Vein Health: What Should You Know about Varicose Veins
The veins are the vessels that carry blood from our legs and arms back to the heart. Because humans walk upright, our leg veins have one-way valves that direct flow up against gravity and prevent blood and fluid from accumulating and building up pressure in our feet and lower legs. These valves also act as back gates that keep the blood in place until the muscles squeeze the veins and push the blood upwards. When the valves cannot close properly, however, the blood is pulled downward by gravity causing the leg veins to become enlarged and uncomfortable like the one in the drawing. These enlarged veins are called varicose veins.
There are many reasons why our vein valves may fail. Blood clots (DVT, or deep venous thrombosis; phlebitis, or superficial vein clots can become attached to the valves, which later develop shortening and scarring, preventing them from closing appropriately. With aging, veins become larger and more visible due to prolonged daily standing, obesity, and hormonal changes, especially in women of childbearing age. Women tend to develop more varicose veins both because of the associated hormonal changes and compression of the deep veins in the abdomen during pregnancy. Another factor involved in venous disease is a familial predisposition. Often young women report that their mother, aunt or other relatives have had vein issues.
Varicose veins and dysfunctional valves can cause a variety of symptoms. Most commonly, people complain of aching, tired legs at the end of the day, itching and irritable legs, along with leg swelling. These can be associated with visible varicose veins or just tiny reddish-blue varicosities that are called spider veins. With more advanced disease, and particularly if blood clots had occurred in the past, discoloration of skin of the lower leg can develop with later skin breakdown, infection, and open wounds. More than 25 million people in the United States suffer some degree of venous disease. For the majority of people, however, venous disease is mostly manifested by unsightly varicosities. Many women are appropriately concerned with the appearance of their legs, especially during warm times of the year when dresses, skirts, and shorts are frequently worn.
Fortunately, successful outpatient treatment is available for most people, regardless of the type of venous disease from which they suffer. It is important to understand that diseased superficial veins are not needed and can only cause further problems. Because there are almost always deep healthy veins in the legs that can carry the blood back to the heart, diseased superficial veins can either be removed or closed by several different methods. It is a common concern that by closing the varicose veins, the blood flow in the leg will be impaired. This is rarely a problem. However, in almost all cases, an ultrasound of the leg is performed before such procedures both to identify the location of the malfunctioning veins and also to ensure that the deep vein system is intact and sufficient to provide the needed blood flow. Today several treatment options exist.
Compression stockings are often prescribed in patients with vein disease. These can be successful in controlling leg swelling and alleviating symptoms. However, they are not a definitive treatment of the underlying problem and they do not prevent progression of valve dysfunction. Definitive treatment in the past has been the complete surgical removal of the superficial veins (“vein stripping”). Although occasionally still recommended, the good news is that vein stripping has been mostly replaced by less invasive and less painful outpatient options. These nonsurgical procedures are performed under local anesthesia using catheters or small plastic tubes that deliver heat inside the vein by either radiofrequency waves or laser. This heating, reaching a temperature of up to 250 degrees Fahrenheit, causes the vein walls to contract and close, preventing blood from enlarging the visible varicose veins or going down the leg. Other local areas of varicose veins can be completely removed at the same time with small stab incisions (“micro phlebectomy”). In cases where the main superficial veins are not involved, such vein closure procedures are not needed. Individual varicose veins may be treated in a non-painful manner by direct injection in the office with a very small needle using a chemical or foam (“sclerotherapy”). These chemical agents irritate the vein wall causing them to close and, without the presence of blood, effectively immediately disappear from sight. Such sclerotherapy is particularly effective for cosmetic improvement in the appearance of legs (see photo).
Accurate diagnosis and treatment of venous disease is critical to maintaining healthy and attractive legs or to treat any complications. This can be effectively and safely done by vascular surgeons who are specifically trained to treat the entire range of venous disease with a variety of treatment options.
For more information please call OU Physicians – Tulsa Division of Vascular Surgery at 918-634-7500.
