by The Welthi Bureau | 06 August, 2018
If one is over 40, we probably notice those little purple veins that suddenly seem to appear on the legs, they are Varicose veins. Veins are the soft, thin walled tubes that return blood from the arms and legs to the heart. Because veins work against the force of gravity, they have valves that allow forward blood flow, but not reverse. The legs and arms have two major types of veins: superficial and deep. The superficial veins are near the surface of the skin and are often visible. The deep veins are located near the bones and are surrounded by muscle. Connecting the deep and superficial veins is a third type of vein, the perforator vein. Contraction of the muscles in the arms and legs with exercise helps blood flow in the veins. Varicose veins are enlarged, bulging superficial veins that can be felt beneath the skin, generally larger than 3mm in diameter. They are usually located inside of the calf or thigh and develop due to weakness of the vein valve and loss of valve function. Under the pressure of gravity. they continue to enlarge, and in the course of time, they may become elongated, twisted, pouched and thickened. Spider veins are tiny dilated veins, usually less than 1 mm in diameter, located at the surface skin layers. Spider veins cannot be felt. Veins larger than the spider veins, but still under 3 mm are called reticular veins.
Varicose veins may be entirely symptom-free and cause no health problems. Treatment in such cases is often for cosmetic purposes. When symptomatic, the varicose veins may cause ankle and leg swelling, heaviness or tension, aching, restlessness, cramps and itching. Varicose veins are more often symptomatic in women than in men. Signs of chronic venous disease include skin pigmentation, and loss of the soft texture of the skin and underlying tissue in the ankle area (called induration). Itching is perhaps the most consistent symptom of varicose vein, along with complaints of leg heaviness, tension and aching legs.
The causes of varicose veins may be primary, secondary or congenital. Primary varicose veins develop as a result of an inherent weakness in the wall of the vein. Varicose veins can have a hereditary factor and often occur in several members of the same family. Varicose veins that develop after trauma or deep vein thrombosis are of secondary cause. Congenital varicose veins are due to disorders in the natural development of the venous system and are usually part of a vascular malformation in the limb, present at birth. No matter the cause, defective venous valves may cause venous blood to stagnate in the leg, leading to increased pressure in the veins. This may result in further enlargement of the varicose veins, increasing the likelihood of symptoms, and causing complications such as skin changes and ulcer formation. Blocking of the pelvic veins may severely aggravate the effects of varicose veins, requiring a separate treatment.
The most important factors leading to the development of varicose veins include, heredity with family history of varicose veins, prolonged standing or sitting, increasing age, multiple pregnancies and deep vein thrombosis. Less physical activity and obesity also contribute to higher incidence of varicose veins in many individuals.
The diagnosis of varicose veins is made primarily by physical examination. The accuracy of physical examination is improved with the aid of a hand-held Doppler instrument, which allows the examiner to listen to the blood flow. The most accurate and detailed test is a duplex ultrasound exam, which provides an ultrasound image of the vein to detect any blockage caused by blood clots and to determine whether the vein valves are working properly.
Most often patients complain of heaviness of legs, leg swelling and pain. Often they consult their family physician, whereas a vascular surgeon would be an ideal choice for correct diagnosis and treatment. Sometimes skin discolouration occurs and patients often consult a dermatologist assuming it to be a skin problem, whereas the underlying problem is chronic venous insufficiency. For symptoms like leg swelling, skin discolouration, heaviness of legs, non healing leg ulcers a Vascular Surgeon is the ideal choice for correct diagnosis and treatment.
The initial treatment option suggested for patients with varicose veins is changes in their lifestyle, including maintaining proper weight, positioning legs in an elevated manner while resting, avoiding long duration standing or sitting, wearing compression stockings regularly etc.
In case the patient doesn't respond to lifestyle changes, the treatment options are, Sclerotherapy, which involves sealing of the veins via an injection of a sclerosant. This procedure is mainly done for smaller veins and is performed under doctor supervision. The other option is vein stripping, performed for more involved varicose veins. The physician may make two small incisions in the groin area and another below the knee and removes the diseased veins. Ablation and laser treatment are performed on patients with severe varicose veins. The ablation procedure involves inserting a catheter, a thin flexible tube into the leg vein. The tip of the catheter has tiny electrodes that heat and seal the walls of the vein. Similarly laser treatments use a tiny fiber placed in the vein through a catheter. The fiber sends out laser energy that closes the diseased portion of the vein.
However, prevention is the best remedy, by which one can delay the development of varicose veins or keep them from progressing. But nothing can be done about heredity, advanced age related varicose vein problem.
Varicose veins can be prevented by
Being active, moving leg muscles to keep the blood flowing.
Keeping blood pressure under control.
Maintain a normal weight.
To temporarily relieve symptoms, lie down and raise your legs at least six inches above the level of heart. This has to be done for ten minutes, a few times each day.
Wear prescription compression stockings as specified by your doctor.
In case of symptoms, it's very important to consult a qualified VASCULAR SURGEON, who can diagnose the cause of varicose veins, the sources of venous reflux in the legs and offer a variety of treatment options
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