Varicose Veins

What are varicose veins?

In some individuals, the superficial veins of the legs can become big and prominent. These unsightly veins are usually seen on the thigh and legs and are cosmetically unappealing. These superficial veins normally move the blood from the legs up to the abdomen. However, when they become enlarged and thick, they are unable to carry out this function and as a result blood remains within the veins. With time the veins become engorged with blood and become visible. Varicose veins are more common in females. They usually become prominent in the 2/3 decade of life and are most common in females with multiple pregnancies.

What is the fate of varicose veins?

Once varicose veins develop, they never disappear. In most cases, they actually worsen with time. The majority of individuals who have varicose veins will complain of swelling in their feet, generalized leg aches and itchiness around the leg. All individuals will admit that the veins appear dark, bluish and present an unacceptable cosmetic appearance. In all cases, the varicose veins will continue to progress and become larger if treatment is not undertaken. Spontaneous resolution of varicose vein is rare.

What is the cause of varicose veins?

In most veins of the body are valves which prevent backflow of blood. When the valves in the veins are defective or destroyed, the blood starts to pool in the veins. Over time, the veins become engorged with blood and the blood starts to flow in a backward fashion. The valves may be destroyed by blood clots, trauma or become weaker due to certain hormones (female sex hormone-estrogen)

Which individuals are prone to varicose veins?

Varicose veins are more common in:

- pregnancy

- obese individuals

- after prolonged standing

- trauma

What are symptoms of varicose veins?

Varicose veins can present with numerous symptoms but not all individuals will be symptomatic. Some may complain of:

- cosmetically unattractive appearance

- heaviness in legs

- swelling of the feet

- itchiness

- throbbing legs

- cramps in the legs

- pain along the vein

- darkening of the skin around the ankles

How can varicose veins be diagnosed?

The diagnosis of varicose veins is straight forward. For those with large varicose veins, a simple examination will suffice. However, an ultrasound can rapidly assess the vein and the degree of blood backflow. The test can also determine if there are any blood clots in the veins.

How are varicose veins treated?

There are numerous methods of treating saphenous veins. Treatment depends on the surgeon and the degree of varicose veins. The methods of treatment include:

Vein ligation & stripping: 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.

Vein ligation & Stabs: 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 with small incisions. The procedure also requires surgery and anesthesia. Since the vein is not removed, it may be utilized in future for a heart bypass.

Ultrasound guided: This method utilizes 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. Only a small amount of local anesthesia is required

Can Varicose veins recur?

Yes, despite the best surgery and technique, a few branches of the vein may persist and re-develop into varicosities. These recurrences can be easily treated with small surgical incisions.

Can laser be used to treat Varicose veins?

No, varicose veins are large and not suitable for laser. Laser therapy is only suitable for the more superficial spider veins

What are complications of untreated varicose veins?

In most individuals, varicose veins are of no great concern. However, in some individuals the varicose veins can cause:

- 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

How does one prevent varicose veins?

There is no cure for varicose veins and thus prevention is the best treatment. Preventive measures should include:

Graded compression stockings worn daily can prevent the development of varicose veins

Resting and elevating the leg at the end of the day helps to prevent varicose veins

Avoid prolonged periods of standing

One should not cross the legs when lying down

Does insurance cover varicose vein surgery?

If one has documented symptoms such as an ulcer, pain, swelling of the legs or skin discoloration, some insurance companies may cover the cost of surgery. In most cases, the surgery is done for cosmetic reasons and most insurance plans do not cover the cost. The cost of treating varicose veins depends on the procedure and varies from $ 200-500.