Health & Disease Info
All You Wanted to Know About ... Varicose Veins

What are Varicose Veins?
Varicose veins are a very common peripheral vascular problem. They are often twisted and tortuous veins which in some areas of the leg become quite dilated. This condition most often occurs in the superficial veins which we refer to as the greater saphenous vein which runs from the groin to the ankle along the inside of the leg, and the lesser saphenous vein which runs from the knee to the ankle on the outside of the leg. Smaller veins close to the skin surface which appear bluish and quite irregular are referred to as spider veins. Under certain conditions the vein valves become stretched and may not be able to close completely so that blood can leak through the valves into the lower legs increasing the pressure within the veins in the legs.

What Causes Varicose Veins?
The pooling of this blood further increases the pressure in the veins making the walls bulge outward. Varicose veins tend to occur within families, but sometimes they are the result of disease or injury to the veins. Other factors which contribute to varicose veins include either hereditarily defective or absent venous valves, hormonal factors in females, increased intra-abdominal pressure from obesity or pregnancy, compression of the veins in the pelvis from tumor or inflammatory processes, occupations which require standing for long periods of time, and a history of phlebitis or blood clots either in the superficial or in the deep venous system of the legs.

What are the Symptoms of Varicose Veins?
The symptoms of varicose veins are quite variable depending on the patient and the extent of the varicosities. The most common symptoms include aching, swelling, burning, itching and some skin discoloration.

What Treatment Options are Available?

Spider Veins
The treatment options for varicose veins are quite varied and dependent on the size and extent of the varicosities, the location of them, the symptoms being caused, and associated medical conditions.

The smaller spider varicosities are not really suitable for surgical treatment, but sometimes respond to injection therapy. This is considered a cosmetic procedure and is not usually included in insurance coverage. Several twigs of the veins are injected using a very fine needle with a strong salt water solution. Small pressure rolls of gauze are taped to the areas and then the legs are bandaged to compress them overnight. These gauze rolls may be removed the next day, however the Ace wrap is used daily for a week. This approach may require several treatments before complete resolution is obtained.

Medical Treatment
Medical treatment of the varicose veins include the application of elastic stockings, and the use of leg elevation. Weight loss is recommended if the patient is overweight. The patient should avoid prolonged standing or wearing of constricting clothing. Walking and swimming is encouraged to exercise the calf muscle pump and lower venous pressure in the extremity. Elastic stockings are a very good treatment for varicose veins. Without elastic support and with the presence of the increased pressure in the deep venous system, further varicosities will form in the future. The only way to prevent recurrence of these varicosities under these circumstances is to wear elastic support at all times.

Surgical Management
The surgical management of varicose veins consists of removing the dilated tortuous veins so that they are no longer present. There are multiple variations of this technique. If the greater saphenous vein is not incompetent and the varicosities are very localized, the localized excision of just the varicosities may be the only thing indicated. Also if incompetence is in one areas of the leg and not in another, then removal of the incompetent segment with preservation of the normal segment could be done. These procedures are quite effective. Following the completion of the vein stripping, the leg is wrapped in a tight elastic bandage and should be kept elevated for 24 hours. Elastic compression is maintained for about one month following ligation and stripping of varicose veins with return to normal activities as soon as possible. The restrictions advised are to avoid standing for long periods of time without walking and avoiding sitting with the legs dependent or below the level of the heart.

Complications
Complications can be encountered when any type of treatment is given. With injection and sclerotherapy, phlebitis and even ulceration can result if leakage of the fluid takes place below the skin. There can be discoloration of the skin along the course of the veins. As resolution takes place this discoloration is usually relieved. However, occasionally it does persist. While it is unusual, the development of deep venous thrombosis can be a major problem. When surgical options are chosen, bleeding and infection can occur anytime the skin is cut. In removal of the veins there is some bleeding that occurs in the area where the veins were removed. The legs may become black and blue, but occasionally hematomas (collections of blood) will occur under the skin and even less commonly these can become infected. Although it is very unusual, venous thrombosis can occur but certainly should not be considered a strong possibility. Occasionally the saphenous nerve will be irritated in the dissection resulting some numbness along the medial side of the leg or medial foot. If a lesser saphenous stripping is done, the numbness on the lateral side of this foot can also be observed. Wound healing is usually not a problem, but when skin is damaged by the effects of long standing venous stasis changes, breakdown and ulceration can occur.

Conclusion
We hope this leaflet has been helpful in allowing you to understand your problem and the treatment options available to you. If you have any further questions or do not understand some points we'll be more than happy to discuss them further with you.