What are varicose veins?
Varicose veins are a very common problem, generally appearing as
twisting, bulging rope-like cords on the legs. They are caused from
backflow or pooling of blood in a damaged vein. The venous system is a
network of blood vessels that carry blood back to the heart. Normal
veins in the legs have one way valves that keep blood flowing back to
the heart and prevent it from flowing backwards. Varicose veins occur
when the vein valves malfunction. The vein walls lose elasticity and
the veins dilate, preventing the valves from closing properly.
Backwards flow (known as venous reflux) causes more pressure on the
adjacent veins, leading to the development of more dilated veins and
pooling of blood in the lower legs. Varicose veins affect an estimated
40% of women and 25% of men.
Spider veins are smaller, red or blue, dilated veins that are close to
the skin surface. They may appear as red or blue bursts, lines, or
spirals and are often seen on the skin over the outside of the thighs
and inside of the knees. Although spider veins are usually considered a
cosmetic problem, they may itch or burn, and may be a sign of
underlying advanced venous disease.
Vein valve failure (Reflux)
Small one-way valves in the veins open to allow blood to flow upward,
towards the heart. In the normal vein, these small valves then close to
prevent flood from flowing backwards, back into the lower legs.
Varicose veins occur when the vein valves malfunction. Stretching and
dilation of the veins, from age, pregnancy, or other factors, lead to
the inability of the vein valve to close properly. Blood flows
backwards in the veins, a condition called venous reflux. Venous reflux
causes aching in the legs, a tired or heavy feeling, swelling, dilated
varicose veins, and in severe cases, brown pigmentation, dermatitis,
and skin ulcers (sores).
What are the symptoms of venous disease?
• Pain or aching discomfort in the legs
• Heaviness or a tired feeling in the legs
• Tenderness over the dilated veins
• Itching
• Swelling
• Dermatitis – a red itchy rash over the lower leg
• Dark pigmentation of the skin
• Ulceration – sores that don’t heal
• Bleeding from veins close to the skin
• Phlebitis – a hard, tender, reddened vein
Symptoms are usually worse at the end of the day, after standing or
sitting for prolonged periods. Many women note that the symptoms are
worse during the days immediately before the menstrual cycle. The
discomfort may be improved with elevation of the legs.
What are the risk factors for varicose veins?
- Heredity – This is one of the most important risk factors.
If your parents and grandparents had varicose veins, you will likely
develop them.
- Gender – Women are at higher risk because the female hormones affect the vein walls, especially during pregnancy.
- Pregnancy
– Because of the increased levels of female hormones and the increase
in blood volume during pregnancy, women who have had multiple
pregnancies are at increased risk.
- Age – The tissue in the vein walls lose elasticity as we age, making the vein weaker and more likely to dilate.
- Prolonged standing
– Because of the increased gravity on the lower legs, people who have
occupations that require prolonged standing have more of a risk of
blood pooling in the legs.
- Obesity – Excessive weight
leads to an increase in abdominal pressure and affects the muscles of
the legs, leading to worsened problems with venous disease.
- Physical trauma
– Injury or surgery of the legs can cause damage to the underlying
blood vessels and increase the risk for the development of varicose
veins.
How is venous disease diagnosed?
Varicose veins are easily seen on physical exam in most people. In
order to better look at the underlying venous function, a painless
ultrasound exam is performed in the office. The ultrasound can detect
direction of flow in the veins, evaluate valve function, examine the
size of feeding veins under the skin too deep to see on inspection, and
can detect any signs of blood clots. The ultrasound exam is necessary
to determine which feeding larger veins are abnormal and is essential
to making a treatment plan.
What can I do to prevent varicose veins?
- Exercise – Exercising regularly improves leg strength and
circulation. Walking is one of the best exercises for vein health.
Start out slowly and try to build up to 30 minutes per day.
- Maintain a healthy weight – Obesity places increased pressure on the veins.
- Wear elastic compression stockings
– Compression stockings gently squeeze veins so that blood flows
upwards to the heart. The stockings will decrease swelling, fatigue,
aching, and pain in the legs and may help prevent the progression of
disease.
- Elevate your legs – Raising the legs above
heart level at the end of the day for 15 minutes will decrease swelling
and keeps blood from pooling in the legs.
- Work your calf muscles
– The calf muscles help pump blood back to the heart. Avoid wearing
high heels as they decrease the use of the calf muscles. When sitting
or standing for long periods take walking breaks when possible, raise
yourself up and down on your toes, or rock back and forth on your heels.
What treatment is available?
- Sclerotherapy – Spider veins and small varicose veins may be
treated by injection, performed in the office. A very small needle is
used to inject a chemical directly into the vein, causing it to close.
- Endovenous vein ablation
– Reflux (or backwards flow) in the great saphenous vein is the most
common underlying cause of varicose veins. Endovenous saphenous
ablation, using either radiofrequency heat (VNUS Closure) or laser
energy (EVLT), is a minimally invasive procedure that is replacing
stripping surgery for the treatment of painful varicose veins. Under
ultrasound guidance, the vein is punctured over the inside of the leg.
A small catheter is threaded inside the vein and advanced towards the
groin. The catheter delivers heat energy to the vein wall, causing it
to seal down on itself. The procedure is performed either in the office
(under local anesthesia) or in the surgical suite (for patients who
request sedation).
- Microphlebectomy - Bulging varicose
veins left over after endovenous ablation may be removed to achieve
optimal cosmetic and functional outcome. The veins are removed through
a series of small skin punctures, resulting in minimal scarring. This
outpatient surgical procedure is usually performed under spinal or
general anesthesia, but may also be performed using local anesthesia
for small areas.
- Percutaneous ablation of perforating veins
– Severe venous insufficiency may lead to pigmentation (dark blotches
in the skin), dermatitis (an itchy scaly rash), or ulceration (sores
that fail to heal). Failure of the one way valves in the connecting
veins (perforating veins) of the lower leg contributes to the chronic
inflammation over the inside of the leg and ankle. New, minimally
invasive, techniques to close these perforating veins have helped the
skin to heal and prevent future complications of venous disease.
- Endovascular therapy
– Blockage of the large veins in the pelvis can be the cause of chronic
leg swelling and fatigue and may also be the underlying cause of acute
deep vein thrombosis. Angioplasty and stenting of the iliac veins is a
procedure, performed under local anesthesia, that uses guidewires and
balloons to open blocked veins in the pelvis.
Wisconsin Heart and Vascular Institute Vein Care Center
Our board-certified vascular surgeon, Sandra C. Carr, MD,
has extensive experience in the treatment of vein disorders ranging
from spider veins to difficult ulcers and venous clots. Our accredited
vascular lab and experienced technicians are available to perform
painless, accurate ultrasound examination. Cosmetic spider vein
injections and other percutaneous procedures are performed in the
office. State-of-the-art technology is used to close off diseased veins
with minimal pain and quick return to normal activities. Endovenous
ablation procedures are covered by most major medical insurance
companies.
In contrast to standard vein stripping procedures, these newer
procedures are associated with minimal discomfort and very little (if
any) scarring. Along with the expertise and technology, you also get
our unparalleled commitment to prompt and exceptional service.
For more information or to schedule and appointment, call (608) 260-2100.
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