Treating varicose veins is not a matter of vanity.
They cause aching, tired legs and can be related to leg ulcers and more
serious circulatory problems.
For many women, pregnancy is the first time varicose
veins appear. They usually improve soon after the child is born.
In some women it looks like a toddler drew a road map on their legs in
blue ink For others the lines are raised up, creating a three-D image
of the Amazon River.
Although a young mother’s toddler may not be responsible for the
varicose veins that begin to appear on her legs, the hormonal changes
and extra weight associated with pregnancy may well play a role. By age
50, two thirds of American women have varicose veins, which are seen more
often in women than in men. They tend to run in families and experts think
that heredity and physical stress combine to increase the chances of veins
There are many treatment options for varicose veins, depending on the
cause and severity of the condition. Among the options for dealing with
the pain and embarrassment are sclerotherapy, laser treatment, radiofrequency
ablation and new surgical techniques that involve minimal scarring.
Varicose veins are essentially a mechanical problem. The heart pumps
blood throughout the body, sending it down the legs through arteries.
The veins are charged with carrying the long column of blood back up the
legs to the heart. The pumping action of the heart isn’t enough
to counteract gravity so two mechanisms combine to keep blood moving back
up the legs on its return trip: powerful contractions in the calf muscles;
and a system of one-way valves that stop the blood flowing backwards down
The valves in the long saphenous veins can become weak with age and stress,
however. When that happens, blood can flow back down again, pooling in
the blood vessels and causing the veins to bulge and widen. The distended
veins eventually become twisted and swollen.
Varicose veins can actually develop anywhere in the body but tend to
show up most often in the legs, which hold one third of the blood circulating
in the body at any given time.
Visible symptoms of varicose veins are bluish-grey lines seen through
the skin or as raised lines on the skin surface. More severe cases can
have a ropey, twisted look or appear as grape-like clusters.
Other symptoms include a heavy, aching sensation and cramping, especially
after standing for long periods of time. Swelling, itching and a tingling
sensations are also common.
A number of factors increase the risk of developing varicose veins.
- Pregnancy is often the first time veins cause problems for many women.
The problem may improve after the baby is born, but will probably get
worse with the next pregnancy. During pregnancy both body weight and
blood volume increase, creating additional pressure on the veins in
the legs. Hormone changes are also believed to affect the development
of varicose veins.
- Having an occupation that requires standing for long periods. Cooks
dentists, hairdressers, sales assistants and people in many other professions
spend long hours on their feet but without a lot of movement.
- Being overweight. Losing weight can help relieve pressure on the legs.
- Excessive exposure to heat. Heat causes veins to expand and trap
more blood, setting the stage for varicose veins. Hot tubs, whirlpool
baths, heated floors, sitting near a heat source and working in overheated
rooms can all add to the problem.
- Some types of sporting activities. Although most forms of exercise
such as walking, jogging, tennis, dancing and swimming help prevent
vein problems some athletic activities such as stair stepping, weight
lifting and mountain biking increase pressure on the veins in the legs.
Making Veins Disappear
Physicians have many options for treating varicose veins. The choice often
depends on the severity and cause of the problem. It’s important
that patients are carefully evaluated so treatment can be tailored to
In some cases varicose veins may present a primarily cosmetic problem.
In others they may be a symptom of a more severe underlying circulatory
condition that should be addressed by a vascular specialist. A wide range
of physicians treat varicose veins including general physicians, vascular
surgeons, plastic surgeons and dermatologists.
Compression hosiery can be used to prevent
varicose veins in high-risk groups such as pregnant women and to treat
mild cases. They work by exerting the greatest pressure on the ankle,
with gradually diminishing pressure on the lower leg and thigh. This helps
with blood flow and reduces the pooling of blood in the lower legs. They
provide support, reduce the aching and tiredness associated with varicose
veins and also lower the risk of leg ulcers, a possible complication of
Sclerotherapy is used for smaller varicose
veins and for spider veins, also known as telangiectasia. A fine needle
is used to inject a chemical solution into the veins. The chemical causes
the vein to collapse and eventually disappear. The procedure can be done
in a doctor’s office and doesn’t require an anesthetic. Patients
feel only a slight burning when the chemical is injected. Often several
sessions are needed to treat the veins.
The most common complication of sclerotherapy is hyperpigmentation, the
appearance of brownish patches on the skin near the injection site.
Ambulatory Phlebectomy involves making
a series of tiny incisions along the length of the vein and gently removing
the vein in sections using a hook. The procedure can be done on an outpatient
basis and can be used for both large and small veins.
Radiofrequency ablation, also called
the closure technique, has been used with success in Europe and is now
offered at some clinics in the United States, including Johns Hopkins
The minimally invasive procedure involves using a catheter to introduce
an electrode into the saphenous vein. The energy from the electrode shrinks
and seals off the vein. Nearby healthy veins take over the job of carrying
blood from the legs.
The patient can usually get up and walk minutes after the outpatient
procedure is completed. This technique works best in patients with large
saphenous veins that are relatively straight.
Laser surgery uses a high intensity laser beam to selectively destroy
some types of varicose veins in the leg and spider veins in the face.
Newer lasers that penetrate the skin using wavelengths just beyond visible
light pose a lower risk of burning the skin.
