Reviewed by Brian R. Robinson, MDVaricose veins are distended, visible, superficial veins on the legs. In most cases, incompetent valves within the venous system of the leg cause them. When one or more of these valves fails to function correctly, or leaks, some blood flows back down into the leg, in the wrong direction.
In normally functioning veins, there are valves that work like trap doors, closing completely at periodic intervals to prevent the backflow of blood. In patients with varicose veins (also called varicosities), valves are damaged or do not work properly, the blood tends to flow backwards and overfill veins. It also distends branches of superficial veins under the skin. Over time, this additional pressure of blood causes the veins to stretch, bulge, and become visible. At the same time, tiny capillary branches of the veins also overfill with blood and produce multiple spider veins and purple discoloration.Leaky venous valves can occur anywhere in the leg, but faulty valves in the groin or behind the knee cause most varicose veins. Both these sites act as a major junction at which superficial veins (those subject to varicose veins) flow into the important deep veins of the leg, with a one-way valve to control flow at the junction. Some people may inherit a weakness of these valves; obesity and pregnancy may also cause valves stretch and leak.
Varicosities resulting from congenitally defective valves may develop early in life. Thrombophlebitis may also lead to the formation of varicose veins by destroying venous valves and causing venous obstruction. Pregnancy, abdominal tumor, excessive weight or height, and prolonged weight bearing are all considered accelerating factors because they cause increased pressure on the legs.
Varicose veins are considered very common and appear in about 30% of women and 20% of men.
Common symptoms of varicose veins include aching, throbbing, stinging, burning, and a feeling of fullness or bloating in the legs. In severe cases, where varicose veins are caused by more severe underlying venous insufficiency, varicose ulcers may also result. There is an increased risk of clotting in patients with varicose veins, and in some cases, this leads to clots forming, them breaking down into smaller clots, which in turn form blockages known as emboli (the singular is embolism) in smaller arteries in the lungs, heart, or brain. Emboli in these regions can represent a life-threatening medical situation.
Treatment for varicose veins depends on the severity of the condition.In the case of mild varicosities that cause little or no discomfort or other symptoms, treatment is mostly conservative and preventative in nature. Compression tights or stockings to increase flow from the extremities and decrease blood pooling are often used at this point; maintaining an active lifestyle full of exercises that promote good circulation is also a key component of prevention and conservative treatment.
If varicose veins become larger and more problematic, surgery is an option. There are a number of surgical techniques for patients and their health care practitioners to consider: phlebectomy, or vein stripping, removes whole sections of vein, while other surgical treatments include laser treatments and sclerotherapy, involves use of a corrosive substance called a sclerosant to collapse veins so that the body can reabsorb them and route blood elsewhere.
The best therapy depends on a number of factors, and consultation between patient and doctor is the best way to come to a safe and healthy decision.
