Varicose Veins

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What are varicose veins?

Veins are tubular vessels, with valves, that bring desaturated (used) blood back to the heart and lungs for re-oxygenation and re-circulation to all parts of the body. Varicose veins are deformed veins, elongated, tortuous, dilated or engorged (usually in the legs), with incompetent valves that allow reversal of flow. Normal veins have efficient valves at various levels that control and direct one-way traffic of blood from the periphery (head, arms, legs, etc.) to the center (heart and lungs).

What causes the blood in the veins to flow back to the lungs?

There are a couple of mechanisms: the pumping action of then heart, the breathing action that "sucks" the desaturated blood into the lungs and then pushes the freshly oxygenated blood out of the lungs, and the muscular contractions in the arms and legs, etc. which squeeze the veins, propelling the blood flow towards the lungs. Added to this is gravity, in situations where we lie supine and raise our legs, helping the flow of blood from the legs back to the lungs. This is the benefit of leg elevation among all of us, when we rest our tired legs, and more especially so for those with varicose veins.

Why do some people have varicose veins?

Nobody knows for sure, but some clinicians and researchers believe that familial component is very common and suggest that there is inherent abnormal weakness in the walls of the veins to begin with, leading to venous distention and therefore incompetent valves. This widening of the diameter of the veins creates a separation of the valve leaflets, with a resultant gap, making them incompetent, allowing reversal of flow of blood. The other theory is that the valves themselves are defective and incompetent, leading to reversal of flow, distention of the veins and formation of varicosities.

How does this cause varicose veins?

Let's think for a moment that leg veins are long straws that are made of soft tissues, with valves inside them. If the valves inside the "straws" are competent and allow only one-way flow of blood, with the help of muscular contraction in the leg, the pressure inside the "straws" remains normal and there is no extra build-up of pressure inside these "straws," so they do not dilate or balloon out. If, however, the valves become incompetent and permit reversal of flow, then there is a back-up of blood inside these "straws," causing them to "over-fill," balloon out, elongate and become tortuous over time, and almost pop out of the skin.

What are the symptoms of varicose veins?

Majority of people with varicose veins do not have symptoms at all. They simply have bad-looking veins in the legs, which, in some cases, involve those in the upper thighs and groins. Some have achy feeling or tiredness in the legs, or actual pain and heat, usually relieved by elevation and compression leg stockings. Many varicose veins are superficial and palpable, but the worse ones enlarge and protrude and become visibly obvious.

Are varicose veins dangerous?

In themselves, varicose veins are not dangerous. In some individuals, these veins can cause thrombophlebitis, painful swelling and inflammation of the inner walls of the veins, with blood clot formation. A piece of the clots can dislodge and travel to the lungs, causing pulmonary embolus (blood clot blocking the artery to the lungs). If the embolus is large enough to block one or two major pulmonary arteries, it will cause interruption of flow to the lungs and therefore interruption in the oxygenation of blood. This condition often kills the patient. But this is not a very common occurrence among persons with the usual varicose veins.

Can varicose veins rupture and bleed?

Yes, this can happen, but statistically, rupture and hemorrhage from varicose veins are rare, unless these distended veins are somehow injured or poked with a sharp object.

Do people with varicose veins have dirty blood?

No, having varicose veins does not mean having dirty blood. The veins are so engorged and obvious under the skin that the bluish color of used blood is more evident than usual, hence the myth about "unclean" blood. Blood in the body is sterile, free of bacteria, unless (septicemia) blood poisoning by infection is present.

Why do varicose veins cause leg discomfort?

When the bright red, freshly oxygenated blood is delivered by the arteries to the muscles and other organs in the body, the cells and tissues supplied consume the oxygen and nutrition in that blood. The desaturated (used) blood is oxygen-depleted and nutrition-poor and becomes dark, with carbon dioxide, lactic acid and other metabolites ("junks") in it. This used blood is then returned to the lungs for re-oxygenation, and then to the heart for re-circulation. When veins are varicose, the incompetent valves allow reversal of flow and pooling of "used blood" in the muscles. This used blood contains lactic acids and other chemical byproducts which are irritating to the veins, the muscles, nerves, etc. Leg elevation (emptying of the leg veins of used blood and refilling them with oxygenated blood), for instance, provides almost relief from the leg aches and discomfort.

How do support stockings help?

Support leg stockings that are properly fitted act much like normal leg muscle contractions, they help empty the varicose veins and propel the used blood forward to the lungs. Elevation of the legs, as we stated earlier, has the same beneficial effect. But elevation has to be done properly. The right way to elevate the feet is to prop them up, so that the feet are the highest point, higher than the knees, and the knees higher than the groin, with the patient either sitting, lounging or lying down flat on the back. By gravitational force, the blood in the feet and legs will flow back to the lungs with greater ease. Drinking at least 8 glasses of water or juices a day and one baby aspirin a day (only if and when prescribed by a physician) help in keeping the blood thin to prevent blood clot formation.

What are the complications of varicosities?

When neglected, some people with varicose veins could develop recurrent thrombophlebitis and deep vein thrombosis (clotted deep veins), which can lead to lower leg skin bluish to brownish discoloration, skin ulceration, non-healing ulcers. The varicose veins in the leg could erode and bleed. Chronic stasis ulcers, as they are called, could lead to swollen, hardened, enlarged, rough and dry leg, resembling the leg of an elephant.

What is sclerotherapy?

This is a technique where a chemical, 1% sodium tertradecyl sulfate, is injected into the varicose veins to destroy the intima (inner wall lining) of the veins, causing total obliteration of the entire varicose veins by fibrosis (scarring down and shrinking). In experienced hands, this form of treatment, which does not require hospitalization, provides excellent results in properly selected patients. Possible complications, which are rare, include allergy, skin scarring in the injection site, brownish pigmentation of skin, blood clots. Women undergoing sclerotherapy are advised against taking contraceptive pills for at least 12 weeks before and 12 weeks after the procedure. Before undergoing the procedure, the patient should discuss every detail at length with the physician performing the sclerotherapy.

When is surgery indicated?

Among patients with very severe varicosities, where sclerotherapy can not help, an operation called Greater Saphenous Vein stripping and ligation can be done. Other more extensive and more involved surgical procedures are also available for patients with complicated varicose veins.

Do all patients with varicose veins need medical care?

If the individual is not having any symptom or problem at all from varicose veins, except the fact that they make the legs look ugly, drinking a lot of liquids, good personal hygiene, elevation and use of support stockings may be all that is needed. But it is prudent for the individual to have at least one consultation with a physician for full evaluation, in case there is a less obvious, but more important, medical condition that is also present contributing to the varicosities.

©2003Raoul R. Diez, M.A.O.D.