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Varicose Veins

Varicose veins

Definition

Varicose veins are dilated, tortuous, elongated superficial veins that appear most often in the legs.

Description

Varicose veins, also called varicosities, are seen most often in the legs, although they can be found in other parts of the body. Most often, they appear as lumpy, winding vessels just below the surface of the skin. There are three types of veins: superficial veins that are just beneath the surface of the skin; deep veins that are large blood vessels found deep inside the muscles; and perforator veins that connect the superficial veins to the deep veins. The superficial veins are the blood vessels most often affected by this condition and are the veins that are visible when the varicose condition has developed.

The inside walls of veins have valves that open and close in response to the blood flow. When the left ventricle of the heart pushes blood out into the aorta, it produces the high pressure pulse of the heartbeat and pushes blood throughout the body. Between heartbeats, there is a period of low blood pressure. During this period blood in the veins is affected by gravity and wants to flow downward. The valves in the veins prevent this from happening. Varicose veins start when one or more valves fail to close. The blood pressure in that section of vein increases, causing additional valves to fail. This allows blood to pool and stretch the veins, further weakening the walls of the veins. The walls of the affected veins lose their elasticity in response to increased blood pressure. As the vessels weaken, more and more valves are unable to close properly. The veins become larger and wider over time and begin to appear as lumpy, winding chains underneath the skin. Varicosities can also develop in the deep veins. Varicose veins in the superficial veins are called primary varicosities, while varicose veins in the deep veins are called secondary varicosities.

Causes & symptoms

Varicose veins have a number of different causes; lifestyle and hormonal factors play a role. Some families seem to have a higher incidence of varicose veins, indicating that there may be a genetic component to this disease. Varicose veins are progressive; as one section of a vein weakens, it causes increased pressure on adjacent sections of the vein. These sections often develop varicosities. Varicose veins can appear following pregnancy , thrombophlebitis, congenital blood vessel weakness, or obesity , but they are not limited to these conditions. Edema of the surrounding tissue, ankles, and calves is not usually a complication of primary (superficial) varicose veins. When edema develops, it usually indicates that the deep veins may have varicosities or clots.

Varicose veins are a common problem. More than 80 million Americans experience the symptoms and complications of varicose veins, including 10%15% of men and 20%25% of women. The symptoms can include aching, pain , itchiness, or burning sensations, especially when standing. In some cases, with chronically bad veins, there may be a brownish discoloration of the skin or ulcers (open sores) near the ankles. A condition that is frequently associated with varicose veins is spider-burst veins. Spider-burst veins are very small veins that are enlarged. They may be caused by back-pressure from varicose veins, but can be caused by other factors. They are frequently associated with pregnancy and there may be hormonal factors associated with their development. They are primarily of cosmetic concern and do not present any medical concerns.

Diagnosis

Varicose veins can usually be seen. In cases where varicose veins are suspected, a physician may frequently detect them by palpation (pressing with the fingers). The physician will examine the veins while the patient is first in a standing position and a second time while the patient is lying down. X rays or ultrasound tests can detect varicose veins in the deep and perforator veins and rule out blood clots in the deep veins. A handheld Doppler instrument is now the preferred diagnostic tool for evaluating the leg veins.

Treatment

There is no cure for varicose veins. Treatment falls into two classes: relief of symptoms and removal of the affected veins. Symptom relief includes such measures as wearing support stockings, which compress the veins and hold them in place. This pressure keeps the veins from stretching and limits pain. Other measures include sitting down, using a footstool to support the feet when sitting, avoid standing for long periods of time, and raising the legs whenever possible. These measures work by reducing the blood pressure in leg veins. Prolonged standing allows the blood to collect under high pressure in the varicose veins. Exercise such as walking, biking, and swimming, is beneficial. When the legs are active, the leg muscles help pump the blood in the veins. This limits the amount of blood that collects in the varicose veins and reduces some of the symptoms but does not stop the disease.

Herbal therapy can be helpful in the treatment of varicose veins. Essential oils of cypress and geranium or extracts from horse chestnut seeds (Aesculus hippocastanum ) are massaged into the legs, stroking upwards toward the heart. Application to broken skin and massage directly on the varicose veins should be avoided. Horse chestnut may also be taken orally and biothavenoids are used to increase vascular stability. In late 2001 a new product derived from aescinate, a chemical found in horse chestnut, was approved by the Food and Drug Administration (FDA) for topical use in the treatment of varicose and spider veins. The new product, sold under the name of Essaven gel, reduces edema. It can be applied underneath support hosiery if desired.

