What are varicose veins?

In the human body, arteries take blood with oxygen from the heart to the tissues, and veins take blood from which the oxygen has been removed, back to the heart. In the legs this means that veins have to conduct blood vertically against gravitational force. Therefore in the legs there needs to be two mechanisms to achieve this. There is a pumping mechanism, which consists of the muscles of the calf and foot. The deep veins in the leg are surrounded by these muscles. These deep veins fill up with blood and when these muscles contract, blood is squeezed upwards and back towards the heart. When the calf muscles relax, blood would normally flow back downhill under the influence of gravity. However in the veins of the lower limb there are many small one-way valves which prevent the blood from flowing backwards. The veins of the calf fill up from below and when the calf muscles contract the whole cycle is repeated.

In addition to the deep veins, there is a system of superficial veins beneath the skin which are not surrounded by muscles. The blood that collects in these veins is not pumped upwards by the calf muscles. Blood which collects in the superficial venous system has to empty into the deep venous system to be pumped back to the heart. The superficial and deep venous system is connected by a series of communications called perforating veins. These veins are protected by one-way valves so that blood can flow in only one direction from superficial venous system to the deep venous system. The most important perforating veins are located in the groin and behind the knee. These communications are called the saphenofemoral and saphenopopliteal junctions. The saphenofemoral junction drains blood from the front and inside of the leg and Sapheno popliteal junction drains blood from the calf and back of the leg.

When one of these one-way valves becomes incompetent, blood can leak from the deep venous system into the superficial venous system. This increases the pressure in the superficial venous system causing venous distension which results in stretching of veins in the superficial venous system. We call these veins, which have been stretched in their length and diameter, varicose veins. When the calf muscle pumps 100 mL of blood in one calf compression, this 100 mL will reach one of the leaking perforating veins and some of this blood will leak retrogradely back down the leg. For the sake of argument if the leakage rate is 10% then 10 mL will leak back down the leg and 90 mL will go to the heart. On the next occasion that the calf muscle contracts it will need to pumped 110 mL to keep up. If 110 mL is pumped on the next occasion then 11 mL will leak back down the leg and therefore on the third contraction 111 mL will need to be pumped for the system to keep up. As the day progresses, one can see that there is a cumulative buildup of blood in the leg. This is how varicose veins cause swelling of the legs with pain as a result of distension of the tissues in the leg.

Apart from the cosmetic appearance of varicose, the next most common symptom is pain and discomfort in the legs at the end of the day. This pain can be relieved by elevating the legs and allowing the fluid that has collected to run downhill under the influence of gravity. An additional simple treatment is to wear elastic stockings which augment the pumping mechanism in the leg. Varicose veins are not life or limb threatening disorders. Complications from varicose veins are infrequent. One of the complications would include, bleeding from a varicose vein. This bleeding usually comes from a small vein at the ankle. The bleeding is usually the result of some minor trauma to small varicose veins or the result of weakening of the wall of the varicose vein in the shower or bath. This bleeding will stop immediately when the leg is elevated above the level of the heart. Occasionally thrombosis can occur in varicose veins. This is called superficial thrombophlebitis. There is usually a red, tender, painful lump at the site of the thrombophlebitis. These symptoms usually last for no more than three weeks. This is not a dangerous condition unless the thrombophlebitis spreads up the long saphenous vein to the groin and involves the saphenofemoral junction. If this occurs the saphenofemoral junction will need to be immediately ligated to prevent clot from breaking off and travelling to the lungs. This is called a pulmonary embolus. Varicose veins may be associated with ulceration of the skin at the inside of the ankle. When this occurs there is usually pigmentation and pruritus involving skin below the knee. Having your varicose veins treated in this condition will help control these symptoms.

Varicose veins do not have any effect on the function of the heart. The presence of varicose veins does not cause heart failure. Varicose veins are very frequently present for many years. Often patients are aware of the presence of varicose veins. Not infrequently patients develop a new pain in the leg, they attribute the pain to the varicose veins. If this is the situation then treatment of the varicose veins is unlikely to remove the pain if it is caused by some other condition such as arthritis, sciatica, arterial disease or a musculoskeletal injury. If a new pain develops in the presence of longstanding varicose veins it is possible to wear elastic stockings to determine if the pain is related to the varicose veins. In wearing elastic stocking any pain that is relieved by this is likely to be due to varicose veins. If the pain is not relieved by wearing elastic stockings then the pain is unlikely to be due to the presence of varicose veins.

There are several choices in the management of varicose veins. Many people who have varicose veins choose to do nothing and to live with their varicose veins. Some people will elect to wear elastic stockings to control the symptoms that may arise from varicose veins. Other people may choose to have their varicose veins treated more aggressively. Surgery for varicose veins involves an operation, excision of the varicose veins and ligation of incompetent communicating veins. Other treatments for varicose veins consist of thermal ablation. These treatments involve the use of radio frequency electrical energy or laser light energy to burn the inside of varicose veins. Occasionally sclerotherapy is used to induce chemical destruction of varicose veins. And occasionally some of these modalities are combined in the treatment of varicose veins. You can obtain more information concerning each of these treatments from other places on this web site.

In general all treatments for varicose veins have a small incidence of potential complications. These essentially consist of bleeding, clotting, infection or damage to nearby tissues. Surgical treatment for varicose veins is usually done in association with a significant anaesthesia, usually general anaesthesia. Usually all treatments with the exception of elastic stockings involve the use of long acting local anaesthetic agents. Treatments for varicose veins can involve the necessity to take time off work ranging from a couple of hours to two weeks. Information on each of these treatments with respect to this matter is provided at other places on this web site.

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