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 developing.

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 vein.

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 individual needs.

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 varicose veins.

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 University, Baltimore.

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 saphenous vein.

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.

REFERENCES:
Andrew Bradbury et al, “What Are the Symptoms of Varicose Veins?” British Medical Journal, February 6, 1999.
Rachel Franz, “Cosmetic Surgery News,” Dermatology Nursing, February 2000.
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 hosiery.
• 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 to heal.
• Phlebitis develops when varicose veins become inflamed.
• 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 condition.

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 1, 2000]

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, September 2000]

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]