Varicose Veins

Introduction

Varicose veins are swollen, twisted and sometimes painful. They are commonly found on the inside of the legs between the groin and the ankle, and at the back of the calf. These veins appear bluish and are close to the surface of the skin. The exact pathophysiology is debated, but it involves a genetic predisposition, incompetent valves, weakened vascular walls, and increased intravenous pressure(1^✔ ✔Trusted Source
Varicose Veins: Diagnosis and Treatment

Go to source).

So What Happens in Varicose Veins?

Normally the veins are stretched or pulled tight. However, if the blood flow is too sluggish, the veins slowly get dilated and twisted in order to accommodate more blood in the lumen. Another possible reason is that the valves in the veins do not function properly and the blood leaks down with gravity and gets collected in the veins of the legs. The cause of piles (or hemorrhoids) around the anus is also due to varicosity of veins around the anus(2^✔ ✔Trusted Source
Hemorrhoids: From basic pathophysiology to clinical management

Go to source).

Are You Prone to Varicose Veins?

Varicose veins can be inherited and if there is a strong predisposition in your family, this may be the most influential risk of all. It is believed that up to 15% of adults in the western world are affected by this condition.Early stages of venous reflux may occur in as many as 25% of women and 15% of men. Later stages of venous reflux, such as venous ulceration, may occur in 5% of the population (Rabe 2016).

Varicose veins are seen globally and influenced by activity and lifestyle and are more likely to occur in women than in men(3^✔ ✔Trusted Source
Varicose Veins

Go to source).

Valves prevent the backflow of blood within the vein and keeps blood in the vein moving towards the heart. When a person with poorly functioning or defective valves stands up for prolonged durations, the blood flow actually reverses and flows down the superficial veins, when it should be flowing up towards the heart(4^✔ ✔Trusted Source
Varicose Veins

Go to source).

Causes and risk factors for varicose veins include -(1^✔ ✔Trusted Source
Varicose Veins: Diagnosis and Treatment

Go to source)

• Birth defectin the valves of the heart
• Obesity
• Pregnancy
• Tumors
• Weakness, wasting of muscle
• Hormonal changes at menopause
• Activities or hobbies that require standing for a long time
• A family history of varicose veins
• inflammation of a vein before a blood clot forms(thrombophlebitis).
• Abdominal straining

The symptoms of varicose veins include -(1^✔ ✔Trusted Source
Varicose Veins: Diagnosis and Treatment

Go to source)

• Leg veins become bigger, blue and twisted.
• Appearance of spider veins (telangiectasia)
• Most people feel severe pain and heaviness in the area
• Swelling
• Constant itching
• The skin becomes thin, hard, dry and discolored
• Minor injuries in the affected areas can also cause severe bleeding.

These symptoms worsen with long day standing; sitting down with the legs raised is the only way to relieve these problems.

Some people may not experience any symptoms and varicose veins are only a cosmetic problem for them.

Varicose veins are diagnosed merely by physical examination of the patient while standing or sitting down with dangling legs.

The doctor may recommend the following tests –

• An X-ray of the vein (venogram)(5^✔ ✔Trusted Source
  Three-dimensional CT Venography: A Diagnostic Modality for the Preoperative Assessment of Patients with Varicose Veins

  Go to source

  )

• CT venography allows clear visualization of the great and small saphenous veins, perforators and deep veins in the entire lower extremity without interference by arterial images. In addition, this method requires a small amount of contrast medium, which is advantageous for reducing cost and renal damage. Furthermore, it facilitates the selection of effective and efficient strategies when it is used in conjunction with ultrasonography. CT venography may be an optional evaluation method for the treatment of varicose veins.
• A duplex ultrasound of the affected leg to tell if there is any problem with the blood flow and to rule out other causes like blood clots. Doppler ultrasound is noninvasive and provides morphological and hemodynamic information, but it takes time for scanning the entire leg, and the accuracy and quality of assessment depends on the skill of the examiner.

The goal of the treatment is to improve blood flow back up to the heart.

Medical treatment is not required for most varicose vein patients unless problems like deep-vein blood clot or severe bleeding occur.

The conservative treatment involves -(6^✔ ✔Trusted Source
Management of varicose veins

Go to source)

• Avoid standing for prolonged periods
• Elevate the legs while sitting
• Exercising and walking every day is highly recommended
• Wear elastic support stockings

Medical treatment involves –

• Sclerotherapy(7^✔ ✔Trusted Source
  Injection sclerotherapy for varicose veins

  Go to source

  ) where a chemical is injected into the veins.this is done only for small veins

• Stripping or vein removal is used to remove larger varicose veins(8^✔ ✔Trusted Source
  The management of varicose veins

  Go to source

  )

• Don’t cross your legs when sitting.
• Exercise regularly. Walking is a good choice. It improves leg and vein strength(4^✔ ✔Trusted Source
  Varicose Veins

  Go to source

  ).

• Avoid weight gain.
• Avoid standing for prolonged period of time. If your job or hobby require you to stand, shift your weight from one leg to the other every few minutes.
• Wear elastic support stockings(4^✔ ✔Trusted Source
  Varicose Veins

  Go to source

  ).

• Don’t wear clothing or undergarments that are tight or constrict your waist, groin or legs(4^✔ ✔Trusted Source
  Varicose Veins

  Go to source

  ).

• Eat high-fiber foods like bran cereals, whole grain breads, fresh fruits and vegetables to promote regularityas constipation contributes to varicose veins due to abdominal straining(9^✔ ✔Trusted Source
  Diets for constipation

  Go to source

  ).

• To prevent swelling, cut your salt intake.
• Exercise your legs. This can be undertaken even if you have a sedentary desk job.
• Elevate your legs when resting(4^✔ ✔Trusted Source
  Varicose Veins

  Go to source

  ).

• Get up and move about every 35 to 45 minutes when traveling by air or even when sitting in an all day conference. (Opt for an aisle seat in such situations).
• Stop and take short walks at least every 45 minutes when taking long car rides or limited exercise of your legs as advised previously.
• Varicose veins tend to get worse with time. One can ease discomfort and slow varicose veins from getting worse by taking good care of them.