What are the other Names for this Condition? (Also known as/Synonyms)

• Spider Veins
• Varicosities (Varicose Veins)
• Venous Varices (Disorder)

What is Varicose Veins? (Definition/Background Information)

• Varicose Veins are dilated and tortuous veins most commonly found on the lower extremities. The condition is caused by various factors such as physical injury, deep vein thrombosis, or due to various genetic defects.
• Women are more affected more commonly than men due to hormonal effects. The risk factors associated with Varicose Veins include pregnancy, continuously standing for long time periods due to certain occupations, and any predisposition of the individual towards blood clot formation.
• The signs and symptoms associated with Varicose Veins are heaviness of the legs, leg pain after exercise, pain over the course of the vein (that improves on elevating the leg), restless legs, and night cramps. Skin ulceration and secondary infections may occur as complications if the condition is severe.
• Conservative measures that  include losing weight, elevating the legs, avoiding tightfitting clothes, and avoiding standing/sitting for long periods of time may help Varicose Veins from worsening.
• The use of compression stockings is usually the first line of treatment measure employed, which is then followed by surgical interventions for severe Varicose Veins. The prognosis is generally good with appropriate treatment.

Who gets Varicose Veins? (Age and Sex Distribution)

• Varicose Veins frequently appear between 60-70 years of age
• Due to hormonal effects, women are generally affected more than men
• It is more common in westernized and industrialized nations

What are the Risk Factors for Varicose Veins? (Predisposing Factors)

Risk factors associated with Varicose Veins are:

• Pregnancy due to increased pressure on the lower legs: Pregnancy causes the developing baby to add pressure in the veins of the abdomen. This in turn increases the pressure in the lower leg veins
• Standing for long time due to certain jobs, such as behind the counter sales persons
• Predisposition of the individual towards blood clot formation: Chronic blood clot formation in the veins weakens the strength of the vein walls, which increases the risk for formation of Varicose Veins
• Chronic venous infections (phlebitis)
• Impaired blood flow in the portal vein (an important vein of the liver) or liver cirrhosis
• Family history of Varicose Veins
• Any congenital defect in the veins

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Varicose Veins? (Etiology)

Normally, the superficial veins of the legs have two leaflet valves that direct the blood flow towards the deeper veins against gravity. The deep veins drain into the inferior vena cava, which is the biggest vein carrying deoxygenated blood to the heart. When one of the valves in the superficial veins fail (leak between two leaflets), blood flows in the reverse direction according to gravity. This reverse flow increases the pressure over other valves; it also fails causing a segment of the vein to dilate. The failure of the valves may be caused by various factors such as mechanical trauma, blood clots in the deep veins (deep vein thrombosis), pregnancy, etc.

Common causes associated with Varicose Veins include:

• Mechanical trauma or physical injury to the veins: It can damage the vein walls and the vein valves
• Deep vein thrombosis (formation of blood clots in the leg veins)
• Pregnancy
• Infection of the veins (thrombophlebitis)
• Factor V Leiden mutation: An inherited defect characterized by an increase chance of forming blood clots, especially in the leg veins
• Congenital absence of valves in the veins (with positive familial history)

What are the Signs and Symptoms of Varicose Veins?

The common signs and symptoms associated with Varicose Veins are:

• Dilated veins that are clearly visible
• Feeling of heaviness in the leg
• Exercise intolerance, pain after exercise
• Pain over the course of the vein (which improves on elevating the leg)
• Restless legs
• Night cramps
• Edema (fluid accumulation in the legs)
• Altered sensation in the leg
• Itching and skin changes (dermatitis) in long-standing cases

How are Varicose Veins Diagnosed?

A diagnosis of Varicose Veins would involve:

• Complete evaluation of medical history along with a thorough physical exam
• Imaging studies that include:
  • Contrast venography
  • Magnetic resonance venography (MRV): It is a highly sensitive and specific imaging tool
  • Color-flow duplex ultrasonography, which is used to determine the direction of blood flow             

Imaging studies are done to locate the level of possible obstruction, reverse flow from deep to superficial veins, and identification of failed valves. If there is a compression within the abdomen that results in increased pressure in the veins of the lower legs, imaging studies of the abdomen may need to be performed.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Varicose Veins?

Possible complications of Varicose Veins include:

• Recurrent infection of the veins
• Skin ulcers and infection, due to thinning of the skin caused by excess venous pressure
• Congestion of legs due to blood pooling

How are Varicose Veins Treated?

The treatment options for Varicose Veins may include:

• Conservative measures may help prevent the condition from progressively worsening. These measures include:
  • Losing weight (if the individual is obese or overweight)
  • Elevating the legs, whenever possible
  • Avoiding tight fitting clothes
  • Avoiding long periods of standing and sitting            
• Compression stockings:  It is usually the first method to be used, wherein the stockings are worn all day. The compression stockings squeeze the legs and help the leg veins and muscles to circulate blood more effectively

Following are the treatment options for severe Varicose Veins not responding to the above measures:

• Sclerotherapy: Injection of a chemical agent which destroys the inner lining of the vein and converts it into a thick fibrous cord
• Laser and intense-pulsed light therapy: It helps burn the inner layer of the vein and close the lumen
• Radiofrequency ablation
• Ambulatory phlebectomy: Removal of the affected veins using surgical procedures

How can Varicose Veins be Prevented?

In some cases, varicose may be prevented by using the following measures:

• Activity (physical) is an important factor which improves venous circulation and prevents stasis of blood in the lower limbs, in contrast to constant standing
• Mobility should be resumed soon after the treatment of Varicose Veins in order to prevent recurrence of the condition

What is the Prognosis of Varicose Veins? (Outcomes/Resolutions)

• Individuals with severe Varicose Veins are at high risk for progression to chronic venous ulcers, which can be very difficult to treat effectively
• With appropriate treatment, the vast majority of individuals have a good outcome

Additional and Relevant Useful Information for Varicose Veins:

• Varicose vein sclerotherapy is a non-invasive procedure to treat Varicose Veins

The following article link will help you understand varicose vein sclerotherapy procedure:

http://www.dovemed.com/common-procedures/procedures-surgical/varicose-vein-sclerotherapy/