Drinking fresh fruit juices, particularly those of dark colored berries (cherries, blackberries, and blueberries) can help tone and strengthen the vein walls. The enzyme bromelain , found in pineapple juice, can aid in the prevention of blood clots associated with the pooling of blood in the legs.

Deep breathing exercises performed while lying down with the legs elevated can assist gravity in circulating blood from the legs. The flow of fresh blood into the legs can help relieve any pain.

Allopathic treatment

Surgery can be used to remove varicose veins from the body. It is recommended for varicose veins that are causing pain or are very unsightly, and when hemorrhaging or recurrent thrombosis appear. Surgery involves making an incision through the skin at both ends of the section of vein being removed. A flexible wire is inserted through one end and extended to the other. The wire is then withdrawn, pulling the vein out with it. This is called "stripping" and is the most common method to remove superficial varicose veins. As long as the deeper veins are still functioning properly, a person can live without some of the superficial veins. Because of this, stripped varicose veins are not replaced.

Injection therapy is an alternate therapy used to seal varicose veins. This prevents blood from entering the sealed sections of the vein. The veins remain in the body, but no longer carry blood. This procedure can be performed on an out-patient basis and does not require anesthesia. It is frequently used if people develop more varicose veins after surgery to remove the larger varicose veins and to seal spider-burst veins for people concerned about cosmetic appearance. Injection therapy is also called sclerotherapy. At one time, a method of injection therapy was used that did not have a good success rate. Veins did not seal properly and blood clots formed. Modern injection therapy is improved and has a much higher success rate.

Two new allopathic treatments have been developed since 1999 that are much less invasive than stripping the veins. One is called radio frequency closure, or the closure technique. In radio frequency closure, the surgeon inserts a catheter into the varicose vein through a small puncture. The catheter is used to deliver radio frequency energy to the wall of the vein, which causes the vein to contract and seal itself shut. The nearby veins then take over the flow of venous blood from the legs.

The second new treatment is called the endovascular laser procedure. The doctor uses a diode laser wire or fiber that is inserted directly into the vein. Energy transmitted from a laser heats the varicose vein and seals it shut. The patient can go back to work the next day, although a support stocking must be worn for two weeks after the laser procedure.

Expected results

Untreated varicose veins become increasingly large and more obvious with time. Surgical stripping of varicose veins is successful for most patients. Most do not develop new, large varicose veins following surgery. Surgery does not decrease a person's tendency to develop varicose veins. Varicose veins may develop in other locations after stripping.

Prevention

While genetic factors play a significant role in the development of varicose veins, swimming and other exercises to increase circulation in the legs help to prevent varicose veins. Preventive measures are especially important during pregnancy, when the additional weight of the fetus and placenta can exert pressure on the mother's legs and feet.

Resources

BOOKS

Alexander, R.W., R. C. Schlant, and V. Fuster, eds. The Heart, 9th ed. New York: McGraw-Hill, 1998.

Berkow, Robert, ed. Merck Manual of Medical Information. Whitehouse Station, NJ: Merck Research Laboratories, 1997.

Larsen, D.E., ed. Mayo Clinic Family Health Book. New York: William Morrow and Company, Inc., 1996.

PERIODICALS

Altizer, James W. "Varicose Veins: A Primary Care Update." Patient Care 35 (October 30, 2001): 33.

Belcaro, G., A. N. Nicolaides, G. Geroulakis, et al. "Essaven Gel: Review of Experimental and Clinical Data." Angiology 52 (December 2001): S1-S4.

"New Noninvasive Procedures Treat Leg Veins Problems." Medical Devices & Surgical Technology Week (December 9, 2001): 16.

Kathleen D. Wright

Rebecca J. Frey, PhD

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Varicose Veins

Varicose Veins

Definition

Varicose veins are dilated, tortuous, elongated superficial veins that are usually seen in the legs.

Description

Varicose veins, also called varicosities, are seen most often in the legs, although they can be found in other parts of the body. Most often, they appear as lumpy, winding vessels just below the surface of the skin. There are three types of veins, superficial veins that are just beneath the surface of the skin, deep veins that are large blood vessels found deep inside muscles, and perforator veins that connect the superficial veins to the deep veins. The superficial veins are the blood vessels most often affected by varicose veins and are the veins seen by eye when the varicose condition has developed.

