Varicose veins are bulging veins near the surface of the skin typically caused by venous insufficiency also called venous reflux. Veins are designed to pump blood back to the heart, and the veins in the legs have valves that help in this process. In patients with venous insufficiency, those valves aren’t working properly and cause a buildup of blood in the veins. This increased venous pressure leads to the development of varicose veins.
Millions of Americans are affected by varicose veins, and in some people, these bulging veins are unsightly but painless. For others, they can be uncomfortable and even incredibly painful. The good news is this common condition can be treated with same-day, minimally invasive procedures that do not require general anesthesia or a trip to the operating room. Here’s a list of the different kinds of vein conditions and the treatment options available to patients.
Some patients with varicose veins have no symptoms, but others may experience a number of symptoms including aching, throbbing, itching, heaviness and fatigue in the legs. Leg swelling is also a common symptom. Venous insufficiency is largely a benign condition, but can be quite frustrating as it starts to change the appearance of your legs and, in some cases, affect your ability to stand for long periods of time.
There have been a number of large studies that specifically looked at the risk factors associated with varicose vein development and the data in those studies did not suggest that crossing your legs leads to the development of varicose veins. Studies have suggested that a family history of varicose veins puts you at increased risk. If both parents suffered from varicose veins, then there may be as high as a 90 percent chance that their children will also have issues with venous insufficiency. Other risk factors include obesity, advanced age, prolonged standing, smoking, sedentary lifestyle, a history of blood clots and pregnancy.
Women are four times more likely to suffer from varicose veins. The hormonal changes associated with pregnancy, especially multiple pregnancies, put women at increased risk for developing varicose veins. In addition, the increased blood volume and pressure from a growing uterus can cause veins to enlarge. Often the varicose veins resolve or at least improve in appearance within about three months of delivery.
Varicose veins and spider veins are not the same thing but they are often the result of the same problem. Varicose veins are the large prominent veins seen and felt on the surface of the skin. They often have an associated blue or green discoloration. Spider veins, or telangiectasias, are the smaller veins with a web-like pattern visible on the surface of the skin. They are typically not raised. Reticular veins are another category of superficial veins that are often seen in patients. They are characterized by larger veins, often green in color, seen under the surface of the skin that aren’t quite bulging.
Vein mapping refers to an ultrasound test that can be done to take a closer look at the veins in the legs. This test is non-invasive and painless. As mentioned above, the study may also be referred to as a venous insufficiency or venous reflux ultrasound. This is different from a venous ultrasound study that is done to look for blood clots in the deep veins. Vein mapping will help the health care professional determine what, if any, procedures are appropriate for each patient. These studies tell where the veins are malfunctioning, how large the veins are, and whether or not an invasive procedure is even feasible for the patient. For most, a vein mapping study is necessary before a procedure can be recommended.
“Treatment for varicose veins typically starts with medical management, which includes regular use of graduated compression stockings and leg elevation,” says Chelsea Dorsey, MD, a vascular surgeon at the University of Chicago Medicine and an expert in caring for individuals with arterial and venous diseases. “If conservative measures don’t work, some patients require procedures to resolve their symptoms. Treatment options include sclerotherapy, thermal ablation procedures and/or phlebectomy. Sclerotherapy involves injecting a solution into visible veins on the skin’s surface. This is typically used to improve the appearance of spider and reticular veins. Ablation procedures use either radiofrequency or lasers to close off malfunctioning veins. Phlebectomy is a procedure where varicose veins are surgically removed through small incisions in the skin. Often a combination of these procedures is necessary to achieve the desired result. Your health care professional can help you decide what treatment is right for you.”
Graduated compression stockings are used in both the prevention and treatment of varicose veins. Compression stockings are available in different pressure gradients. Individuals with moderate venous insufficiency are often prescribed a stocking with a "firm" 20 to 30 mmHg gradient. It is typically recommended that patients wear their compression stockings daily, putting them on in the morning and removing them at the end of the day prior to heading to bed. The white “anti-embolism” stockings given to patients in the hospital are typically not adequate for patients with symptomatic venous insufficiency and typically have a gradient well below 20 mmHg.
Most of the medical procedures are done in an office setting. For some patients with more extensive venous disease, the procedures are done in the operating room on an outpatient basis that allows the patient to go home the same day. Most of the procedures involve very small incisions in the skin – one to three millimeters. It depends on the type of procedure that you pursue, but most patients have very little associated scarring. The risks vary slightly depending upon what procedure you are getting done. As with any invasive vascular procedure, there is a small risk of bleeding, infection or damage to surrounding structures, such as small superficial nerves. The vast majority of patients will have a smooth post-procedure course. Some patients experience bruising, swelling or mild discomfort at the site of the incisions. However, all of these are typically short-lived and resolve within days of the procedure.
Some patients experience recurrence of their varicose veins. The likelihood of recurrence depends upon the type of procedure that you have and the degree of underlying venous insufficiency. It is important to be evaluated by an experienced vein specialist who will work with you to treat the underlying cause for your varicose veins. If recurrence does occur, it typically takes several years for new varicosities to develop.
Is Height A Risk Factor For Varicose Veins?
The taller you are, the more likely you are to develop varicose veins, according to a study led by Stanford University School of Medicine researchers that examined the genes of more than 400,000 people in search of clues to what causes this common but little understood condition. "Genes that predict a person's height may be at the root of this link between height and varicose veins and may provide clues for treating the condition," says Nicholas Leeper, MD, associate professor of surgery and of cardiovascular medicine at Stanford. The study - published in Circulation - also identified 30 genes linked to varicose vein disorder and to a strong genetic correlation with deep vein thrombosis. Leeper and Erik Ingelsson, MD, Ph.D., professor of cardiovascular medicine, are the senior authors. Eri Fukaya, MD, PhD, clinical assistant professor of vascular surgery, and medical student Alyssa Flores share lead authorship. "The condition is incredibly prevalent but shockingly little is known about the biology," Flores said. "There are no medical therapies that can prevent it or reverse it once it's there." Treatment is mainly limited to surgical procedures, such as laser treatment or vein stripping. We're hoping that with this new information, we can create new therapies, as our study highlights several genes that may represent new translational targets."
Researchers used data from the UK Biobank to look for varicose vein risk factors using machine learning combined with epidemiological methods in 413,519 participants. They confirmed that currently established risk factors including being older, female, overweight or pregnant, or having a history of deep vein thrombosis are all associated with varicose veins. "We confirmed that having had deep vein thrombosis in the past puts you at increased risk in the future," Leeper said. "Recent research suggests that the converse appears to be true as well. Having varicose veins puts you at risk of these blood clots." The study also confirmed that surgery on the legs, family history, lack of movement, smoking and hormone therapy are risk factors. But the correlation they found between height and the condition was unexpected.
The machine-learning algorithm also showed that bioimpedance, a measure of how well the body impedes electric current flow, is a strong predictive marker for varicose veins. This measurement could potentially be used as a diagnostic tool to predict for varicose veins. When height emerged from the machine-learning analysis as a possible risk factor, the researchers conducted further tests to see if it was an actual cause for the disease using mendelian randomization analyses, a statistical technique to determine causal effects. "Our results strongly suggest height is a cause, not just a correlated factor, but an underlying mechanism leading to varicose veins," Ingelsson added. "By conducting the largest genetic study ever performed for varicose vein disease, we now have a much better understanding of the biology that is altered in people at risk for the disease."
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With over 30 years of writing and editing experience for newspapers, magazines and corporate communications, Kevin Kerfoot writes about natural health, nutrition, skincare and oral hygiene for Trusted Health Products’ natural health blog and newsletters.
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