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Varicose veins are abnormally enlarged superficial veins usually seen in the thigh and leg. In the majority of cases, these large superficial veins are of a cosmetic nuisance. These veins connect with the deep veins of the leg and play a minor role in the transfer of blood to the heart. The veins become more prominent in the 3-4 decade of life and are more common in females.
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In the majority of cases, the varicose veins worsen with time. The varicose veins start to become more prominent and swell. With time, the veins are engorged with blood and can cause localized pain and itching. Once the veins become prominent, it is very unlikely that they will spontaneously resolve without any treatment.
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The cause of varicose veins is unknown but is definitely linked to increase pressure in the veins. There are valves in the veins which prevent the back flow of blood back into the legs. When these valves become damaged/defective, the blood flows backwards and causes swelling and engorgement of the veins.
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Conditions that can cause destruction of the veins are pregnancy, obesity, prolonged standing and trauma. Varicose veins are more common in females and this has been linked to the sex hormone, estrogen.
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Aside from being unattractive, varicose veins may be responsible for leg aches, a feeling of heaviness or fatigue of the legs. The majority of individuals will complain of leg ache at the end of the day. Symptoms are often worse after prolonged standing and may include feelings of fatigue, heaviness, aching, burning, throbbing, itching, cramping, and restlessness of the legs.
With time, darkening or hyperpigmentation around the ankles is a classic feature of prolonged varicose veins. Hemorrhoids are analogous to varicose veins and involve engorgement of veins in the rectum. Varicose veins do not cause joint pains or a decrease in blood supply to the legs.
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Varicose veins can usually be diagnosed by a simple physical examination. However, the cause of the varicose vein requires the use of Doppler ultrasound. This painless test assesses the valve function in the groin and can also determine how much blood is flowing back into the legs. The test can also determine the presence of blood clots in the veins.
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There are many options in the treatment of varicose veins. If the saphenous vein is very “thick and rope like”, stripping may be the best option. This is a surgical procedure and the most invasive. If only the valve in the vein is defective, the vein can be tied off in the groin and the few superficial veins can be removed by small incisions. This also requires surgery and moderate amount of anesthesia. It preserves the vein for future use. The latest technology of varicose vein removal is using ultrasound with laser or radiofrequency ablation. In both techniques, the vein is burnt away. Both procedures are relatively painless and destroy the vein in the thigh.
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In the majority of cases, varicose veins are of a cosmetic nuisance. Varicose veins generally tend to get worse without any treatment. Those who do not get them treated are more likely to develop:
- constant itching
- pigmentation around the ankles
- ulcers at the ankles
- mild swelling of the feet
- occasional blood clots in the veins
- infection of the vein
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If one starts early in life, varicose veins can be prevented. The major preventive measure is to exercise and wear
compression stockings.
- Elevation of the legs at all times is also recommended.
- During pregnancy, one should always lie on the left side with the legs elevated on a pillow. This prevents the fetus from
pressing on the leg veins and decreases the chance of developing varicosities.
- One should avoid standing for prolonged periods.
- Don't cross your legs when sitting down.
- Wear elastic support stockings.
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Most people with varicose veins do not develop complications. It is impossible to predict who will develop complications.
The size of the varicose vein is no related to complications but the duration of the varicose vein is. Complications that may occur
include:
- Superficial thrombophlebitis – in this condition, the varicose vein is inflamed and tender. A clot is usually
present in the vein.
- Bleeding – even with minor trauma, the varicose vein may be associated with bleeding. Because the vein is under
high pressure, the bleeding can be quite profuse.
- Venous eczema – the skin round the vein may become dry and very itchy.
- Venous pigmentation - this is brown staining of the skin around the ankle. It is due to the leakage of small
amount of blood from the veins into the skin.
- Venous ulceration - ulcers at the ankle.
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Depends, if one has symptoms of leg swelling, pain, ulcers or clots, then all medical insurance and even Medicare covers the cost of surgery. However, if the surgery is done purely for cosmetic reasons, then the cost of the procedure is not covered. The average cost of varicose vein surgery per leg ranges from $200-$600 depending on the type of procedure.
