Varicose Veins

Varicose veins are enlarged, dilated veins. Any vein may become varicose, but the veins most commonly affected are those in your legs and feet. That’s because standing increases the pressure in the veins of your lower body.

For many people, varicose veins and thread veins- a common, mild variation of varicose veins- are simply a cosmetic concern. For other people, varicose veins can cause aching pain and discomfort and lead to varicose eczema and varicose ulcers.

Varicose veins may also signal a higher risk of other circulatory problems. Treatment may involve self-care measures or procedures by your dermatologist to close or remove veins.

Signs and Symptoms

Signs you may have with varicose veins include:

Prominent veins that are dark purple or blue in colour
Veins that appear twisted and bulging; often like cords on your legs

When painful signs and symptoms occur, they may include:

An achy or heavy feeling in your legs
Burning, throbbing, muscle cramping and swelling in your lower legs
Worsened pain after sitting or standing for a long time
Itching around one or more of your veins
Bleeding from varicose veins
A painful cord in the vein with red discoloration of the skin
Colour changes, hardening of the vein, inflammation of the skin or skin ulcers near your ankle, which can mean you have a serious form of vascular disease that requires medical attention

Thread veins are similar to varicose veins, but they’re smaller. Thread veins are found closer to the skin’s surface and are often red or blue.

When to see a dermatologist

Self-care — such as exercise, elevating your legs or wearing compression stockings — can help you ease the pain of varicose veins and may prevent them from getting worse. But if you’re concerned about how your veins look and feel and self-care measures haven’t stopped your condition from getting worse, see your doctor.

Causes

Arteries carry blood from your heart to the rest of your tissues. Veins return blood from the rest of your body to your heart, so the blood can be recirculated. To return blood to your heart, the veins in your legs must work against gravity.

Muscle contractions in your lower legs act as pumps, and elastic vein walls help blood return to your heart. Tiny valves in your veins open as blood flows toward your heart then close to stop blood from flowing backward.

Causes of varicose veins can include:

As you get older, your veins can lose elasticity, causing them to stretch. The valves in your veins may become weak, allowing blood that should be moving toward your heart to flow backward. Blood pools in your veins, and your veins enlarge and become varicose. The veins appear blue because they contain deoxygenated blood, which is in the process of being recirculated through the lungs.
Some pregnant women develop varicose veins. Pregnancy increases the volume of blood in your body, but decreases the flow of blood from your legs to your pelvis. This circulatory change is designed to support the growing foetus, but it can produce an unfortunate side effect — enlarged veins in your legs. Varicose veins may surface for the first time or may worsen during late pregnancy, when your uterus exerts greater pressure on the veins in your legs. Changes in your hormones during pregnancy also may play a role. Varicose veins that develop during pregnancy generally improve without medical treatment three to 12 months after delivery.

Risk factors

These factors increase your risk of developing varicose veins:

The risk of varicose veins increases with age. Aging causes wear and tear on the valves in your veins that help regulate blood flow. Eventually, that wear causes the valves to allow some blood to flow back into your veins where it collects instead of flowing up to your heart.
Women are more likely to develop the condition. Hormonal changes during pregnancy, pre-menstruation or menopause may be a factor because female hormones tend to relax vein walls. Taking hormone replacement therapy or birth control pills may increase your risk of varicose veins.
Family history. If other family members had varicose veins, there’s a greater chance you will too.
Being overweight puts added pressure on your veins.
Standing or sitting for long periods of time. Your blood doesn’t flow as well if you’re in the same position for long periods.

Treatment

Sclerotherapy

This procedure involves injecting sclerosant through a tiny needle, very superficially into the veins, causing the lining of the vein to swell and clot. There is usually minimal discomfort with the treatment due to the needle being so small.

Microsclerotherapy is a relatively quick procedure and most people can resume normal activities, including driving, on the same day.

Over the course of several weeks following your treatment, you may feel the veins are more pronounced and infection sites may feel slightly itchy. This is quite common and will fade over time. It is also possible you may need to schedule further treatments as some patients will require 2 to 6 treatments of 4-8 week intervals.

Endovenous Ablation

Varicose vein treatment, also known as endovenous ablation, uses radiofrequency or laser energy to cauterize and close varicose veins in the legs. It may be used for cosmetic purposes, but it is most commonly used to help ease varicose vein related symptoms such as aching, swelling, skin irritation, discolouration or inflammation. Endovenous ablation is safe, less invasive than conventional surgery, and leaves virtually no scars.

Ultrasound is used to visualize the varicose vein. A laser fiber or radiofrequency electrode is advanced to the desired location within the vein through an IV. Local anaesthesia is injected to collapse the vein around the laser and act as an insulation for the heat of the radiofrequency or laser energy. Laser or radiofrequency energy is then applied, heating the vessel and causing it to close. Following the procedure, the faulty vein will shrink and scar down.