Varicose veins overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3]

Varicose veins are veins that have become enlarged and twisted. The term commonly refers to the veins on the leg, although varicose veins occur elsewhere. Veins have leaflet valves to prevent blood from flowing backwards (retrograde). Leg muscles pump the blood in veins to return it to the heart. When veins become enlarged, the leaflets of the valves no longer meet properly, and the valves don't work. A common cause of valve failure is Deep Vein Thrombosis (DVT), which can cause permanent damage to the valves. The blood collects in the veins and they enlarge even more. Varicose veins are common in the superficial veins of the legs, which are subject to high pressure when standing.

Varicose veins are more common in women than in men, and are linked with heredity.^[1] Other related factors are pregnancy, obesity, menopause, aging, prolonged standing, leg injury and abdominal straining. Varicose veins are bulging veins that are larger than spider veins, typically 3 mm or more in diameter.^[2] Varicose veins are distinguished from reticular veins (blue veins) and telangiectasias (spider veins) which also involve valvular insufficiency,^[3] by the size and location of the veins.

These often occur in people who are involved in work requiring prolonged periods of standing. The high pressure that builds up during those periods cause the veins to become tortuous and their valves to fail. With time, these varicosities can enlarge and cause swelling as well as pain of legs at the end of the day. Eventually, these can become associated with superficial ulcers which can bleed and/or get infected. Stagnation of the venous blood in these veins can also lead to formation of blood clots.

Serious complications are rare but severe varicosities can lead to major complications such as thrombophlebitis, venous ulcers & clotting of blood^[4], due to the poor circulation through the affected limb.

Besides cosmetic problems, varicose veins are often tortuous and painful, especially when standing or walking. They often itch, and scratching them can cause ulcers.

Non-surgical treatments include sclerotherapy, elastic stockings, elevating the legs, and exercise. The traditional surgical treatment has been vein stripping to remove the affected veins. Newer surgical treatments are less invasive (see radiofrequency ablation) and are slowly replacing traditional surgical treatments. Since most of the blood in the legs is returned by the deep veins, and the superficial veins only return about 10%, they can be removed or ablated without serious harm.^[5]

Several techniques have been performed for over a century, from the more invasive named "saphenous stripping" up to mini invasives like superficial phlectomies and CHIVA cure.

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