The inside wall of veins have valves that open and close in response to the blood flow. When the left ventricle of the heart pushes blood out into the aorta, it produces the high pressure pulse of the heartbeat and pushes blood throughout the body. Between heartbeats, there is a period of low blood pressure. During the low pressure period, blood in the veins is affected by gravity and wants to flow downward. The valves in the veins prevent this from happening. Varicose veins start when one or more valves fail to close. The blood pressure in that section of vein increases, causing additional valves to fail. This allows blood to pool and stretch the veins, further weakening the walls of the veins. The walls of the affected veins lose their elasticity in response to increased blood pressure. As the vessels weaken, more and more valves are unable to close properly. The veins become larger and wider over time and begin to appear as lumpy, winding chains underneath the skin. Varicose veins can develop in the deep veins also. Varicose veins in the superficial veins are called primary varicosities, while varicose veins in the deep veins are called secondary varicosities.

Causes and symptoms

The predisposing causes of varicose veins are multiple, and lifestyle and hormonal factors play a role. Some families seem to have a higher incidence of varicose veins, indicating that there may be a genetic component to this disease. Varicose veins are progressive; as one section of the veins weakens, it causes increased pressure on adjacent sections of veins. These sections often develop varicosities. Varicose veins can appear following pregnancy, thrombophlebitis, congenital blood vessel weakness, or obesity, but is not limited to these conditions. Edema of the surrounding tissue, ankles, and calves, is not usually a complication of primary (superficial) varicose veins and, when seen, usually indicates that the deep veins may have varicosities or clots.

Varicose veins are a common problem; approximately 15% of the adult population in the United States have varicose veins. Women have a much higher incidence of this disease than men. The symptoms can include aching, pain, itchiness, or burning sensations, especially when standing. In some cases, with chronically bad veins, there may be a brownish discoloration of the skin or ulcers (open sores) near the ankles. A condition that is frequently associated with varicose veins is spider-burst veins. Spider-burst veins are very small veins that are enlarged. They may be caused by back-pressure from varicose veins, but can be caused by other factors. They are frequently associated with pregnancy and there may be hormonal factors associated with their development. They are primarily of cosmetic concern and do not present any medical concerns.

KEY TERMS

Congenital Existing at or before birth; a condition that developed while the fetus was in utero or as a consequence of the birth process.

Edema Swelling caused by a collection of fluid in a tissue or body cavity.

Hemorrhage Bleeding from blood vessels.

Palpation The process of examining a patient by touch.

Diagnosis

Varicose veins can usually be seen. In cases where varicose veins are suspected, but can not be seen, a physician may frequently detect them by palpation (pressing with the fingers). X rays or ultrasound tests can detect varicose veins in the deep and perforator veins and rule out blood clots in the deep veins.

Treatment

There is no cure for varicose veins. Treatment falls into two classes; relief of symptoms and removal of the affected veins. Symptom relief includes such measures as wearing support stockings, which compress the veins and hold them in place. This keeps the veins from stretching and limits pain. Other measures are sitting down, using a footstool when sitting, avoiding standing for long periods of time, and raising the legs whenever possible. These measures work by reducing the blood pressure in leg veins. Prolonged standing allows the blood to collect under high pressure in the varicose veins. Exercise such as walking, biking, and swimming, is beneficial. When the legs are active, the leg muscles help pump the blood in the veins. This limits the amount of blood that collects in the varicose veins and reduces some of the symptoms. These measures reduce symptoms, but do not stop the disease.

Surgery is used to remove varicose veins from the body. It is recommended for varicose veins that are causing pain or are very unsightly, and when hemorrhaging or recurrent thrombosis appear. Surgery involves making an incision through the skin at both ends of the section of vein being removed. A flexible wire is inserted through one end and extended to the other. The wire is then withdrawn, pulling the vein out with it. This is called "stripping" and is the most common method to remove superficial varicose veins. As long as the deeper veins are still functioning properly, a person can live without some of the superficial veins. Because of this, stripped varicose veins are not replaced.

Injection therapy is an alternate therapy used to seal varicose veins. This prevents blood from entering the sealed sections of the vein. The veins remain in the body, but no longer carry blood. This procedure can be performed on an out-patient basis and does not require anesthesia. It is frequently used if people develop more varicose veins after surgery to remove the larger varicose veins and to seal spider-burst veins for people concerned about cosmetic appearance. Injection therapy is also called sclerotherapy. At one time, a method of injection therapy was used that did not have a good success rate. Veins did not seal properly and blood clots formed. Modern injection therapy is improved and has a much higher success rate.

