Veins are blood vessels, which are a part of the circulatory system. Arteries and arterioles carry oxygenated blood to the body tissue and the heart. Veins and venules carry deoxygenated blood back to the heart. Normally, 90% of venous blood should be carried up to the heart through the deep venous system. The remaining 10% is returned superficially through veins just beneath the skin. Since these superficial veins have less supporting tissue than deep veins, they are more likely to become varicose.
Varicose veins, which affect around 10% to 15% of men and 20% to 25% of women, are a benign arteriovenous disorder that is closely related to cosmetic concerns. Although the treatment of varicose veins has seen a recent increase in effectiveness, the best form of treatment will always be prevention. Although the precise cause of varicose veins is still debated, our understanding of the pathophysiology of venous reflux has grown immensely over the years.
What are varicose veins?
Other ways to say this: – Saphenous veins, which usually cause varicose veins in the legs, are a group of large superficial veins that travel a long distance, giving plenty of opportunity for them to become varicose. – The cause is essentially vein wall weakness and vessel dilation in settings of increased intra-luminal pressure.
Varicose veins are enlarged, swollen, and twisting veins, usually appearing dark purple or blue in colour. The condition is most common in women and occurs in up to 15% of men. In general, a vein is any blood vessel that takes blood towards the heart. Most veins in the legs have one-way valves to help keep blood flowing towards the heart. If the walls of the vein become stretched and less flexible, the valves may become incompetent. When this happens, blood can flow backwards and pool in the leg veins. This high pressure of the pooled blood can cause the vein to stretch and bulge near the surface of the skin, becoming what we call a varicose vein.
Causes and risk factors
Varicose vein occur when vein walls and the valves that control blood flow weaken and can no longer support the backflow of blood. The blood pools in the legs and exerts pressure, which causes the veins to dilate and stretch. The exact reasons for this are not completely understood, but there are many factors which can make it more likely that you will develop varicose veins. There are a number of genetic factors which affect the strength and elasticity of your vein walls. If these are weak, then varicose veins are more likely. Age increases the risk of developing varicose veins. As we get older, our veins lose their elasticity, which can cause them to stretch. Women are also more likely to develop varicose veins. This is because female hormones can affect vein walls. During pregnancy, the blood volume in the body is increased, but the flow of blood from the legs to the pelvis decreases. This change is designed to support the growing fetus, but it has the side effect of increasing the pressure in leg veins, which can cause varicose veins. Being overweight also increases the risk of varicose veins because the body has to carry the excess weight, and this puts additional pressure on the veins. This can also be said for people who have to stand for long periods in their job. This can cause the veins to dilate as they work for longer to pump blood up to the heart.
Symptoms and complications
The nature and severity of symptoms can vary significantly, independent of the size or presence of varicose and spider veins. There are substantial differences in symptoms among patients with superficial varicose veins or incompetent leg veins in general and those with combined superficial and deep vein incompetence. Common symptoms of varicose veins include leg pain, aching or cramping, fatigue, leg or ankle swelling, itching or burning, restless legs, and night cramps. Early on, especially with internal varicose veins, there may be no symptoms. In few cases, patients will not relate their symptoms to underlying vein disease because the only recognizable symptoms are skin changes or a chronic ulcer. If specific leg symptoms are not elicited, they will not improve post vein treatment, and patients may attribute their more general leg symptoms to other conditions and may undergo a thorough but unnecessary neurological or rheumatological assessment.
Vein Anatomy
The veins are part of a complex system of conduits that carry blood. The arteries deliver oxygen-rich blood to the body’s tissues, and the veins return oxygen-low blood to the heart for re-oxygenation. The veins themselves act as blood-storage reservoirs. Approximately 70-80% of the body’s blood is stored in the veins at rest, and during exercise or in times of stress, the body has the ability to increase the amount of blood flow to the heart and muscles by constricting the veins. This is accomplished with the aid of special protein receptors in the vein walls. Stimulated by higher adrenaline levels, these receptors cause the vein walls to contract and, in some instances, depending on the nature of the specific receptors, to even dilate, allowing a greater volume of blood to flow to the heart via the deeper veins. The excess blood will then be readily available for the muscles should the need for it arise. This is done by further dilation and constriction of veins in the muscle groups, which force the blood into the small perforator veins that pass through the vein walls to the deep veins. The increased blood flow within the veins is what causes varicose veins to develop.
Structure and function of veins
There are two types of blood vessels: the arteries, which carry oxygen-rich blood from the heart to the rest of the body, and the veins, which carry the now oxygen-poor blood back to the heart. If you can imagine your body as a city in which the circulatory system is the transportation system, the heart would be the central train station, the arteries would be the highways leading out of the city, and the veins would be the back-roads leading back to the central station. This metaphor can be carried even further in that the further you get from the central station, the worse the roads become. This can be likened to the fact that the deeper veins are located beneath the surface of the skin.
