Varicose Veins

Varicose veins are large dilated blood vessels that have a red or bluish colour and protrude above the surface of the skin. Varicose veins are commonly associated with symptoms such as aching, throbbing, tired legs, varicose leg ulcers, cramp, heavy legs, burning, itching, varicose eczema, leg swelling and restless legs.

Varicose Veins and their complications.
Varicose veins can affect upto 40% of the population with slightly more women affected than men.  There is often a genetic predisposition to the problem but environmental factors also play a significant role eg jobs which involve prolonged standing. Pregnancy often precipitates varicose veins – such veins can include the vulval area during pregnancy.

For some, the varicose veins are simply a cosmetic issue but many people develop symptoms from the varicose veins.  Typical symptoms include: heavy, tired legs, aching, burning and cramp. More sever varicose veins can be associated with: swelling, restless legs, varicose eczema, varicose ulcers, skin changes such as dark pigment staining and loss of fat (lipodermatosclerosis).

What causes the veins to bulge?
Blood is brought to the legs via arteries and the blood is returned back to the heart and lungs via veins.  The blood is pumped up (against gravity) by using the foot and calf muscles as a pump.  Most of the blood is pumped up the deep vein system inside the muscles of the leg and the rest comes up superficial saphenous veins. The deep and superficial saphenous veins have one-way valves which prevent the blood falling down again when the muscles are relaxed. The saphenous vein walls are not supported by muscle and can become weak over time leading to stretching of the vein which means the valves cannot close properly which in turn allows blood to fall down with gravity.  The pooling of blood causes further stretching of the vein and they start to bulge out usually becoming most noticeable in the lower leg.  The two main veins that cause varicose veins in the leg are the great saphenous vein (GSV) which runs from the groin to the instep of the foot and the small saphenous vein (SSV) which runs from behind the knee to the outside of the foot.

Complications of Varicose Veins 

Varicose Eczema:  this is a skin irritation associated specifically with varicose veins and the itchy, inflamed dry scaly skin is usually directly over the varicose vein.  We do not know what specifically causes the eczema in some people but we do know that stasis of blood in varicose veins can lead to a build up of toxins in the skin which may cause the irritation.

Varicose Ulcers: these are ulcers typically found in the inside or outside lower leg just above the ankle.  Skin ulcers can have many different causes so it is important you have the correct diagnosis made.  If your doctor confirms that your ulcers are related to varicose veins the best treatment is to treat the varicose veins as the congestion and stasis of blood caused by the reverse flow of blood is what leads to the breakdown of the skin.  In some cases the ulcers are initially caused by trauma but fail to heal because of the poor venous return associated with varicose veins.  Either way the swelling needs to be controlled by compression hosiery, the ulcers need to be appropriately addressed and as soon as possible the underlying varicose veins should be treated to aid healing and prevent recurrences.  The current common practice of daily dressings without treating the underlying problem causes a lot of unnecessary prolonged discomfort for patients.

Lipodermatosclerosis:  the stasis of blood caused by the varicose veins leads to changes to the skin and underlying fat.  The fat thins out and the skin becomes woody and discoloured.  In severe cases the leg can change shape dramatically as in the photo.

Leg swelling: swelling can occur for a variety of reasons such as congestive heart failure, kidney diseases, low protein levels so it is important to have this diagnosed by your doctor.  Leg swelling is however a common accompaniment of varicose veins as the blood is not returned properly.  The resultant pooling of blood can lead to fluid collecting in the tissues.  This will usually settle overnight with leg elevation and reaccumulate during the day.  Wearing compression hosiery will help but the definitive treatment is to treat the varicose veins.