Varicose veins – Diagnosis, treatment and causes

Varicose veins

Varicose veins are gnarled, bulged and twisted veins that appear beneath the skin and are most commonly found in the legs.

What are Varicose Veins? 

 A varicose vein is an enlarged, twisted vein that usually occurs in the leg. Veins are fragile, thin-walled pipes that return blood to the heart from the arms and legs. Veins function against the force of gravity.

They possess valves that permit forward blood flow but do not allow reverse blood flow. Your legs and arms have two types of veins: superficial and deep.

The superficial veins are present on the surface of the skin and are the visible ones. The deep veins are found near the bones and are surrounded by muscle.

Varicose veins are large, bulged superficial veins, visible on the skin, approximately bigger than 3 mm in diameter.

A varicose vein usually develops inside the calf or thigh and is caused when the vein wall weakens and the valves no longer function.

Under the pressure of gravity, they continue to grow large or bulge, and in the course of time, they may become enlarged, twisted, swollen and thickened. Varicose veins become visible, may project, and small capillaries can overfill, leading to purple discolouration.

Varicose veins develop anywhere on the leg but are usually found behind the knees or groin. It is often an inherited tendency passed on genetically, and it affects both men and women equally. It affects a person at any time but becomes more persistent with age.

Causes of Varicose Veins 

 Leg veins have one-way valves that support the return of blood to the heart. When there is increased resistance to blood flow in the leg due to pressure, the valves can become damaged, and bleeding may occur. The blood that leaks and flows in the wrong direction instead of the heart and down the legs causes the superficial veins to stretch and bulge.

The reasons vein walls stretch, and valves weaken are only vaguely understood. Some people develop the disorder for no apparent reason.

Pregnancy 

The amount of blood in the body increases during pregnancy to help support the developing baby. This increases the strain on the veins, causing Varicose veins.

Varicose veins can also form as the uterus grows. As the uterus expands, pressure is exerted on the veins in the pelvic area, resulting in the condition.

Although pregnancy increases the risk of developing Varicose veins, most women find that their veins improve significantly after the baby is born.

Menopause 

Hormonal fluctuations during perimenopause, menopause and postmenopause can last for years. During these phases, estrogen and progesterone’s rise and subsequent fall can result in thickened and less flexible vein walls.

Age over 50 

With increased age, the one-way valves in our veins that prevent blood from flowing backwards become weaker, allowing blood to flow back.

The pressure from the high amount of blood within the vein builds up, resulting in twisted, bulging veins known as varicose veins.

Occupation

A person’s type of occupation also plays a role. A job that requires people to stand for a longer duration, for example, hairdressers or nurses. Such professionals are at greater risk of developing varicose veins than people who have a genetic predisposition.

Prolonged standing

Too much sitting or standing can cause blood to build up in the leg veins, increasing the pressure within the veins.

The increased pressure can cause veins to stretch. This may weaken the vein wall and damage the valves, making them inefficient and resulting in varicose veins.

Sitting for several hours rather than standing is also not a viable option. Prolonged sitting causes blood to accumulate in the legs, increasing vein pressure and potentially leading to varicose veins.

Obesity 

Obesity is associated with increased abdominal pressure. Abdominal pressure increases the pressure on the leg veins. Increased venous pressure promotes the development and progression of Varicose veins.

Another effect of obesity on vein health is the blood flow exchange between deep veins and the superficial vein system in the legs. It is said that fatty and fibrous tissue surrounding the veins may disrupt venous circulation and slow blood flow in the veins, which can lead to varicose vein formation.

Family history 

Varicose veins do run in families. But genetics cannot be the sole reason for Varicose veins. Heredity combined with factors which put additional stress and strain on the veins, like being obese, contribute to the development of varicose veins.

Risk factors of Varicose Veins

Age 

As we age, the veins lose elasticity, and the valves inside them stop working. This increases the risk of varicose veins.

Heredity

Chances of developing Varicose veins are high if a close family member has the condition.

Gender

Varicose veins are more commonly seen in women than in men. Research suggests that female hormones tend to relax the walls of veins, making the valves more prone to leaking.

Changes in hormone levels can occur in women due to pregnancy, premenstrual syndrome or menopause, which increases the risk of Varicose veins.

Weight 

Being overweight puts additional strain on the veins, requiring them to work harder to return blood to the heart. This creates extra strain on the valves, causing the valves to leak, allowing the blood to flow back to the legs and finally resulting in enlarged veins.

Symptoms of Varicose Veins

 Bulging veins 

Blood is accumulated in the veins when the valves become weakened or damaged. The veins bulge as a result of this.

Itching

Itchy varicose veins are due to venous stasis dermatitis, which can appear alongside varicose veins.

This condition occurs when the blood accumulated in the damaged blood vessels begins to leak out.

The inflammation and swelling caused due to damaged veins are due to a lack of oxygen reaching the skin near the veins. Both these factors contribute to itchy veins.

Pain 

Varicose veins can also cause inflammation and clot formation in the vein. This clot is frequently found near the skin’s surface, resulting in a condition known as superficial thrombophlebitis. Pain due to Varicose veins is also as a result of this.

Swelling  

A series of tiny valves that open and close to allow blood to flow through veins prevents blood from flowing backwards.

If the valves become damaged, blood can flow backwards and collect in the vein, making it swollen and causing Varicose veins.

Deep vein thrombosis 

Deep Vein Thrombosis (DVT) is not usually associated with varicose veins. This is because only the veins closest to the skin’s surface are affected in varicose veins.