Blood plays the vital role of carrying essential nutrients to the organs and tissues of our body. Likewise, waste products are carried away from these tissues and organs by the circulatory system in order to maintain a healthy environment within our bodies. The circulatory system includes the heart, which pumps the blood, and a complex system of blood vessels, which serve as roads for the blood to travel.
Overview of the circulatory system
Arteries are blood vessels that carry blood away from the heart. As the left heart ventricle contracts to pump the blood into the body, it goes through the aorta, which is the largest artery in the body. The aorta has another two major arteries that come off at right angles to it: the carotid arteries supplying the head, and the subclavian and innominate supplying the arms. As the aorta moves down towards the legs, it eventually divides into the common iliac arteries, which then divide into the internal and external iliac arteries. The external iliac artery then becomes the femoral artery, and so major arteries keep branching into smaller and smaller arteries as they deliver blood to all the different parts of the body. High pressure is needed to force blood to distal body parts, so arteries have thick muscle walls and elastic tissue, which allows them to recoil and snap back. This is significant in terms of the development of varicose veins because if the valves in the veins are damaged and the blood begins to flow backwards, the veins will be subjected to higher pressure than normal and become distended.
The circulatory system is responsible for getting oxygen and nutrients from other parts of the body and carrying carbon dioxide, metabolic waste products, and other compounds to the appropriate places for excretion. The components of the circulatory system are the heart, blood, and blood vessels. The heart pumps blood coming from the lungs and going to the lungs. This means the right side of the heart pumps blood to the lungs, and the left side pumps blood to the other tissues of the body. The blood can be thought of as a fluid that fills both the heart and blood vessels. It is contained within a closed system of tubes that begin and end at the heart. These tubes are the blood vessels, and the fluid that fills them is blood.
Structure and function of veins
Veins are blood vessels that carry blood to the heart. The blood in the heart is depleted of oxygen and nutrients and filled with waste. When the waste is taken out of the blood and replaced with nutrition and oxygen in the capillaries, the blood needs to get back to the heart. This is where the veins come in. There are three kinds of veins: superficial veins, deep veins, and perforating veins. Superficial veins are the veins just under the skin, which are connected by many tiny veins called spider veins. This is commonly where varicose veins occur. The deep veins are surrounded by muscle and are usually less visible. Perforating veins are the veins that connect the superficial veins to the deep veins. Usually, the blood in the veins only flows one way, back to the heart. To ensure this, veins have valves that act as one-way flaps to prevent blood from flowing in the wrong direction. The veins are responsible for taking blood from all areas of the body to the heart; therefore, they need to withstand various pressure and conditions. For this reason, veins are very elastic, allowing them to widen and narrow. When veins become dilated from increased pressure, or in the case of varicose veins, the elasticity of the veins is lost. Veins also contain a large portion of blood volume in the body, as much as 70%. This is known as the venous reserve. Due to this large volume and their blood pooling function, veins are a good place to draw blood or administer IVs, as most health professionals and former varicose vein treatment patients are all too aware!
Differences between normal veins and varicose veins
Varicose veins are tortuous dilated veins due to abnormally high pressure in the saphenous vein and are filled with a pooling of blood. They develop when the vein walls and/or the valves in the veins become weak, causing blood to pool in the leg. Symptoms can include pain in the legs, fatigue easily, leg swelling, or in severe cases, ulcers or blood clots. This condition occurs more frequently in women who have a genetic predisposition and often worsens with prolonged standing.
Normal veins and varicose veins may look similar in terms of their outward appearance, but they are significant in terms of how they function in the circulatory system. This is due to the defect in the valves within the saphenous veins that leads to high venous pressure. A normal vein functions as a blood vessel returning blood to the heart. Veins have one-way valves that prevent the blood from flowing backwards. These valves open as blood flows towards the heart and close to prevent backflow. This mechanism forces the blood to flow in stages to the high-pressure system of the lungs and heart. If the fluid column becomes too heavy in the veins (as in standing) and the vein dilates, the valves cannot meet properly and the last valve in the segment must stay closed to prevent backflow. This has been termed the “valve lock”. The capillary then feeds its blood into a distal vein, and since this segment is now lower pressure, the vein valve dilates. This process goes on until a vein segment becomes a varicose vein in a process known as “reflux”.
Varicose Vein Diagnosis and Treatment
Pre-treatment duplex mapping is advisable for patients undergoing any form of sclerotherapy or surgery. Follow-up studies are important in demonstrating the success of treatment and in detecting recurrent or residual reflux. This is essential in the current climate of high patient expectation of good results from varicose vein treatment and of increasing litigation.
