Varicose veins

Varicose veins
Leg Before 1.jpg
Leg affected by varicose veins
SpecialtyVascular surgery
TreatmentEndovascular surgery

Varicose veins are veins that have become enlarged and twisted. The term commonly refers to the veins on the leg, although varicose veins can occur elsewhere.[1][2] Veins have pairs of leaflet valves to prevent blood from flowing backwards (retrograde flow or venous reflux).[3] Leg muscles pump the veins to return blood to the heart, against the effect of gravity. When veins become varicose, the leaflets of the valves no longer meet properly, and the valves do not work. This allows blood to flow backwards and the veins to enlarge even more. Varicose veins are most common in the superficial veins of the legs, subject to high pressure when standing. Besides being a cosmetic problem, varicose veins can be painful, especially when standing. Severe long-standing varicose veins can lead to leg swelling, venous eczema, skin thickening (lipodermatosclerosis) and ulceration.

Non-surgical treatments include sclerotherapy, elastic stockings, leg elevation and exercise. The traditional surgical treatment has been vein stripping to remove the affected veins. Newer, less invasive treatments which seal the main leaking vein are available. Alternative techniques, such as ultrasound-guided foam sclerotherapy, radiofrequency ablation and endovenous laser treatment, are available as well. Because most of the blood in the legs is returned by the deep veins, the superficial veins, which return only about 10% of the total blood of the legs, can usually be removed or ablated without serious harm.[4][5]

Secondary varicose veins are those developing as collateral pathways, typically after stenosis or occlusion of the deep veins, a common sequel of extensive deep venous thrombosis (DVT). Treatment options are usually support stockings, occasionally sclerotherapy and, rarely, limited surgery.

Varicose veins are distinguished from reticular veins (blue veins) and spider veins, which also involve valvular insufficiency,[6] by the size and location of the veins. Many patients who suffer with varicose veins seek out the assistance of physicians who specialize in vein care or peripheral vascular disease. These physicians include vascular surgeons, phlebologists or interventional radiologists.

Signs and symptoms

  • Aching, heavy legs (often worse at night and after exercise).
  • Appearance of spider veins (telangiectasia) in the affected leg.
  • Ankle swelling, especially in the evening.
  • A brownish-yellow shiny skin discoloration near the affected veins.
  • Redness, dryness, and itchiness of areas of skin, termed stasis dermatitis or venous eczema, because of waste products building up in the leg.
  • Cramps may develop especially when making a sudden move as standing up.
  • Minor injuries to the area may bleed more than normal or take a long time to heal.
  • In some people the skin above the ankle may shrink (lipodermatosclerosis) because the fat underneath the skin becomes hard.
  • Restless legs syndrome appears to be a common overlapping clinical syndrome in people with varicose veins and other chronic venous insufficiency.
  • Whitened, irregular scar-like patches can appear at the ankles. This is known as atrophie blanche.

Complications

Most varicose veins are reasonably benign, but severe varicosities can lead to major complications, due to the poor circulation through the affected limb.

  • Pain, tenderness, heaviness, inability to walk or stand for long hours, thus hindering work
  • Skin conditions / dermatitis which could predispose skin loss
  • Skin ulcers especially near the ankle, usually referred to as venous ulcers.
  • Development of carcinoma or sarcoma in longstanding venous ulcers. Over 100 reported cases of malignant transformation have been reported at a rate reported as 0.4% to 1%.[7]
  • Severe bleeding from minor trauma, of particular concern in the elderly.
  • Blood clotting within affected veins, termed superficial thrombophlebitis. These are frequently isolated to the superficial veins, but can extend into deep veins, becoming a more serious problem.
  • Acute fat necrosis can occur, especially at the ankle of overweight people with varicose veins. Females have a higher tendency of being affected than males.
Other Languages
العربية: دوالي وريدية
беларуская: Варыкоз
беларуская (тарашкевіца)‎: Варыкоз
български: Разширени вени
català: Variu
dansk: Åreknude
Deutsch: Krampfader
ދިވެހިބަސް: ލޭނާރު ފުއްޕުން
Ελληνικά: Κιρσοί
español: Variz
Esperanto: Variko
euskara: Barize
فارسی: واریس
français: Varice
한국어: 정맥류
hrvatski: Proširene vene
Ido: Variko
italiano: Varicosi
עברית: דליות
македонски: Проширени вени
Nederlands: Spatader
日本語: 静脈瘤
norsk: Åreknuter
norsk nynorsk: Åreknutar
oʻzbekcha/ўзбекча: Venalarning varikoz kengayishi
português: Variz
română: Varice
Simple English: Varicose veins
slovenščina: Krčne žile
srpskohrvatski / српскохрватски: Proširene vene
suomi: Suonikohju
svenska: Åderbråck
українська: Варикоз
中文: 靜脈曲張