Prognosis

Untreated varicose veins become increasingly large and more obvious with time. Surgical stripping of varicose veins is successful for most patients. Most do not develop new, large varicose veins following surgery. Surgery does not decrease a person's tendency to develop varicose veins. Varicose veins may develop in other locations after stripping.

Resources

BOOKS

Alexander, R. W., R. C. Schlant, and V. Fuster, editors. The Heart. 9th ed. New York: McGraw-Hill, 1998.

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varicose veins

varicose veins A varix or varicosity is an irregularity or lumpiness. In the body, this means irregularities caused by dilated and distorted veins.

Veins in the legs have valves which normally prevent any backflow of the blood on its way towards the heart. The pressure of the blood tending to distend these veins is greater than in veins elsewhere simply because, for most of most people's waking hours, they are lower than the rest of the body, and vertical. This can put a considerable strain on the valves, each of which supports the column of blood immediately above it, between it and the next valve further up. In ideal normal circumstances the blood is kept moving upwards effectively because of persistent squeezing of veins by actively contracting muscles as we walk about, as well as by other mechanisms which tend continually to draw the blood towards the chest. The superficial veins just under the skin benefit less directly than the deep ones from leg movements — but because they connect to the deep veins, squeezing by the muscles helps to siphon blood from those near the surface, as well as ‘milking’ it up the deep ones.

Thus gravity does not normally cause an accumulation of weighty blood in our lowest parts, as it would in, say, a liquid-filled bicycle inner tube suspended vertically. But there are less than ideal circumstances which cause relative stagnation, particularly in the superficial unsupported veins; blood then leans more heavily on the valves, and in some cases these become damaged and develop leaks. This can occur if there is an obstruction to blood flow up from the legs (such as a heavily pregnant uterus pressing on the veins in the pelvic cavity) and the problem is exacerbated by sitting or standing still. As for many bodily dysfunctions, there is no doubt a combination of innate propensity (weak veins and valves) and risk factors (flow obstruction and immobility). The leakage of valves in turn leads to the irregular bulges on the veins which are known as varicosities, along with enlargement and distortion. The sluggishness imposed on the circulation to the skin and underlying tissues by back pressure from these veins predisposes to discomfort, ulceration, and oedema.

Applying pressure by support stockings to keep the varicose veins from filling is the first line of treatment. But the veins which are affected are fortunately usually dispensible: if they are removed, blood can flow through alternative deeper channels. Effective surgical treatment involves making cuts only at the top and the bottom of the offending vein, which is then removed by using a ‘stripper’. From the top end (say at the knee) a thin flexible rod is passed down the vein to the far end (say at the ankle). The vein is tied around the rod, which has a knob on its end. Pulling from the top then causes the knob to draw the whole length of the vein up before it, ‘crumpling’ it as it comes. Thus the vein is pulled by the stripper from under the skin and out through the upper incision.

A similar problem can occur at other sites. In the lower end of the oesophagus, ‘varices’ may result from back pressure associated with liver disease. In the scrotum a ‘varicocoele’ is a swelling of the veins around the testis. Haemorrhoids represent a comparable condition of the anal veins.

Sheila Jennett


See also blood circulation; blood vessels.

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varicose vein

varicose vein, superficial vessel that is abnormally lengthened, twisted, or dilated, seen most often on the legs and thighs. Varicose veins develop spontaneously, and are usually attributed to a hereditary weakness of the vein; the valves in the vein that keep the blood circulating upward toward the heart are usually incompetent. Increased pressure from long standing or exertion, or internal factors such as pregnancy, or lessened support by the tissues surrounding the veins that occurs with aging and obesity causes the weakened veins to dilate. Mild varicosities often cause no discomfort. Persons with more severe cases may develop swelling of the legs, ankles, and feet, and local eczema or ulcers. Mild varicosities may be treated with rest, elevation of the legs, and the use of elastic bandages or stockings. In severe cases surgical treatment may be necessary. Traditional surgery involves tying off and removing a vein segment. Varicose veins may now also be treated without removing them through an endoscopic surgical procedure that uses the heat produced by radio waves or a laser to seal off the veins. Varicose veins that occur around the rectum are called hemorrhoids, and those that form in the scrotum are called varicoceles.

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Varicose Veins

Varicose Veins

What Are Veins and Arteries?

Where Do People Get Varicose Veins?

What Is the Treatment for Varicose Veins?