A recent advance in duplex imaging is the use of ultrasound and colour Doppler to quantify the severity of superficial reflux and to measure the response of calf muscle contraction to assess the competence of perforator veins in the pathophysiology of venous ulceration. This is still a specialist area and the techniques are not yet widely available. Magnetic resonance imaging is another method of full venous mapping but is expensive and the quality of images is influenced by operator and patient factors. Venous phlebography is now used only selectively before surgical treatment of recurrent varicose veins or in certain other complex diagnostic situations because it is an invasive investigation and has potential risks of contrast allergy and deep vein thrombosis.
Clinical history and examination are important in planning the management of patients with varicose veins but are unreliable in identifying the site and extent of venous reflux. The key questions are whether the superficial veins are connected to a site of saphenous junction or saphenous trunk reflux and whether there is perforator reflux. Colour duplex ultrasound is the only accurate imaging investigation. Veins should be scanned while the patient is upright, preferably by a vascular technologist who has been specially trained in venous ultrasound, using equipment that is suitable for imaging superficial veins (10 MHz or 7 MHz linear array transducer) and that has colour and pulsed wave Doppler capabilities. In expert hands, ultrasonography can demonstrate the site and extent of venous reflux and map out key sites for potential surgery or injection sclerotherapy.
Diagnostic tests for varicose veins
A Doppler test may be carried out to see how well your leg veins are functioning. This is a special test which checks the direction of blood flow in your veins. You will be asked to stand up so that the blood pressure in your leg veins can be checked when they are most stretched and most likely to cause problems. The test also checks for any clots in your veins which may be causing the varicose veins and discoloration in your skin. A color flow Duplex Ultrasound scan may also be used to obtain detailed images of your leg veins. This type of scan is non-invasive and does not involve the use of radiation. A series of elastic-compression stockings can be used either alone or following an operation or injection for varicose veins. These stockings are designed to squeeze your legs firmly. This helps to improve blood flow in your legs and should reduce any swelling. It is important to wear the correct size which can be purchased at most pharmacies. More simple methods of management can be to elevate your legs and massage regularly to reduce pain and swelling.
Non-surgical treatment options
Endovenous laser techniques have become widely used for varicose vein treatment. Using ultrasound to map the vein, a thin catheter is inserted into the vein through a small entry point, usually around the knee. A laser fiber is then passed through the catheter. Normally, local anesthetic is applied to the area, but in some cases, a general anesthetic may be used. The laser is then fired up, causing the vein to close as the fiber is slowly pulled out. This method is most effective for killing the veins and has a relatively low side effect rate. The catheter is moved in a pull-push manner, effectively closing the vein as the phlebologist moves the entire length of the catheter. The procedure is primarily used on the great saphenous vein, and the procedure takes around an hour to 90 minutes. Once the procedure is completed, the leg is then bandaged. The patient then needs to wear class 1 compression stockings for 2 weeks, and for the first 3 days following the procedure, it is important to go for a short walk, preferably walking a total of around 40 to 60 minutes for each 24-hour period. This is important as it reduces the risk of deep vein thrombosis. A medical review of endovenous methods has shown that endovenous methods are highly effective for the treatment of the great saphenous vein. The RECOVERY trial showed that endovenous treatment was more effective than surgery for small saphenous vein reflux and has a faster recovery time for both small and great saphenous veins. Tumescent laser has now become the main endovenous treatment method, despite the above-described procedure and its relative effectiveness. Tumescentless endovenous methods exist; however, it is thought that they carry a higher risk of DVT and nerve damage due to the reduced effect of the cushion of tumescent.
Compression stockings are often the first treatment in patients with varicose veins. The pressure they apply to the skin surface helps counteract the distending effects of blood in the veins and prevents the pooling of blood associated with varicose veins. Minor varicose veins and spider veins are easily treatable with sclerotherapy. This is a technique whereby a sclerosing agent is injected into the vein. The injection of the solution causes the vein to collapse and fade from view. The body then reabsorbs the treated vein. Treated veins generally fade within a few weeks, although occasionally it may take up to a month to see the full results. Most patients can expect a 50-90% improvement.