Surgical ligation and stripping is a
procedure normally performed under anesthetic by a vascular surgeon. It
involves either tying off or removing the blood vessel, usually the long
Varicose veins may be a cosmetic concern, but treating them is not a
matter of being vain. They cause aching, tired legs, and can be related
to leg ulcers and more serious circulatory problems in the legs. If you’re
bothered by varicose veins make an appointment with your doctor to see
if you need a diagnosis by a specialist and for suggestions about ways
to treat the problem and improve your circulation.
Andrew Bradbury et al, “What Are the Symptoms
of Varicose Veins?” British Medical Journal, February 6, 1999.
Rachel Franz, “Cosmetic Surgery News,” Dermatology Nursing,
Erik Goldman, “Radiofrequency Ablation Alleviates Leg Varicosities,”
Family Practice News, October 1, 1999.
Nick London and Roddy Nash, “Varicose Veins,” British Medical
Journal, May 20, 2000.
Bonnie Marting, “Understanding Sclerotherapy,” Plastic Surgical
Nursing, Winter 2000.
“Pros and Cons of Nonsurgical Therapy for Varicose Veins, “
Consultant, January 2001.
“Treatments for Spider and Varicose Veins,” Pamphlet by :
American Society for Dermatologic Surgery, June 1, 2000.
Preventing Varicose Veins
There are a number of steps you can take if you suffer from tired and
aching legs that might be an early symptom of varicose veins.
- Wear compression hosiery. Many pregnant women benefit from compression
hosiery. The extra support helps their bodies deal with the extra weight
and blood volume of pregnancy. Older adults often benefit from compression
- Get regular exercise. Walking, jogging, playing tennis, gardening
and dancing are all activities that keep leg muscles pumping.
- Avoid sitting with your legs crossed. It impedes circulation It’s
okay to cross your legs at the ankles.
- If your legs are tired and swollen after hours of standing, lie down
and put your feet up, higher than the level of your head to encourage
good blood drainage from the ankles.
[SOURCE: Sarah Purcell, “Show A Leg,”
Chemist and Druggist, November 25, 2000]
Veins Have Long History In Western Cultures
Despite the fact that varicose veins are rarely seen among many African
peoples they’re hardly an artefact of modern industrialized society.
As early as the fourth century B.C., the Greek physician Hippocrates was
interested in varicose veins and possible methods for their removal “with
a slender instrument of iron.”
Scientists theorize that varicose veins are seen less often in Africa
because of the high fiber diet common to many African peoples and the
fact that it is more common for people to sit or squat on the ground,
rather than sitting in chairs as is more common in Western countries.
[SOURCE: Bonnie Marting, “Understanding
Sclerotherapy,” Plastic Surgical Nursing, winter 2000.]
Complications of Varicose Veins
Varicose veins can make legs feel tired and achy. They may also cause
cosmetic problems making some women reluctant to wear shorts or swimsuits.
But when severe, varicose veins can lead to more serious problems.
- Skin ulcers develop as a result of poor
circulation. They occur on the skin surface and can often be difficult
- Phlebitis develops when varicose veins
- Thrombophlebitis is a more serious condition
that occurs when a blood clot develops in the inflamed area. It is important
to identify and treat blood clots promptly.
[SOURCE: Nick London and Roddy Nash, “Varicose
Veins,” British Medical Journal, May 20,2000]
Age Increases Vein Risk
Forty-one percent of women between the ages of 40 and 50 suffer from varicose
veins. Men aged 40 have a 24 percent chance of having varicose veins.
By age 70, 72 percent of women and 4 percent of men have developed the
For most individuals, varicose veins cause discomfort and a cosmetic
problem. For some, however, the poor circulation associated with the condition
causes ulcers and blood clots. It is estimated that up to 100,000 persons
in the United States are totally disabled by serious complications arising
from varicose veins.
[SOURCE: “Treatment for Spider and Varicose
Veins,” Pamphlet: American Society for Dermatologic Surgery, June
Keep Those Legs Moving
The couch potato syndrome–being overweight and spending too much
time sitting–can contribute to developing varicose veins. Exercise
can prevent or help relieve poor circulation and muscle tone that contribute
to the problem.
Brisk walking, cycling, rowing, swimming and Nordic track are all good
forms of exercise. Strength and resistance training are also good.
Women who already have problems with varicose veins should avoid wearing
exercise clothes that constrict the groin area and upper legs. If you
wear compression hosiery for varicose veins at other times, they will
probably also help when exercising. Compression hose exert more pressure
on the lower part of the leg than on the upper area, helping with blood
flow back to the heart.
[SOURCE: Harvard Women’s Health Watch,
Pregnancy and Varicose Veins
Varicose veins are rarely seen in women under age 25, except in those
who have already borne children. The risk of developing veins is greatly
increased by pregnancy, and the more pregnancies a woman has, the greater
her likelihood of developing veins.
Varicose veins develop because of hormonal changes plus the extra weight
and the added blood volume during pregnancy. Estrogen causes blood vessels
to dilate so varicose veins are often seen in women in the early stages
of pregnancy, before weight and blood volume have significantly increased.
The veins will probably resolve after pregnancy. Wearing compression hosiery
may be the only treatment needed.
[SOURCE: Nancy Risser and Mary Murphy, “Varicose
Vein Prevention,” The Nurse Practitioner, September 2000]