treating varicose veins

The truth about varicose veins

About 60 per cent of the adult population suffer from varicose or thread veins, but what causes these disfiguring, painful veins and what can be done about them?

Your body has two types of blood vessels: arteries that carry oxygen and nutrient-rich red blood from your heart to your muscles and organs, and veins that return 'used' deoxygenated blood back to your heart.

The deep veins located within the muscles carry 90 per cent of the blood travelling from your legs back to your chest. The other 10 per cent of veins are located closer to the surface, often visible, and are less well supported.

The superficial veins drain blood into the deep veins via small perforating veins. Contraction of the leg muscles help your veins pump the blood upward, while an intricate system of one-way valves prevents blood from draining back down the leg into the superficial veins.

Why do varicose veins appear?
Sometimes the valves stop working as well as they should and no longer seal properly, making it difficult for the muscles to push the blood upwards. So instead of flowing from one valve to the next, the blood pools in the superficial vein, increasing venous pressure and causing it to bulge and twist. The result is varicose veins. As veins closest to your skin have less muscular support than deep veins, superficial veins are more likely to become varicose.

How harmful are they?
Although painful and disfiguring, visible varicose veins are usually harmless. When inflamed, they can become tender to the touch and can hinder circulation, causing swollen ankles, itchy skin and aching in the affected limb.

On rare occasions a deep interior leg vein can become varicose. These are not usually visible, but can cause swelling or aching throughout the leg. Blood clots can form in deep varicose veins.

Varicose or thread?
If you suffer from varicose veins, you're not alone. Varicose veins or a related disorder, thread veins, affects up to 60 per cent of the adult population. Thread veins, also known as telangiectasia or broken capillaries, are formed by the dilation of a small group of blood vessels located close to the surface of the skin and are most commonly found on the legs and face. They look like red or purple 'sunbursts', branched or web patterns, and can cause a dull ache after prolonged standing.

Varicose veins are:

Larger - usually more than a quarter of an inch in diameter - and often distended

Darker red, purple or blue

Located deeper than thread veins

Tend to bulge or twist

Complications
For the majority of sufferers, varicose veins are a cosmetic problem. However, on rare occasions, the following complications can occur:

Varicose eczema: itching and discolouration of the skin on the lower leg.

Phlebitis: an inflammation of the vein.

Thromboses: blood clots that form in the enlarged vein.

Venus stasis ulcers: these occur when the enlarged vein does not provide adequate drainage of fluid from the skin, the swollen skin receives insufficient oxygen and an ulcer forms.

Risk factors
Certain people seem to be more predisposed to varicose veins than others. The condition is slightly more common in women, who are more likely to seek treatment than men. You are more at risk from developing varicose veins if members of your family have them and if you are over 40, because as skin ages and loses its elasticity it cannot support the veins as firmly.

Other factors include changes in hormonal levels brought on by pregnancy, menopause and the use of birth control pills (oestrogen and progesterone). Obesity, a leg injury, inactivity and strain in the abdominal region, from repeated heavy lifting, pregnancy or constipation - a haemorrhoid is actually a varicose vein - can bring on the condition.

Varicose veins due to pregnancy often improve within three months after delivery. However, these abnormal veins are more likely to remain with successive pregnancies.

Diagnosis
Most cases of varicose veins are visible, with the knotted, twisted or bulging darkened veins showing beneath the skin of the lower legs, and the legs may be swollen. If you have varicose veins, you may also experience pain in your lower limbs, especially after standing or sitting still for a long time. Some women describe the pain as feelings of fatigue, heaviness, aching, burning, throbbing, cramping or restlessness.

Vein disorders are not always visible. Your doctor will refer you to a vascular surgeon to help determine the cause and severity of the problem. The surgeon may carry out an ultrasound scan of the leg veins.

Seek medical advice if swelling becomes incapacitating, or if the skin over your varicose veins becomes flaky, ulcerated, discoloured or prone to bleeding. In addition, if you have bright red varicose veins, call your doctor as this can be a sign of phlebitis or a blood clot.

Treatment and prevention

Simple treatments
Varicose and thread veins are congested with blood, so they really aren't doing their job any more. Fortunately, there are plenty of other, healthy veins to take over. So most of these unwanted veins simply aren't necessary and can be removed. Surgery is an option, but there are simpler things you can try first, including:

Regular walking: it improves muscle tone and circulation, and reduces body weight.

Elevating the legs for 10 to 15 minutes several times a day.

Wearing compression hose or stockings, which can be purchased at most pharmacies. This helps the leg muscles push blood upward by concentrating pressure near the ankles. Specially manufactured gradient-compression support stockings are the most effective for controlling symptoms.

Taking an over-the-counter anti-inflammatory drug, such as aspirin or ibuprofen, to alleviate occasional swelling and pain.

If you're pregnant, trying to sleep on your left side rather than on your back to minimise pressure from the uterus on the veins in your pelvic area.

Using regular sun protection, as some unwanted thread veins on the face may be related to sun exposure)

Sclerotherapy
If these conservative methods don't work you might want to try sclerotherapy. This treats varicose and thread veins, normally at an outpatient's department or a day care centre and has a success rate of between 50 to 90 per cent. A tiny needle is used to inject the veins with sclerosing (hardening) solution, which irritates the lining of the vein. In response, the vein collapses and is reabsorbed. You may need one or several sclerotherapy sessions four to six weeks apart, and may have one or several injections per session.

Complications of sclerotherapy includes the development of fine, red blood vessels near the injection sites of larger vessels on the thighs, some of which disappear on their own. Muscle cramps which go away in within minutes, temporary swelling of your feet or ankles, bruising which usually fades and pigmentation - brown lines or spots - that can last for several months.

Surgery
Surgery is used to treat large varicose veins and can be performed using a local, spinal or general anaesthetic. Most patients return home the same day as the procedure. It can take several forms:

Ligation: the tying of a vein.

Stripping, or removal of a long segment of vein by pulling it out with a special instrument.

Multiple avulsion ambulatory phlebectomy, or removal of veins through a series of tiny incisions.

No treatment can prevent new veins from becoming varicose. Varicose veins sometimes recur after surgery, but it's not the same vein coming back, but a new vein becoming affected.

Prevention
There are a few things you can do to reduce the risk or keep varicose veins from becoming more prominent, swollen and distorted:

Try and avoid standing or sitting for long periods.

Take breaks from an office job to get up and move around.

When you're driving for long periods, get out of the vehicle and stretch your legs.

If you work in a 'standing' profession, such as teaching or retail sales, stretch and exercise your legs as often as possible to increase circulation and reduce pressure build-up.