Resource

Varicose veins are veins that become stretched, enlarged, or twisted. They can often be seen on the legs, just below the surface of the skin, and they may give legs a lumpy appearance.

KEYWORDS

for searching the Internet and other reference sources

Circulatory system

Vascular system

What Are Veins and Arteries?

The body has two systems for carrying blood to and from all its cells, tissues, and organs. Arteries carry blood from the heart to the organs, and veins return blood back to the heart. Although veins and arteries are similar in structure, veins usually carry blood with less oxygen than arteries do, and vein walls are thinner and weaker than arterial walls. When veins become injured or empty, they sometimes dilate* or collapse and become varicose*.

* dilate
(DY-late) means to become enlarged or stretched beyond the usual boundaries.
* varix
, varices, varicose are the Latin words that describe veins, arteries, or lymph vessels that have become stretched or enlarged.

Where Do People Get Varicose Veins?

Varicose veins develop on the inside areas of the leg or on the back of the calf. The veins look bluish in color and may become swollen, which gives the leg a lumpy appearance. About 15 percent of adults in the United States develop varicose veins. Women sometimes develop varicose veins during pregnancy and develop them more often than men do. There is a tendency for varicose veins to run in families.

What Is the Treatment for Varicose Veins?

Many people with varicose veins have no symptoms, but some people feel pain in their legs, especially when they stand for long periods of time.

Mild cases

In mild cases, doctors usually suggest that people with varicose veins exercise to improve circulation and that they wear support hose or stockings around the swollen veins to help relieve pain. People with varicose veins are usually told to sit with their feet up as often as possible and to avoid standing for prolonged periods of time.

Severe cases

When people have more severe cases of varicose veins, doctors sometimes inject a solution into the vein to block it. The body then reroutes the blocked veins blood supply to nearby veins that are healthier. Sometimes doctors strip varicose veins, which means they remove them surgically. This process takes about 30 minutes and is often quite successful.

Resource

The U.S. National Institutes of Health (NIH) has a search engine at its website that locates information about varicose veins at the U.S. National Heart, Lung, and Blood Institute (NHLBI) and elsewhere. http://www.nih.gov

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varicose veins

varicose veins (va-ri-kohs) pl. n. veins that are distended, lengthened, and tortuous. The superficial veins of the legs are most commonly affected; other sites include the oesophagus (see oesophageal varices) and testes (see varicocele). There is an inherited tendency to varicose veins but obstruction to blood flow is responsible in some cases. Treatment includes elastic support and sclerotherapy, but stripping, excision, or laser treatment is required in some cases. Medical name: varices.

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varicose veins

varicose veins Condition where a vein becomes swollen and distorted. Varicose veins can occur anywhere in the body, but are commonly found in the legs.

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Varicose Veins

Varicose Veins

Definition

Varicose veins are dilated, tortuous, elongated superficial veins that are usually seen in the legs.

Description

Varicose veins, also called varicosities, are seen most often in the legs, although they can be found in other parts of the body. Most often, they appear as lumpy, winding vessels just below the surface of the skin. There are three types of veins: superficial veins that are just beneath the surface of the skin, deep veins that are large blood vessels found deep inside muscles, and perforator veins that connect the superficial and deep veins. The superficial veins are the blood vessels most often affected by varicose veins and are the veins first seen when the varicose condition has developed.

The inside walls of veins have valves that open and close in response to blood flow. When the left ventricle of the heart pushes blood out into the aorta, it produces the high pressure pulse of a heartbeat and pushes blood throughout the body. Between heartbeats, there is a period of low blood pressure. During the low pressure period, blood in the veins is affected by gravity and tends to flow backward. The valves in the veins prevent this from happening. Varicose veins start when one or more valves fail to close. The blood pressure in that section of vein increases, causing additional valves to fail. This allows blood to pool and stretch the veins, further weakening the walls of the veins. The walls of the affected veins lose their elasticity in response to increased blood pressure. As the vessels weaken, more and more valves are unable to close properly. The veins become larger and wider over time and begin to appear as lumpy, winding chains underneath the skin. Varicose veins can also develop in the deep veins. Varicose veins in the superficial veins are called primary varicosities, while varicose veins in the deep veins are called secondary varicosities.

Liver disease can cause the appearance of varicose veins in the esophagus or on the surface of the abdomen. These appear in response to increased pressure of blood that is unable to move through a diseased liver. Varicose veins in the esophagus are called esophageal varicosities. Varicose veins on the surface of the abdomen often resemble a spider or the head (caput) of the mythological character Medusa.

