Varicose veins

Varicose veins may be asymptomatic; however, some people may experience a number of symptoms related to their varicose veins. These can range from mild to severe and may include heavy, swollen feet and ankles, uncomfortable burning pain in the legs, and sometimes even muscle cramps. The skin overlying the veins themselves may become dry and itchy. Often people are not happy with their appearance as they can become unsightly as they bulge or become blue or purple.

Small veins inside your legs are responsible for returning blood to the heart and they contain valves in them which prevent blood from flowing backward. If the valves become damaged or don't work properly, this can lead to blood flowing backward and collecting in the vein which causes them to enlarge and swell.

The risk of developing varicose veins increases with pregnancy, a family history of the condition, any occupation that involves prolonged periods of standing, and menstruation. Typical symptoms include heaviness and tiredness in the legs (particularly after standing) and the appearance of large, tortuous blue veins that are most easily seen under the skin while standing. These are most commonly seen in the back of the calf or on the inside of the leg between the ankle and the groin. Occasionally there may be night-time cramps, and the legs may become more swollen and painful as the veins worsen. The over 55’s are more prone to them as age is a factor in their development. Women tend to be more affected than men.

If your varicose veins cause irritation during the day, if standing up or walking causes discomfort or if sleep is interrupted because of discomfort then a doctor should be consulted about the possibility of receiving treatment.

What complications can they cause?

For most people with varicose veins these cause little trouble but potential complications include:

• Thrombophlebitis – the superficial veins can become painful and red due to inflammation or a blockage in them.
• Bleeding – varicose veins can bleed heavily if you cut or bump your leg.
• Varicose eczema – the skin can become brown or purple and this discoloration is often permanent.
• Venous ulcers – ulcers can develop if fluid leaks out of the varicose vein into the surrounding tissue.

How are varicose veins diagnosed?

Most cases are simply diagnosed by the obvious clinical appearance and no tests are required. However, to work out the position and extent of any valve damage, your doctor may perform the following tests;

A Doppler test. This is an ultrasound technique that uses sound waves to produce an image of the inside of your leg and gives your doctor information about the direction of blood flow in the leg and whether the valves are working properly.

An ultrasound scan (duplex). This allows a doctor to examine the deep veins of the leg in detail.

If your symptoms are severe or you have complications, your doctor may refer you to a vascular surgeon (a doctor who specializes in blood vessels).

There is no way to stop varicose veins from occurring, but you can do things to reduce the symptoms that you may experience. Avoiding standing for long periods of time to reduce the pressure placed on your veins. Staying active helps improve your circulation as well as helps manage your weight. Elevating your legs when resting is also important to aid the flow of blood and prevent pooling in the lower legs.

What can be done about them?

Your doctor will advise you on your treatment options. Not everyone with varicose veins will require treatment. If you have no symptoms and your varicose veins do not cause discomfort, then you do not necessarily need to have treatment.

Elevate the legs when resting, try wearing lightweight elastic compression stockings for any discomfort (usually prescribed as a class 1 (light compression) or class 2 (medium compression) type of compression stocking, available in different colors) and lose weight if you are overweight. Compression stockings usually have to be replaced every three to six months. Sometimes, injecting a sclerosing solution into the vein will close it, but if the condition becomes more serious then complete removal of the vein from ankle to groin may be necessary (known as ligation and stripping). Although many people won't need any further treatment after surgery, it is possible that new varicose veins can form.

What other treatments are available?

There are 3 other types of treatment that can be considered - endovenous laser treatment (ELT), ablation and TIPP.

In ELT, a surgeon passes a fine laser inside the varicose vein in order to heat the inside of it and so damage the vein wall, causing it to close. With radiofrequency ablation, a surgeon uses a high frequency electrical current to heat the wall of a varicose vein, again causing it to close. Transilluminated powered phlebectomy (TIPP) is a newer treatment where a special light is placed under the skin and the varicose vein removed by suction.