Varicose Veins causes and treatment

Overview

Veins, with the exception of the pulmonary vein, are blood vessels responsible for transporting deoxygenated blood from various parts of the body back to the heart. As your organs utilise oxygenated blood for their respective functions, they expel the used blood, now containing waste products like carbon dioxide, into the veins. This blood is transported to the heart and then the lungs, where carbon dioxide is expelled, and oxygen is replenished for circulation to the body via the arteries.

The size and location of veins influence their dimensions and functions. The largest veins are centrally located within the body and serve as channels for collecting blood from smaller veins and directing it toward the heart. Branches of these veins become progressively smaller as they extend outward from the body's centre. Superficial veins lie closer to the skin's surface, while deep veins are located near the body's centre. Connecting these two types are perforating veins, which link superficial veins to deep veins.

What are varicose and spider veins?

Veins can enlarge and accumulate blood when they fail to circulate it efficiently. These swollen, prominent veins are known as varicose veins and often appear in the legs and thighs, although they can develop elsewhere on the body. Large varicose veins are visible, bulging, and palpable, with diameters exceeding 4 millimetres.

Spider veins, on the other hand, are smaller and typically not palpable. They may manifest as short, delicate lines, starburst-shaped clusters, or intricate, web-like patterns on the skin's surface. These are most common on the thighs, ankles, feet, and occasionally the face. Medically referred to as telangiectasias, spider veins are aesthetically different but may co-exist with varicose veins.

What causes varicose and spider veins?

The precise causes of varicose and spider veins remain unclear. In some cases, deficiencies or malfunctions in vein valves result in inadequate blood circulation, leading to varicose veins. Normally, vein valves prevent blood from flowing backwards, ensuring proper circulation towards the heart. These valves are found primarily in perforating and some deep veins.

Additionally, weaknesses in vein walls may cause blood pooling and result in varicose veins. Weak vessel walls may become incompetent, causing blood to accumulate and expand the veins. Since varicose veins are more prevalent in the legs, gravity and an upright posture are likely contributing factors. Chronic straining, such as during bowel movements due to constipation, can cause varicose veins near the anus, known as haemorrhoids.

In less common cases, varicose veins are associated with conditions such as:

• Phlebitis (inflammation of the veins)
• Blood clots or obstructions in veins
• Congenital vein abnormalities

While venous diseases often progress and cannot always be prevented, wearing support hosiery, ensuring and maintaining a healthy weight, and engaging in regular physical activity can help mitigate risks.

Who is at risk of developing varicose and spider veins?

Both men and women can develop varicose and spider veins at any age, although they are more prevalent in women of childbearing age and older individuals. Approximately 10%–15% of men and most older women are estimated to have varicose or spider veins.

Risk factors include:

• A family history of varicose veins
• Advancing age
• A sedentary lifestyle
• Obesity
• Prolonged sitting or standing
• Pregnancy

Symptoms of Varicose Veins

While varicose veins often present itself as a cosmetic concern, they may sometimes lead to physical symptoms such as:

• Aching and cramping
• Swelling, redness, or itching, often below the knee
• Fatigue in the legs
• A sensation of dull ache or pressure

Less common and more severe symptoms include:

• Bleeding
• Thrombophlebitis (blood clot formation in a varicose vein)
• Skin ulceration
• Oozing or dermatitis (weeping dermatitis or stasis dermatitis)

In advanced cases, scarred skin and fibrotic changes may occur, resembling an inverted "hourglass" (lipodermatosclerosis).

These symptoms should be assessed promptly by a doctor.

Diagnosis by medical professionals

Varicose veins are typically diagnosed through a physical examination, during which the doctor will inquire about family history, symptoms, and worsening of the veins. A general assessment of height, weight, and underlying conditions is also carried out. In some cases, the veins' appearance is assessed after standing for 5–10 minutes to enhance visibility. Additional diagnostic tools such as duplex ultrasound, may help evaluate vein structure and function.

Treatment Options

The treatment of varicose veins depends on the severity and size of the affected veins. Options can range from self-care methods to surgical procedures.

Varicose and spider veins can be addressed with a range of treatments, including:

• Leg elevation
• Compression stockings or bandages
• Sclerotherapy (injecting a solution to shrink the vein)
• Ablation techniques using laser or radiofrequency
• Surgery (phlebectomy or vein stripping)

Treatments may vary depending on vein size, location, and associated complications, such as swelling or skin changes.

Prognosis and Recurrence

Despite treatment, varicose veins may recur due to the progressive nature of venous disease. The treatment method, accuracy of diagnosis, and expertise of the medical professional significantly influence recurrence rates. Unfortunately, no method guarantees permanent results, and the appearance of new veins over time remains a possibility.

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