Causes and symptoms

The predisposing causes of varicose veins are multiple. Lifestyle and hormonal factors play a role. Some families seem to have a higher incidence of varicose veins, indicating that there may be a genetic component to this disease. Varicose veins are progressive. As one section of a vein weakens, it causes increased pressure on adjacent sections. These sections often develop varicosities. Varicose veins can appear following pregnancy, thrombophlebitis, congenital blood vessel weakness, or obesity, but are not limited to these conditions. Edema of the surrounding tissue, ankles, and calves, is not usually a complication of primary (superficial) varicose veins and, when seen, usually indicates that the deep veins may have varicosities or clots.

Varicose veins are a common problem. Approximately 15% of the adult population in the United States has varicose veins. Women have a much higher incidence of this disease than men. The symptoms can include aching, pain, itchiness, or burning sensations, especially when standing. In some cases, with chronically bad veins, there may be a brownish discoloration of the skin or ulcers (open sores) near the ankles. A condition that is frequently associated with varicose veins is spider-burst veins. Spider-burst veins are very small veins that are enlarged. They may be caused by back-pressure from varicose veins, but can be caused by other factors. They are frequently associated with pregnancy, and there may be hormonal factors associated with their development. They are primarily of cosmetic concern and do not present any medical concerns.

Diagnosis

Varicose veins can usually be seen. In cases where varicose veins are suspected, but cannot be seen, a physician may frequently detect them by palpation (pressing with the fingers). X rays or ultrasound tests can detect varicose veins in the deep and perforator veins and rule out blood clots in the deep veins.

Treatment

There is no cure for varicose veins. Treatment falls into two classes: relief of symptoms and removal of the affected veins. Symptom relief includes such measures as wearing support stockings, which compress the veins and hold them in place. This keeps the veins from stretching and limits pain. Other measures are sitting down, using a footstool when sitting, avoiding standing for long periods of time, and raising the legs whenever possible. These measures work by reducing the blood pressure in leg veins. Prolonged standing allows the blood to collect under high pressure in the varicose veins. Exercise such as walking, biking, and swimming, is beneficial. When the legs are active, the leg muscles help pump the blood in the veins. This limits the amount of blood that collects in the varicose veins and reduces some of the symptoms. These measures reduce symptoms, but do not stop the disease.

Surgery is also used to remove varicose veins from the body. It is recommended for those that cause pain or are very unsightly and when hemorrhaging or recurrent thrombosis appear. Surgery involves making an incision through the skin at both ends of the section of vein being removed. A flexible wire is inserted through one end and extended to the other. The wire is then withdrawn, pulling the vein out with it. This is called "stripping" and is the most common method to remove superficial varicose veins. As long as the deeper veins are still functioning properly, a person can live without some of the superficial veins. Because of this, stripped varicose veins are not replaced.

Injection therapy is an alternate therapy used to seal varicose veins. This prevents blood from entering the sealed sections of the vein. The veins remain in the body, but no longer carry blood. This procedure can be performed on an out-patient basis and does not require anesthesia. It is frequently used if people develop more varicose veins after surgery to remove the larger varicose veins and to seal spider-burst veins for people concerned about cosmetic appearance. Injection therapy is also called sclerotherapy. At one time, a method of injection therapy was used that did not have a good success rate. Veins did not seal properly and blood clots formed. Modern injection therapy is improved and has a much higher success rate.

Prognosis

Untreated varicose veins become increasingly large and more obvious with time. Surgical stripping of varicose veins is successful for most people. Most do not develop new, large varicose veins following surgery. Surgery does not decrease a person's tendency to develop varicose veins. Varicose veins may develop in other locations after stripping.

Health care team roles

Family physicians or gynecologists often make a initial referral to a vascular surgeon for treatment. Nurses may instruct patients in practices to prevent worsening of the condition, if surgery is not warranted.

Prevention

Varicose veins in the legs can be minimized by maintaining good physical condition and engaging in exercise throughout life. This is especially important for women during pregnancy. Persons who are at risk of developing varicose veins can wear support hosiery. Refraining from standing for long periods of time is helpful. If standing is inevitable, flexing the muscles of the calf every minute or two will help to prevent blood pooling.

KEY TERMS

Congenital— Existing at or before birth; a condition that developed while the fetus was in utero or as a consequence of the birth process.

Edema— Swelling caused by a collection of fluid in a tissue or body cavity.

Hemorrhage— Bleeding from blood vessels.

Palpation— The process of examining a person using the sense of touch.

Thrombosis— Blockage of a blood vessel due to a clot or thrombus.

Resources

BOOKS

Goldman, Michael P., Robert A. Weiss, and John J. Bergan. Varicose Veins and Telangiectasias: Diagnosis and Treatment. 2nd ed. New York: Matthew Medical Books, 1999.

Hull, Russell. "Peripheral Venous Disease." In Cecil Textbook of Medicine, 21st ed. Ed. Lee Goldman and J. Claude Bennett. Philadelphia: W.B. Saunders, 2000.

Sadick, Neil S. Manual of Sclerotherapy. Philadelphia: Lippincott Williams & Wilkins, 2000.

Townsend, Courtney M. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 16th ed. Philadelphia: Saunders, 2001.

Tretbar, L. L. Venous Disorders of the Legs: Principles and Practice. New York: Springer Verlag, 1999.

PERIODICALS

de Cossart, L. "Varicose Veins and Pregnancy." British Journal of Surgery 88, no. 3 (2001): 323-324.

Foldi, M., and G. Idiazabal. "The Role of Operative Management of Varicose Veins in Patients with Lymphedema and/or Lipedema of the Legs." Lymphology 33, no. 4 (2001): 167-171.

Guex, J. J., and M. N. Isaacs. "Comparison of Surgery and Ultrasound Guided Sclerotherapy for Treatment of Saphenous Varicose Veins: Must the Criteria for Assessment be the Same?" International Journal of Angiology 19, no. 4 (2000): 299-302.

Tessari, L., A. Cavezzi, and A. Frullini. "Preliminary Experience with a New Sclerosing Foam in the Treatment of Varicose Veins." Dermatological Surgery 27, no. 1 (2001): 58-60.

ORGANIZATIONS

American Association for Vascular Surgery. 13 Elm Street, Manchester, MA 01944-1314. (978) 526-8330. 〈http://www.vascsurg.org/doc/842.html〉.

Peripheral Vascular Surgery Society. 824 Munras Avenue, Suite C, Monterey, CA 93940. (831) 373-0508. 〈http://www.pvss.org〉[email protected]

OTHER

Merck Manual. 〈http://www.merck.com/pubs/mmanual/section16/chapter212/212h.htm〉.

National Library of Medicine. 〈http://www.nlm.nih.gov/medlineplus/varicoseveins.html〉.

University of Michigan School of Medicine. 〈http://www.med.umich.edu/llibr/topics/circ03.htm〉.

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Varicose Veins

Varicose veins

Definition

Varicose veins are veins right below the surface of the skin (superficial veins) that are swollen with blood and which become twisted and painful.

Description

Veins return unoxygenated blood from the body back to the heart and lungs. When the veins lose their elasticity they become thickened and enlarged with twists and turns. Varicose veins occur most often in the legs and thighs but can occur anywhere in the body.

Demographics

Approximately 25 million people in the United States have varicose veins. Varicose veins are more common between the ages of 30 and 70 years. Most elderly individuals have some evidence of varicose veins. Women are two to three times more likely than men to develop varicose veins and about half of women in the United States have varicose veins. Changes in hormones associated with puberty, pregnancy, menopause , and taking oral contraceptives may increase a woman's chance of developing varicose veins.

Causes and symptoms

Varicose veins may be due to weakness in the walls of the veins or improper functioning of the valves within the veins. Weakened vein walls lose their elasticity allowing the vein to become wider and

longer. The swollen vein often twists and turns to remain in its normal position.

Veins have one-way valves that keep blood moving toward the heart. When the valves malfunction, blood backs up and collects in the veins. This abnormal pooling of blood causes the vein to swell resulting in the development of a varicose vein.

Certain conditions are associated with the development of varicose veins including pregnancy, prolonged sitting or standing, obesity , history of trauma or surgery to the leg, and age. An increased volume of blood and added weight of the uterus during pregnancy increases pressure on the leg veins contributing to the development of varicose veins. Varicose veins that develop during pregnancy usually get better within three to twelve months after childbirth. Prolonged sitting, especially with the legs bent or crossed, or standing causes the veins to work harder to pump blood back to the heart and varicose veins may result. Obesity places increased pressure on the veins increasing the risk of developing varicose veins. Previous surgery or injury to the leg may disrupt normal blood and contribute to the development of varicose veins.