Surgical procedures for varicose veins
Vein stripping is the common surgical procedure used to correct skin ulcers, varicose veins, and other related problems. Minimally invasive surgical techniques are being utilized, frequently in the presence of ultrasound, to allow accurate placement of special elastic or chemical irritant to close the vein. The Venefit procedure is a minimally invasive treatment that utilizes radiofrequency. After applying a local anesthetic to the vein, the physician inserts a catheter to provide radiofrequency energy to the vein wall, causing it to heat, collapse, and seal shut. The VNUS closure procedure is used similarly but uses temperature-controlled radiofrequency. Ambulatory phlebectomy is an outpatient surgical procedure for the removal of surface varicose veins. It is a minimally invasive procedure, and the patient is allowed to return to normal activity the following day. Using a local anesthetic, tiny incisions are made in the skin in which a phlebectomy hook is used to remove the varicose vein. This vein is collapsed while the hook is utilized to minimize bleeding, bruising, and discomfort. Stitches or tape are not necessary as the incisions are very small, and scarring is at a minimum. Both legs are treated in one to three sessions, and each session lasts thirty minutes to two hours. This procedure is effective in removing superficial varicose veins but does not treat existing reflux or prevent the development of future varicosities in the saphenous veins.
Prevention and Lifestyle Tips
Sitting and standing for long periods, crossing your legs, and wearing tight clothes constrict veins. The blood that must be pumped back to the heart is forced to remain in the legs, overloading the veins. It is advisable to avoid long periods of sitting or standing and to take regular breaks to elevate and stretch your legs. Try to alternate resting and movement. Regular exercise is the single most important factor in improving vein health and preventing varicose veins. Exercise enhances the tone and strength of the muscle pump and the elasticity of the veins. It also improves lymph flow. Good exercises for vein health are walking, cycling, swimming, and exercises that work the calf muscles. Walking is one of the best exercises because it yields a continuous muscle pumping action. Other exercises are also effective if they are done regularly. If you have not been exercising, you should start slowly. Check with your doctor about what exercises would be good for you. Wear supportive athletic shoes as much as possible during exercises. This way, the feet, ankles, and legs are cushioned and both the calf muscle and foot pump are enhanced. Avoid high-impact sports which primarily involve vigorous up and down movement, such as basketball. This type of activity tends to overwork the vein.
Lifestyle changes to prevent varicose veins
It is widely believed that varicose veins are primarily caused by prolonged standing. Although this is not the sole cause, it is agreed that this does exacerbate the condition. It is likely that genetic influence, in combination with prolonged standing, works as a catalyst for the development of varicose veins. In understanding this, it is logical to deduce that preventing prolonged standing should in turn prevent furthering the condition of varicose veins. This communicates an important issue as regards workplace health and safety. For those with a genetic predisposition to developing varicose veins, special accommodations should be made to help prevent the progression of this condition. This will also help to prevent its development in those who are not already affected. Measures may be as simple as making seats available to staff, reducing the time spent on feet. For those who have increased risk factors, job rotation with colleagues to help reduce individual periods of standing or more demanding work may be beneficial. In instances where work posture cannot be altered, regular short breaks to rest and elevate the legs may be effective. Thank you, your payment can be identified, and this will be packaged under MH095180 on your next statement. If you have any further inquiry, please contact us quoting the number provided above.
Exercises and activities to improve vein health
Exercise is the miracle cure noted in the British Heart Foundation publication number 44. In terms of chronic venous disease, exercise has been shown to improve calf muscle pump efficiency, have a positive effect on the endothelial lining of venous walls, and significantly improve quality of life. Those suffering from venous symptoms should always seek advice from a qualified healthcare practitioner before embarking on an exercise regime. Exercise should be tailored to an individual’s fitness level, age, general health, and the severity of their condition. Low-impact, non-weight bearing exercise is recommended, particularly if the patient is obese or has additional joint problems. The most effective form of exercise therapy for those with venous symptoms is daily walking. This does not need to be excessive, and the patient should rest if symptoms worsen. Cycling and swimming are also beneficial as the leg muscles are activated in a similar way during walking. Step aerobics or activities that involve a great deal of stop-start action should be avoided as this can increase the pressure in the veins. If the patient has access to a hydrotherapy pool, the pressure of the water can help to reduce swelling in the ankles and improve skin texture. This can be achieved by walking up and down or performing a few simple exercises.
Tips for managing varicose veins during pregnancy
– When sitting, avoid crossing your legs. – Elevate your legs when resting as much as possible. – Sleep on your left side to avoid pressure on the vena cava, the major vein on the right side of the body. – Exercise daily. This will help improve your circulation and prevent constipation (a condition that also puts added pressure on your veins). Activities such as walking or swimming are effective in preventing varicose veins. This is because they work the calf muscles, which help to move blood more efficiently through the veins. – Wear maternity support hose. This compresses your veins and prevents blood from pooling. For maximum effectiveness, put the support hose on before you get out of bed in the morning.
During pregnancy, your hormone levels rise and this can cause the vein walls to weaken, making varicose veins form or worsen. The good news is that they often improve after delivery. Here are a few tips to prevent varicose veins during pregnancy or to ease the discomfort if you’re already experiencing them: