HYDERABAD: Varicose veins are those little purple veins that suddenly seem to appear on the legs, if you are above forty years of age. Veins are the soft, thin walled tubes that return blood from the arms and legs to the heart. Because veins work against the force of gravity, they have valves that allow forward blood flow but not reverse. Your legs and arms have two major types of veins: superficial and deep. The superficial veins are near the surface of the skin and are often visible. The deep veins are located near the bones and are surrounded by muscle. Connecting the deep and superficial veins is a third type of vein, the perforator vein. Contraction of the muscles in the arms and legs with exercise helps blood flow in the veins.
Varicose veins are enlarged, bulging superficial veins that can be felt beneath the skin, generally larger than 3mm in diameter. They are usually located in the inside of the calf or thigh and develop due to weakness of the vein valve and loss of valve function. Under the pressure of gravity, they continue to enlarge, and in the course of time, they may become elongated, twisted, pouched and thickened.
Spider veins are tiny dilated veins, usually less than 1mm in diameter, located at the surface skin layers. Spider veins cannot be felt. Veins larger than the spider veins, but still under 3mm are called reticular veins.
Symptoms: Varicose veins may be entirely symptom-free and cause no health problems. Treatment in such cases is often for cosmetic purposes. When symptomatic, varicose veins may cause ankle and leg swelling, heahiness or tension, aching, restlessness, cramps and itching. Varicose veins are more often symptomtic in women than in men. Signs of chronic venous disease include skin pigmentation, and loss of the soft texture of the skin and underlying tissue in the ankle area (called induration). Itching is perhaps the most consistent symptom of varicose vein, along with complaints of leg heaviness, tension and aching legs.
Causes : The causes of varicose veins may be primary, secondary or congenital. Primary varicose veins develop as a result of an inherent weakness in the wall of the vein. Varicose veins can have a hereditary factor and often occur in several members of the same family. Varicose veins that develop after trauma or deep vein thrombosis are of secondary cause. Congenital varicose veins are due to disorders in the natural development of the venous system, ane are usually part of a vascular malformation in the limb, present at birth. No matter the cause, defective venous valves may cause venous blood to stagnate in the leg, leading to increased pressure in the veins. This may result in further enlargement of the varicose veins, increasing the likelihood of symptoms, and causung complications such as skin changes and ulcer formation. Blocking of the pelvic veins may severely aggravate the efects of varicose veins, requiring a separate treatment.
The most important factors leading to the development of varicose veins include:
■ heredity (family history of varicose veins)
■ prolonged standing or sitting
■ increasing age
■ multiple pregnancies
■ deep vein thrombosis
Less physical activity and obesity also contribute to higher incidence of varicose veins in many individuals.
Diagnosis : The diagnosis of varicose veins is made primarily by physical examination. The accuracy of physical examination is improved with the aid of a hand-held Doppler instrument, which allows the examiner to listen to the blood flow. The most accurate and detailed test is a duplex ultrasound exam, which provides an ultrasound image of the vein to detect any blockage caused by blood clots and to determine whether the vein valves are working properly Most often patients complain of heaviness of legs, leg swelling and pain. Often they consult their family physician, whereas a vascular surgeon would be an ideal choice for correct diagnosis and treatment. Sometimes skin discolouration occurs and patients often consult a deramtologist, thinking it to be a skin problem, whereas the underlying problem is chronic venous insuffuciency. For symptoms like leg swelling, skin discolouration, heaviness of legs, non healing leg ulcers a Vascular Surgeon is an ideal choice for correct diagnosis and treatment.
Initial treatment options for varicose veins Lifestyle changes are suggested for patients with varicose veins.
■ maintaining the proper weight
■ elevating legs when resting
■ avoid standing or sitting for long duration
■ wearing compression stockings regularly This is the mainstay of treatment.
Additional treatments for varicose veins ; Sclerotherapy is the sealing of the veins via an injection of a sclerosant. This procedure is mainly done for smaller veins and is performed in the doctor’s office.
Prevention : You can’t do anything about your heredity, age or gender. However, you can help delay the development of varicose veins or keep them from progressing.
■ Be active. Moving leg muscles keep the blood flowing.
■ Keep your blood pressure under control.
■ To temporarily relieve symptoms, lie down and raise your legs at least six inches above the level of your heart. Do this for ten minutes a few times each day.
■ Maintain a normal weight.
■ Wear prescription compression stockings as specified by your doctor.
■ See a qualified vascular surgeon who can diagnose the cause of your varicose veins, the sources of venous reflux in your legs and offer a variety of treatment options
(The author is a Sr consultant - peripheral vascular surgeon, Apollo Hospitals)