According to the JAMA study, varicose vein patients are about five times more likely to develop a DVT.

Diagnosis of Varicose veins

Venous Doppler ultrasound

Doppler ultrasound is required to determine the cause of the Varicose vein.

This painless test evaluates the groin valve function and determines how much blood flows back into the legs.

The test can also check the structure of the leg veins and the presence of blood clots. It takes 20 to 30 minutes to perform the test for each leg.

Treatments for Varicose veins 

 Self-care

It is possible to treat varicose veins and keep them from worsening. Practising self-care will aid in the proper flow of blood through the body.

Self-care can include

• Engaging in regular exercise
• Losing weight for obese individuals
• Restricting from standing or sitting in the same position for a longer period.
• Wearing loose clothing and
• Elevating the legs for a few minutes if the Varicose veins are in the legs.

Ayurvedic treatments

Ayurvedic treatment for varicose veins consists of products made from plants, animals, minerals, and metals. Massage therapy, known as abhyanga, is proven to cure varicose veins and their symptoms. In an abhyanga treatment, warm herbal oil is applied to the body to help treat varicose veins.

Compression stockings 

 Compression stockings can help alleviate most of the symptoms of varicose veins and are recommended by medical professionals for those who cannot take the  surgery option—for example, pregnant women.

Compression stockings prevent further damage to people whose veins are mildly affected. The stockings work by applying pressure on the superficial veins to force blood into the deep veins of the leg and then push it back to the heart. They stop the blood from pooling and reduce the swelling of the veins.

Homeopathy Treatments

The use of certain homeopathic medicines is said to offer pain relief as well as elasticity, which is beneficial in conditions like Varicose Veins.  By doing so, circulation improves, and swelling is reduced. Here is a list of some homeopathic remedies that work best to treat varicose veins.

• Hamamelis
• Pulsatilla
• Calcarea
• Graphites
• Arnica

Surgeries for Varicose veins

 Surgery proves to be the most effective treatment for severe varicose veins. Damaged valves that are leaking, especially those behind the knee or in the groin, can be removed through surgery.

Surgery can also strip off long stretches of veins if they contain faulty valves and remove large swollen varicose veins.

Sclerotherapy

Sclerotherapy is the preferred treatment for small varicose veins. The procedure involves directly injecting a solution into a vein. This causes the veins to scar and collapse, forcing blood to flow through healthier veins.

The collapsed vein is absorbed into the surrounding tissue and eventually disappears.

Laser treatment 

 Laser treatments are also one of the latest and effective treatments for Varicose Veins. The Varicose Veins Laser Surgery uses a laser to treat the wide, twisted, or inflated veins that are located beneath the surface of the skin of the leg.

A laser device emits a thin beam of light radiation. Laser treatment shrinks and closes the Varicose vein, causing scar tissue within the vessel. This closes the vein. Instead, blood flows through other nearby veins.

Catheter-based procedures using radiofrequency

Radiofrequency endovenous catheter ablation, also known as endovenous ablation, is a minimally invasive, image-guided treatment. It makes use of radiofrequency heat (RF).

RF heat is delivered into the vein via a thin, flexible tube during the treatment (catheter). This closes the abnormal veins that lead to Varicose veins.

High ligation

High ligation refers to surgically tying off a vein to prevent blood flow into a diseased or non-functioning vein.

The great saphenous vein, which is a large, superficial vein that runs from the groin into the foot, is the vein most likely to be ligated.

Ambulatory phlebectomy

The surgical removal of visible varicose veins through a keyhole incision is known as ambulatory phlebectomy.

The procedure removes varicose veins by making a series of small incisions, as small as 1 mm, in the skin adjacent to the vein. The varicose vein is then cut into small segments and removed.

Prevention of Varicose veins

Avoiding High Heels

High heels are not known to cause Varicose veins directly. But, they will contribute to the problem by affecting blood flow in the veins.

Avoid tight hosiery

Tight hosiery blocks blood flow and is, therefore, better to be avoided.

Other ways

Varicose veins can also be prevented by,

• Maintaining an ideal weight
• Regular physical activity
• Sitting with the feet raised
• Sitting without crossing the legs
• Wearing clothing that is loose

Conclusion

One can take a few steps to reduce the risk of developing varicose veins. Varicose veins may not be prevented, but certain precautionary measures may be followed to reduce the risk of developing them or getting new ones.

Regular exercising, maintaining a healthy weight, elevating the legs, and changing the sitting or standing position frequently have been said to be helpful.

FAQs

What not to do when a person has varicose veins? 

One should not do the following things when they have Varicose veins.

• Overstrain – This includes lifting heavy weights or participating in high-impact activities. 
• Fad diets – While many promises quick results, avoiding sugar and fat through healthy eating is the best thing for the veins. 
• Prolonged sitting – Staying active throughout the day and night can help prevent varicose veins from forming. 
• Loose Clothing and high heels – One should not wear clothing that is too tight around the waist, groin or thighs. High heels are to be used only when necessary.

Do varicose veins ever heal?

Varicose veins do not improve over time. When a varicose vein is treated, its appearance should gradually fade and eventually disappear.

What happens if I do not treat my Varicose veins? 

Untreated varicose veins can become inflamed. This results in a condition known as superficial thrombophlebitis (ST). 

If left untreated, varicose veins can sometimes lead to ulcers, open sores, bleeding, and skin discolouration. Severe varicose veins could indicate chronic venous insufficiency.

Can you get rid of Varicose veins?

Varicose veins will not disappear unless they are surgically treated or removed.