A family history of varicose veins may also increase the risk of developing them. Age weakens vein valves which increases the likelihood of developing varicose veins.

Symptoms include pain and swelling in the legs; visible, enlarged veins; itching around one or more veins; and discoloration of the skin around the varicose vein. Pain may be described as burning, throbbing, tingling, soreness, aching, or cramping. Prolonged standing or sitting may aggravate the pain.

Diagnosis

Diagnosis begins with a complete medical history and physical examination. The history will include questions about pain characteristics and physical examination will include observation for any prominent veins. Testing may include ultrasound to evaluate blood flow and structure of the leg veins. Referral to a blood vessel specialist (vascular medicine specialist or vascular surgeon) may be made. If necessary, referral to a dermatologist may also be made.

Treatment

Treatment is aimed at reducing symptoms, preventing complications, and improving the physical appearance of the legs. Mild symptoms may respond to self-care treatment including avoiding prolonged sitting or standing, raising the legs above the level of the heart when sitting or lying down, wearing support hose, maintaining adequate exercise , losing weight if overweight or obese, and avoiding wearing tight or binding clothes especially around the waist and legs.

Medical or surgical treatment may be needed if self-care measures do not work or symptoms are severe and disrupt activities of daily living. These treatments include sclerotherapy, laser surgery, endovenous ablation therapy, endoscopic vein surgery, ambulatory phlebectomy, and vein ligation and stripping.

Sclerotherapy involves injection of a chemical irritant into the vein causing scarring inside the vein which results in the vein closing off and dying away. Several treatments may be needed to completely close off the vein. This procedure is usually done in a doctor's office on smaller varicose veins.

Laser surgery involves light energy to fade away varicose veins. Laser surgery is usually done on smaller varicose veins.

During endovenous ablation therapy, an incision is made into the skin and a small tube is inserted into the vein. A laser or other energy source heats up the inside of the vein causing it to close off. This procedure is usually done in a doctor's office and pain and recovery time may be less than with other procedures.

Endoscopic vein surgery involves a small incision through which a tiny camera at the end of a small tube is used to move through the vein. A surgical instrument at the end of the camera closes off the vein. This type of procedure is usually reserved for severe cases of varicose veins in which skin ulcers have developed.

Ambulatory phlebectomy uses small incisions made into the skin to remove varicose veins. This procedure is usually done to treat superficial varicose veins and the patient usually goes home the same day.

In vein ligation and stripping, veins are ligated (tied off) and stripped (removed) through small skin incisions. This procedure is usually done in cases in which pain is severe or skin ulcers are present. This procedure is usually done on an outpatient basis with anesthesia.

Nutrition/Dietetic concerns

Consume a low-salt diet to reduce water retention and swelling. Eat a high-fiber diet to decrease constipation , which can contribute to varicose veins because of straining. Lose weight if overweight or obese. Avoid alcohol because it can cause the veins in the legs to dilate.

Therapy

Exercise regularly, lose weight if necessary, don't wear tight-fitting clothes, avoid sitting or standing for long periods of time, and elevate the legs when sitting or lying down. Get up and walk at least every hour to help with blood flow in the legs. Don't cross the legs when sitting. Wear support hose. Put hose on in the morning before beginning to walk around and legs become swollen.

Prognosis

Symptoms of varicose veins usually worsen with time but self-care may reduce the symptoms and progression of the condition.

Prevention

Nothing can prevent varicose veins from developing but lifestyle dietary and activity modifications may decrease the chances of developing varicose veins.

QUESTIONS TO ASK YOUR DOCTOR

  • Which vein or veins in my legs is causing the problem?
  • What is causing my varicose veins?
  • What type of treatment is needed?
  • Are there treatments I can try at home?
  • Will surgery be required?
  • Do I need to see a specialist?
  • Will my varicose veins get worse?
  • Will my varicose veins recur after treatment?

Caregiver concerns

Varicose veins sometimes cause skin problems, blood clots , or other complications. Skin complications may include ulcers caused by severe problems with blood circulation. These skin ulcers are difficult to heal and usually recur even if they do heal. Varicose veins may also cause red, scaly, itchy skin usually around the ankle.

Blood clots can be life-threatening because the clot can disrupt blood flow to a major organ. Symptoms including chest pain and shortness of breath require immediate medical attention. Sudden leg swelling may indicate a blood clot in the leg (thrombophlebitis) which also requires immediate medical attention.

June G. Borazjani R.N., B.S.N., C.P.H.Q.

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