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. Varicose veins are more common in pregnant women and become more prominent during the 2nd trimester.
How common are varicose veins?
The majority of affected individuals are women and at least 50-60% of women suffer to some degree from varicose veins. Varicose veins commonly occur on the legs and thighs but may also occur in the vulva or vagina. Hemorrhoids and varicoceles are other examples of varicose veins.
Why are varicose veins common in pregnancy?
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.
In addition, during Pregnancy, there is a gain of weight and volume. Further the female sex hormones are thought to weaken the walls of the veins and make them lax- thus causing them to engorge with blood.
Where are varicose veins most common during pregnancy?
Varicose veins are generally more prominent in the legs but during late pregnancy, they may develop near the vulva or vagina. The major reason is that the female retains a lot of weight and fluid during pregnancy. In addition, the baby in utero may also compress some parts of the pelvis (lower abdomen) and lead to an engorgement of the veins in the vulva/vagina. If a female has varicose veins of the vulva during pregnancy, she will always have varicosities of the legs at the same time.
What generally happens to varicose veins during pregnancy?
Unfortunately, in the majority of cases, the varicose veins on the legs 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 leg veins become prominent, it is very unlikely that they will spontaneously resolve without any treatment. However, varicose veins on the vulva/vagina do get better once the baby has been delivered. The majority of women who do develop varicosity of the leg veins will retain these varicosities after pregnancy.
Who can get varicose veins during pregnancy?
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. In pregnancy, varicose veins have been linked to excess weight gain and fluids. Multiple pregnancies are also associated with varicose veins. In fact, with multiple pregnancies, the varicosities always worsen in size, shape and also symptoms.
What are symptoms of varicose veins?
Aside from being unattractive and very prominent, varicose veins of the legs cause swelling of the legs. As varicose veins progress, some females will develop discoloration at the ankles and prominent "rope like" veins along the thigh and lower leg.
How can varicose veins be diagnosed?
Varicose veins can usually be diagnosed by a simple physical examination. There is no other examination indicated. However, when the legs are involved with varicose veins, the use of Doppler ultrasound may be used to determine the presence of blood clots. 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.
What is treatment of varicose veins of the vulva?
There is no treatment required for vulvar/vaginal varicosities. Once the baby is delivered, the varicosities will subside. In rare instances, there may be a rope-like vein but this will soon disappear with time. For those with varicosities of the legs, the treatment is always delayed until the pregnancy is over.
Are varicose veins serious?
In the majority of cases, varicose veins are of a cosmetic nuisance. When the legs are involved, the following can 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
Do varicose veins develop clots?
Yes, but unlike the deep veins of the leg, the clots formed in the varicose veins rarely move to the lungs. The blood clots in varicose veins remain in one place and are often the cause of tenderness and itchiness. There is no need to take blood thinning medications when clots are found in the varicose veins.
Can one prevent varicose veins during pregnancy?
Unfortunately there is no cure for varicose veins but one can undertake preventive measures. The preventive measures may prevent the varicose veins or delay the worsening of existing varicose veins. The following may help to prevent varicose veins:
- If one starts early in pregnancy, varicose veins can be prevented. The major preventive measure is to exercise and walk.
- 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.
- Walk or exercise daily as this stimulates the muscles which can push the blood away from the leg.
- Control your weight -varicose veins are more common in obese individuals.
- When lying down, keep the legs elevated.
- Avoid tight clothing that can compress the waist or groin.
- Eat a low-salt diet (salt does have the ability to retain water).
What problems can occur if varicose veins are left untreated?
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 not 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.
Can varicose veins return after treatment?
Yes, unfortunately, there is no cure for this disease. Only complete stripping of the large superficial veins in the leg can completely remove the vein. In addition, the branches must also be removed otherwise recurrence will occur. When the large vein has been removed, only small spider veins can occur. To prevent recurrence of varicose veins, the best therapy is exercise and wearing compressible hose stocking.
Can varicose veins be treated with sclerotherapy?
There are various types of surgery procedures to treat varicose veins in the leg. These include:
- Surgical Ligation and Stripping: this is only done when the varicose veins are very large and unsightly; it does require anesthesia and 5-7 days to recover. It does have a few more complications than the other newer procedures.
- Ligation and stabs: In this procedure, the superficial vein is tied off in the groin under anesthesia and only the very large prominent varicosities in the leg and thigh are removed. Small 1 cm stabs are made on the skin under local anesthesia and the superficial veins are removed. Most patients can return to work in 2-3 days. The most common side effect is bruising.
Ultrasound Guided laser therapy: This is the latest procedure which involves burning the large vein in the thigh with a laser guided probe under ultrasound guidance. It only requires local anesthesia and is done as an outpatient. It only involves one small incision near the knee.
The best surgical procedure can only determined by your surgeon and his experience. Before one embarks on vein surgery, read about it and you will know what to expect.
Is Varicose Vein Surgery covered by insurance?
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 $300 - $600 depending on the type of procedure.