What are Varicose Veins?
Varicose veins are dilated (enlarged), elongated and tortuous sections of veins which are located just under the surface of the skin - usually on the leg. They are often easily visible, as they look thick and knobbly and generally blue or dark purple in colour. They may be less obvious if you are overweight, as they are hidden by fatty tissue under the skin.
Spider / reticular veins can often occur alongside varicose veins or can occur on their own.
Healthy Vein |
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Diseased Vein |
How common are Varicose Veins?
About 3 in 10 adults develop varicose veins at some time in their life. More women develop varicose veins than men. Most people with varicose veins do not have an underlying disease and they usually occur for no apparent reason. Varicose veins do not cause symptoms or complications in most cases, although some people find them unsightly.
How do Veins work?
Arteries bring blood from the heart to the organs and tissues in your body, veins take the blood back to the heart.
Veins contain one way valves to prevent the blood from flowing back. When the valves become faulty the blood can travel back to the feet. This causes the veins that are near to the surface of the skin to enlarge and result in what is commonly called varicose veins. These can range from small dilated veins to large bunch of grape-like structures in the calf.
Varicose veins are a slowly progressive disease which if left untreated can lead to marked skin damage or ulceration near the ankle.
Why do Veins occur?
Up to 30% of the adult population have varicose veins and heredity is a primary cause.
Environmental factors also play a large part, for example, prolonged standing in various occupations and our Western diet with high fat, refined sugar and low fibre content may also contribute.
Varicose veins become more frequent in advancing age but can appear at any time in life. Hormonal changes in puberty, pregnancy and the menopause may influence the course of the disease, though 60-70% of varicose veins during pregnancy will disappear within a few months of delivery.
What are the Symptoms of Varicose Veins?
Varicose veins may cause feelings of fatigue, heaviness, aching, burning, throbbing, itching and cramps in the legs. These symptoms are often accompanied by swelling of the ankle. Spider veins can also produce the same symptoms. These symptoms will usually be worse during warm weather or when you have been standing up for long periods of time.
What are the potential complications of untreated Varicose Veins?
Most people with varicose veins do not develop complications. Complications develop in a small number of cases when veins are left untreated. However, it is impossible to predict who will develop complications. The complications are due to chronic high venous pressure in the varicose veins resulting in changes to the skin around the ankle.
If complications do develop, it is typically several years after the varicose veins first appear. The visible size of the varicose veins is not predictive whether complications will develop.
Possible complications include:
- Inflammation of the vein (thrombophlebitis).
- Swelling of the foot or lower leg.
- Skin changes over the prominent veins. The possible skin changes are: discolouration, eczema, skin ulcers, or lipodermatosclerosis (hardening of the fat layer under the skin, causing areas of thickened, red skin).
- Rarely, varicose veins may bleed.
Why should I have my Varicose Veins treated?
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To ease unpleasant symptoms, like pain, cramps or discomfort,
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To treat complications, such as skin discolouration swelling, bleeding, thrombophlebitis or leg ulcer,
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To rid your legs of unsightly veins! Get them looking like they were before…
I have Varicose veins and would like to seek help. What do I do?
You would need to make an appointment to see a trained Vascular Specialist. After arranging an appointment, the surgeon will obtain full medical history followed by a thorough physical examination. This is an important part of the consultation to assess the veins and the condition of the skin. This will determine the extent and severity of the varicose veins and whether there are associated complications such as leg swelling, skin discolouration/ hyperpigmentation, dermatitis or ulcers. However it is not always clear from where varicosities arise. This is especially true when varicose veins have recurred after a previous operation. Specialised investigations are then required.
What are the investigations/tests required for Varicose Veins
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Duplex ultrasound scan
Duplex ultrasound scan is a non-invasive and pain free investigation. It is the gold standard investigation for venous diseases. It allows assessment the condition of both deep and superficial veins. It is often the only investigation required in majority of patients with varicose veins as it is able to provide adequate information to allow decision making on treatment.
This should be performed by a trained Ultra-sonographer.
With colour duplex ultrasound imaging all veins and arteries can be visualized so that the direction of the blood flow can be demonstrated and measured. In patients with varicose veins, it will demonstrate incompetent valves and reversal of blood flowing toward the feet. A venous mapping and report is then produced to indicate all incompetent veins and where they arise from. This will assist surgeon to decide how to best manage your varicose veins.
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Magnetic Resonance Venography (MRV)
Magnetic Resonance Venography (MRV) is Magnetic Resonance Imaging (MRI) of veins. It is a radiation-free scanning technique that uses radio waves and magnetic fields to produce detailed three-dimensional images of the body. It is a very sensitive test for deep and superficial venous disease in the lower legs and in the pelvis, where other imaging methods (eg duplex ultrasound scan) cannot reach.
MRV is particularly useful for investigating nonvascular causes for leg pain and oedema. In addition, non-contrast imaging techniques are available with MRV, making MRV the preferred technique in patients with renal impairment or contrast allergy.
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CT venography
CT venography is also useful for evaluation and visualization of the anatomical structure of venous system varicose veins and venous malformations. CT venography has advantages of speed and spatial resolution in comparison with MRV. Many patients who are not candidates for MRV by virtue of pacemakers or other MRI incompatible devices, or claustrophobia, can be examined with CT venography.
CT venography always requires the use of intravenous contrast and radiation exposure which are the main limitations of this technique.
What are the Treatment Options Available?
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What can I do to Prevent them?
- Avoid standing still for long periods
- Take plenty of walking exercise.
- Eat a good diet.
- Wearing support stockings may help in relieving they symptoms.
No creams or drugs are available to prevent of treat varicose veins.
The earlier varicose veins and dermal flares are treated the better the long term and cosmetic outcome.
What are Reticular Veins?
Reticular veins are smaller types of veins. These veins are usually about 2-3mm in diameter, and often do not protrude on the skin surface. They are a closely grouped network of small veins. They are usually blue to greenish in colour and frequently feed areas of spider veins which are closer to the surface. Reticular veins are predominantly located on the inner part of thighs, backs of legs and ankles. They can also be associated with symptoms of pain and discomfort of the legs.
Reticular veins do not normally exist for no reason. Sometimes (though not always), there is underlying venous insufficiency which cause them to occur.
See Spider Veins
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