What you should know about ‘varicose veins’

The term ‘varicose’ is derived from the Greek word for ‘grape-like’. Varicose veins are dilated blood vessels that are visible and at times can be felt.  They are usually present along the legs, more common in females and can lead to major distress.  The veins can first appear as thin greenish streaks and increase in size and in some cases reach a few centimetres in diameter. Up to 50% of patients may have some signs and symptoms of pulling feeling, pain, itchiness, swelling at the ankles, eczema, spider veins next to the big varicose veins and change in colour around the veins.

1.What treatments are available?
The newest treatment method for varicose veins, is the use of an Endovenous radio-frequency machine. A probe is inserted inside the vein and a radio-frequency signal is sent, which leads to sclerosis of the venous walls. There are various laser probes that can also be used with equal success.  This procedure can be carried out under general or even local anaesthetic. This treatment is quite expensive and the success rate is not far superior to sclerotherapy.
Sclerotherapy  for varicose veins using various substances has been present for many years.  During the turn of the 20thcentury, Linser reported many successful treatments using per-chloride of mercury injected in the veins. His method had to be abandoned due to the development of mercury intoxication in a few patients. Since then, the method has been refined and various safer intravenous substances are used.
Phlebectomy is a surgical procedure for treating varicose veins.  It is the most common treatment performed in third world countries which entails the removal of the varicose veins by tying them at the origin and stripping the smaller veins by making small incisions along the leg. Anaesthesia is required.  This treatment is starting to become obsolete as newer methods, which are less painful, less invasive, and cheaper are more accessible now.
All treatments for varicose veins carry comparable success. Once somebody has varicose veins, recurrence is common and re-treatment with sclerotherapy is easy.

2. Causes of varicose veins
There are various theories as to the cause of varicose veins, the main one being genetic factors. Other causes could be female gender, use of oral contraceptives, pregnancy occupation-commoner in people who stand for long hours, obesity and deep vein thrombosis, to name a few.   Rarer causes include vein wall weakness, incompetent perforating veins, secondary valvular incompetence, arterio-venous communication and phlebitis.

3. How are varicose veins formed?
Veins carry blood back to the heart and those in the legs consist of two systems, the deep and the superficial venous networks. The deep system carries the bulk of the blood back to the heart, whilst the superficial system acts more as a reservoir. However, any resistance to the flow of the venous blood from the deep system increases the pressure on the superficial veins and with time they get dilated and result in varicosities. Basically there is a complex anatomy of veins in the legs, consisting of the longest vein in the body, called the long saphenous vein, the lesser saphenous vein, perforating veins and many unnamed superficial veins.

4. How are varicose veins diagnosed?
Varicose veins are superficially visible below the skin of the limbs and do not require any special diagnostic methods. They can even be felt on palpation with our hands.  In few cases, one can use a doppler ultrasound to locate the origin of the venous incompetence, however, this does not add any value to the diagnosis of varicose veins. X-rays and scans are of no value.

5. Do they carry any risk factors?
In most people, varicose veins do not produce any symptoms. They are more of a cosmetic concern.  Some do however become symptomatic where patients can have pain, night cramps, leg fatigue, swelling of the ankles and a feeling of heaviness. Rarely, one can have discoloration along the varicose veins, eczema along the veins, bleeding and ulceration from trauma to the superficial dilated veins. Some may even develop a superficial thrombo-phlebitis which is an inflammation along  the veins and can be very painful.

6. Who is more at risk of varicose vein formation?
As discussed before, heredity can play a big role in the formation of varicose veins. Incompetent valves in leg veins tend to be inherited.  Varicose veins are much more common in females and they tend to suffer from symptoms mainly on the first few days of their menstrual cycle.  These veins are more prevalent post- adolescence and in the fourth and fifth decades of life.  Apart from genetic factors, obesity; use of contraceptives; and occupations which entails long hours of standing, can increase the chance of developing these dilated veins.

7. Can one prevent varicose veins from forming?
Eating healthy, maintaining a good body mass index and regular exercise can limit the formation of varicose veins. However, once the veins appear dilated, they need to be treated. In early cases, graded elastic stockings, worn for the whole day, can increase circulation of blood and decrease the progression.  Hereditary causes cannot be prevented.