Varicose veins are abnormally enlarged, twisted blood vessels with valves that do not function properly. Veins channel blood back to the heart using a series of one-way valves. When the valves in the vein fail to open or close completely the blood is not circulated properly and tends to 'pool'. This creates increased pressure and stretches the vein, causing abnormally enlarged, twisted blood vessels which appear under the skin as blue, bumpy, rope-like veins which are varicose veins.
What are spider veins?
Spider veins or Telangiectasias are small, thin dilated veins that lie close to the surface of the skin. (Varicose veins form beneath the skin.) Though they are connected to the larger venous system, they are not an essential part of it because they do not carry blood to the heart. They do not enlarge to become varicose veins but can cause significant symptoms despite their small size.
What are the symptoms of varicose and spider veins?
Varicose veins develop gradually and progressively. They are unsightly and are often a source of considerable discomfort. The symptoms can include:
Leg pain: aching, heaviness, fatigue, tenderness
Leg cramps, particularly at night
Skin discoloration at the ankle
Skin ulcers above the ankle
Symptoms often become worse during the menstrual cycle and pregnancy.
What causes varicose veins?
Many factors contribute to the development of varicose veins.
Heredity: predisposes one to most medical conditions
Gender: women are affected almost four times more than men, though the number is not certain because men do not seek treatment as often as women
Pregnancy: As many as 70 to 80% of pregnant women develop varicose veins during the first trimester. Pregnancy causes an increase in blood volume, but it is hormonal changes that cause the veins to enlarge. Elevated levels of progesterone, which the body produces to stabilize the uterus, allow veins to dilate. Later, the uterus enlarges and causes increased pressure on the veins in the pelvic area. Fortunately, 60 to 80% of varicose veins that develop during pregnancy disappear a few months after delivery.
Occupation & Activities: people who spend a great deal of time on their feet are much more likely to develop varicose veins and their symptoms. Workers such as teachers, flight attendants, nurses, waitresses, and salesclerks experience more symptoms and greater discomfort than people of the same age who work in more sedentary occupations.
Age: Varicose veins and spider veins occur at any stage of life but they worsen with advancing age. They occasionally develop in childhood.
Obesity is related to varicose veins but no one knows why
Progesterone, but not birth control pills or hormone replacements
Are varicose veins preventable?
Varicose veins are not preventable. However, there are things one can do to ease mild symptoms. The following suggestions can give welcome, but temporary, relief:
Exercise: Strengthening the leg muscles helps to push the blood back to the heart. The following are recommended:
Maintaining ideal body weight
Elevating the legs eases discomfort
Wearing graduated elastic support hose, as recommended by your physician
What happens to untreated varicose veins?
One of the few things we are certain about is that varicose and spider veins will not disappear by themselves. The effects of faulty valves and the pressure of gravity continue to work on the veins, causing them to stretch further and to become more extensive.
The changes in the size and number of varicose and spider veins are difficult to predict. They vary greatly from patient to patient. Some varicose veins do not change but recent studies indicate that 20% of untreated varicose veins worsen and become leg ulcers, which are painful and difficult to heal. Therefore, it is important to pay attention to symptoms and to have a thorough clinical evaluation.
How is vein disease diagnosed?
For the great majority of patients, a simple visual examination by an experienced physician may be all that is necessary to establish the presence and, therefore, the treatment of varicose and spider veins. The clinical examination is often confirmed with a hand-held Doppler, which detects the backward flow of blood (reflux).
Vein problems can be much more complicated than other circulatory conditions. In some complex cases, it is difficult to ascertain the exact anatomy and the site of abnormal veins. In such situations, a detailed examination using a sophisticated Duplex Doppler ultrasound scanner is done to 'map' the blood flow and characterize the vessels. This scan produces a detailed 'roadmap' of both superficial and deep veins in the leg. The Duplex Doppler is totally non-invasive: no needles, drugs, or x-rays are used. It is an outpatient test that can be performed either in a medical office or in a vascular laboratory.