What are varicose veins?
The purpose of veins is to return blood to the heart. In the legs, when the main surface veins in the legs fail, blood is allowed to flow down to the feet, rather than being returned to the heart. This causes increased pressure in the leg veins and, as a result, the veins slowly grow in size over time.
Leg veins bigger than usual, and ones that bulge outwards, are called varicose veins.
Inside veins are small, one-way valves that keep the blood flowing up the leg, even when standing. It is the failure of these valves that allows blood to run down the leg towards the feet, causing pooling and increased pressure.
Who gets them?
Varicose veins often run in families but this is not always the case.
Other risk factors for veins are: pregnancy, obesity, standing occupations and trauma.
What problems can they cause?
People who have varicose veins, particularly in the early stages, often do not have any symptoms. In this group, the veins may simply look unsightly.
When symptoms do occur, they usually relate to the increased pressure created by the pooling of blood in the legs. Common symptoms are: aching, throbbing, itching, burning, and cramping. Varicose veins do not cause restless legs syndrome.
As veins become more advanced, the increased pressure may start to have an effect on the skin. This may develop as discolouration, thickening, eczema or cellulitis.
Occasionally, blood can clot within the veins, causing surface blood clots, also called superficial vein thrombosis (SVT), phlebitis or superficial thrombophlebitis. This condition may be serious if blood clots form in the deep veins of the legs, causing deep vein thrombosis (DVT) and sometimes lung clots, called pulmonary embolism (PE).
Bleeding from veins is also a serious medical problem, particularly in the elderly.
Investigations
Ultrasound scan is the main investigation for varicose veins. This is non-invasive and provides a detailed map to help plan treatment.
Varicose veins treatments
Treatments broadly fall into two categories: symptom management with compression stockings or socks and varicose veins closure. Surgical treatment is not common these days.
Compression stockings and socks give good relief for vein symptoms and also for the skin problems caused by veins. They need to be worn every day to be most effective. People say there are two main issues when wearing compression stockings and socks: they’re hard to put on and they’re too hot to wear all of the time.
Vein closure treatments usually use a combination of heat (laser, RFA) or with medical sealant (VenaSeal) and sclerotherapy, where irritant injections close the veins. Usually, these treatments happen at the same time. Often sclerotherapy is the only treatment necessary.