothes on day to day basis as tight clothes block movement of blood up the leg.

Summary

A varicose vein is a medical condition characterized by tortuous, dilated and often visibly enlarged veins. It is commonly seen in the lower extremities of the body.

Patient Information

Varicose veins are not a skin condition but it affects the veins of the body especially of the legs. Exact cause of varicose veins is not known hence preventing its development is not possible. Various factors like lifestyle, occupation, surgery, heredity, obesity etc. are seen to affect the veins. Having knowledge of these factors and accordingly making changes in our life can help to keep this disease at bay.

Diagnosing and taking proper steps to treat this disease is necessary because if not treated it can lead to complications like deep vein thrombosis which can be sometimes life threatening.

In case you are already suffering from varicose veins, you can avoid exacerbation of symptoms by timely lying down or sitting down. Use support stockings or compression stockings so as to avoid blood from pooling in the veins. Knocking off extra pounds is essential so that there is less stress on your legs. Regular exercises helps to maintain good body weight and your leg muscle tone remains good.

References

Article

  1. Ng M, Andrew T, Spector T, Jeffery S. Linkage to the FOXC2 region of chromosome 16 for varicose veins in otherwise healthy, unselected sibling pairs. J Med Genet. 2005 Mar; 42 (3): 235–9.
  2. Brand FN, Dannenberg AL, Abbott RD, Kannel WB. The epidemiology of varicose veins: the Framingham Study. Am J Prev Med. 1988 Mar-Apr;4(2):96-101.
  3. Chiesa R, Marone EM, Limoni C, Volonte M, et al. Chronic venous insufficiency in Italy: the 24-cities cohort study. Eur J Vasc Endovasc Surg. 2005 Oct;30(4):422-9.
  4. Racette S, Sauvageau A. Unusual sudden death: two case reports of hemorrhage by rupture of varicose veins. Am J Forensic Med Pathol. 2005 Sep;26(3):294-6.
  5. Cho ES, Kim JH, Kim S, Yu JS, Chung JJ, Yoon CS, et al. Computed tomographic venography for varicose veins of the lower extremities: prospective comparison of 80-kVp and conventional 120-kVp protocols. J Comput Assist Tomogr. 2012 Sep;36(5):583-90.
  6. Shouten R, Mollen RM, Kuijpers HC. A comparison between cryosurgery and conventional stripping in varicose vein surgery: perioperative features and complications. Ann Vasc Surg. 2006 May; 20 (3): 306–11.
  7. Mao J, Zhang C, Wang Z, Gan S, Li K. A retrospective study comparing endovenous laser ablation and microwave ablation for great saphenous varicose veins. Eur Rev Med Pharmacol Sci. 2012 Jul;16(7):873-7.
  8. Nael R, Rathbun S. Treatment of varicose veins. Curr Treat Options Cardiovasc Med. 2009 Apr;11(2):91-103.
  9. Nijsten T, van den Bos RR, Goldman MP, et al. Minimally invasive techniques in the treatment of saphenous varicose veins. J Am Acad Dermatol. 2009 Jan;60(1):110-9.
  10. Dudelzak J, Hussain M, Goldberg DJ. Vascular-specific laser wavelength for the treatment of facial telangiectasias. J Drugs Dermatol. 2009 Mar;8(3):227-9.

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Last updated: 2019-06-28 12:36