Varicose veins

Reviewed by Dr John Pillinger, GP

What is the difference between veins and arteries?

The heart pumps blood through the arteries to all parts of the body - the vital organs, the head, arms and legs. The blood is then spread through tiny vessels called capillaries which form a network . Later it is returned in increasingly large vessels - veins - which complete the circulation of blood back to the heart.

The arteries are rather thick and elastic and their size constantly changes due to the fluctuating pressure which varies with the heartbeat.

The veins, on the other hand, have very thin walls and have no elastic fibres. They are therefore unable to contract and push the bloodflow onwards. The veins are completely dependent on the functions of the surrounding muscles and the valves inside the veins helping the blood to flow in the right direction towards the heart.

What are varicose veins?

Varicose veins are permanently dilated (widened) and twisted veins. Although this can occur in any part of the body, it usually develops in the legs.

Veins contain one-way valves every few inches to help the blood return to the heart against gravity. If these valves leak, then the increased pressure prevents the blood from draining properly. The valves may leak and fail because of previous vein disease, eg thrombophlebitis, pressure on the veins in the pelvis from pregnancy or other causes of raised pressure within the abdomen.

Varicose veins come on with advancing age and are often no great inconvenience apart from being unsightly.

Who develops varicose veins?

The risk of developing varicose veins increases with:

pregnancy

a family history of the condition

an occupation that involves prolonged periods of standing

menstruation - the symptoms worsen before and during menstruation.

How do I tell if I am developing varicose veins?

heaviness and tiredness in the legs particularly after standing.

they appear as enlarged, snake-like, blue veins and are most easily seen under the skin while standing.

they are most commonly seen in the back of the calf or on the inside of the leg between the ankle and the groin.

there may be a creeping sensation across the skin and possibly night-time cramps in the legs.

the legs may become swollen, sore and painful as the condition progresses. This is due to incomplete blood circulation (oedema or accumulation of fluid in the legs).

When do I seek help?

Help should be sought when varicose veins cause irritation during the day; if fluid accumulates in the legs; if working standing up causes discomfort; or the legs become agitated at night (and sleep is interrupted). In these cases consult a doctor about the possibility of receiving treatment.

How are varicose veins treated?

Frequent rest periods with the legs elevated.

In mild cases, lightweight elastic compression stockings should ease the discomfort but they will not remove the varicose veins.

A loss of weight, if obesity is a problem.

The injection of a sclerosing solution into the vein will close it.

If the conditions becomes more serious and the whole leg is affected by varicose veins, a complete removal of the vein from ankle to groin may be necessary (ligation and stripping).

If the varicose veins are allowed to worsen there is a risk of developing:

phlebitis (inflammation of the wall of the vein)

eczema

leg ulcers

deep vein thrombosis .

To avoid these complications, an operation may be required.

Surgery will be offered if there is:

pain.

phlebitis (inflammation of the wall of the vein).

skin changes, eg chronic eczema or recurrent ulceration leading to scarring and tightening of the skin.

for cosmetic improvement, small, localised 'spider veins' (idiopathic telangiectases) which may be extensive can be treated with injections using a needle with a very fine bore. Several treatments may be required before a satisfactory resolution is achieved. Laser treatment can also be effective for these small veins. For most cosmetic cases however, this treatment tends to be available privately rather than on the NHS. Your doctor will be able to advise you as to the situation in your area.

Can varicose veins develop in places other than the legs?

Varicose veins can develop, for example, in the oesophagus (gullet or food pipe), pelvis, uterus (womb), vagina and rectum (back passage). Haemorrhoids (piles) can be regarded as varicose veins around the anus.

The majority of people with varicose veins manage by using simple conservative treatment measures. Varicose veins are not a disease in themselves although they can cause daily irritation and worry. People with this problem should consult their GP to discuss whether treatment is necessary.

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