What are Varicose Veins?
As arteries carry oxygenated blood pumped from the heart to your legs, so do veins carry the depleted blood back via the action of the calf and thigh muscles in your legs. In doing so, the blood must overcome gravity, with one-way valves within your veins preventing blood from flowing back to your feet. When veins become varicose these valves or the vein walls weaken so that blood bulges or pools within the vein, causing swellings (usually on the legs) that are easily visible on the skin as bluish and lumpy areas.
Varicose veins are very common and may be inherited or result from increased pressures in the veins, typically as a result of pregnancy or if you become very overweight. Other factors such as prolonged standing, smoking and poor diet may contribute but there is a lack of scientific evidence for this.
What symptoms may I have?
Apart from the cosmetic aspect that varicose veins are not very flattering, there may be little or no symptoms apart from an aching or discomfort in your legs, itching of the skin of your legs, or swollen ankles.
However, varicose veins can also lead to more serious complications, which include:
Thrombophlebitis - veins close to the surface of the skin can become painful and reddened due to inflammation or blockage of the vein (see also Deep Vein Thrombosis)
Bleeding - if a varicose vein near to the surface is cut or bumped, the resulting bleed might become a medical emergency if it can't be stopped. If this happens, you should lie down, raise your leg, apply pressure to the bleeding area, and then get medical help.
Chronic venous insufficiency - over the long term, the poor blood flow that causes varicose veins can also damage the way the skin exchanges oxygen, nutrients and waste products with the blood. This can lead to brown or purple patches on the skin (venous eczema and lipodermatosclerosis) or venous ulcers around the shin or ankle.
Varicose veins are easy for you to see but there are a number of tests which can help confirm what precisely is happening in your veins and how they could be treated. For example, ultrasound can be used to check blood flow and whether valves in your veins are working correctly. Duplex can also identify abnormalities in vein structure and assess the deep veins for signs of DVT.
At the simplest level, relief of swollen and aching legs can be achieved by wearing compression stockings, as they help blood flow back up to the heart. However, they do not prevent more varicose veins from developing and are only effective whilst being worn.
There are now a number of different treatments for varicose veins. Traditional surgery involves ligating the leaking veins and stripping out the diseased ones. With guidance from duplex scanning and more modern minimally invasive techniques, excellent functional and cosmetic techniques can be achieved. More recently, techniques under local anaesthetic have been developed, but not everyone is suitable for these.
The most common of these involves passing a probe inside the vein which is then heated (laser or radiofrequency) to destroy the wall causing the vein to close off preventing blood flow in it. Another technique uses an irritant foam substance injected into the vein (injection sclerotherapy) to achieve similar results. Your surgeon will advise you which technique is most suitable for you.