Victory over varicose veins

A few years ago, you may have noticed a few light blue veins starting to snake down your calves. But now, they’ve darkened and become more noticeable, resembling twisted cords lying just under the surface of your skin (see illustration).

For many women (and some men), varicose veins are all too common. Although most may look worse than they feel, varicose veins can cause aches and pains in the legs. In rare cases, they can even lead to more serious problems, such as skin ulcers or blood clots.

Veins and Valves

Veins anywhere in the body can become enlarged and twisted (varicose). But varicose veins most commonly occur in the legs and feet. To understand why, it’s helpful to know a little something about how blood is circulated in your body.

Arteries carry blood from your heart to the rest of your tissues. Veins return blood from your body back to your heart. To return blood from your body back to your heart, the veins in your legs must work against gravity. Thin, one-way valves inside your veins help in the effort by preventing blood from flowing backward. If these valves are weakened or damage, blood can back up and pool in your veins – causing pressure that can change the size and shape of a vein.

Who gets varicose veins

Age is the most common risk factor. More than 40 percent of women over age 50 and 75 percent of women over age 70 have some form of varicose veins. Not only do blood vessels weaken with age, so do calf muscles, which normally help squeeze veins and send blood back toward the heart as you walk.

Other risk factors that can predispose you to varicose veins include the following:

•Gender. Women are slightly more susceptible to varicose veins than men. Pregnancy may be one reason: increased blood volume, extra weight, and greater abdominal pressure subject the veins to more wear and tear. The more full-term pregnancies a woman has had, the greater her risk. Hormones can also cause blood vessels to dilate, and there’s some evidence that taking either oral contraceptives or hormone therapy increases the likelihood of developing varicose veins.

•Heredity. Varicose veins tend to run in families, probably because of inherited weakness in vein walls or valve functioning.

•Occupation. A large Danish study found that women who spent more than 75 percent of their working time standing or walking were nearly twice as likely to be treated for varicose veins as women who spent fewer working hours on their feet.

•Weight. Excess weight, particularly around the middle, puts added pressure on leg veins. Moderately overweight women are more likely to have varicose veins than their thinner counterparts, and the risk is tripled in obese women.

Beyond cosmetic concerns

Varicose veins are sometimes viewed as just a cosmetic concern. That’s because the only thing that may be a problem is their appearance. Most varicose veins are dark purple or blue in color. They can also bulge out from under the skin, making them quite noticeable.

However, varicose veins can cause other problems, including an achy or heavy feeling in your legs. Some people also experience throbbing, cramping, or mild swelling in their lower legs – especially after standing for a long period of time.

More serious complications are rare. But varicose veins can sometimes lead to an itchy skin rash (dermatitis) and cause open sores (skin ulcers) to develop. Occasionally, blood clots may develop in a vein and cause pain, tenderness and swelling.

What can be done

If you have varicose veins and notice changes in the way your legs feel, consult your doctor. This is especially important if you notice any skin discoloration or swelling in your legs. Skin ulcers and sudden painful swelling should receive immediate medical attention.

Depending on your signs and symptoms, varicose veins may be treated with lifestyle changes, drugs, other ancillary medical procedures, or surgery. Lifestyle changes are often the first treatment recommended for mild symptoms because they can reduce discomfort and keep varicose veins from getting worse.

•Avoid long periods of standing or sitting. To encourage blood flow in your legs, try not to stay in one position for hours on end. And, when sitting, do not cross your legs. Elevating your legs above your heart a few times a day can also help with circulation.

•Be physically active.  Walking and other physical activities that get your legs moving help pump blood through your veins and back to your heart.

•Lose weight, if necessary. Shedding excess pounds takes pressure off your veins.

Your doctor also may recommend that you wear compression stockings. These stockings create gentle pressure up the leg, which can keep blood from pooling in legs and decrease swelling. A variety of strength and styles are available over-the-counter or by prescription.

Physical therapy treatments may also help in pumping blood into the venous system and lessen leg edema with the use of intermittent or sequential compression therapy. Strengthening the muscles in the legs, especially the calves, may be helpful as well.

Pharmacology

Until 2001, US guidelines mainly discussed surgical treatment for varicose veins, and only briefly mentioned the possibility of oral medications. Thereafter however, the guidelines of the American Venous Forum devoted an entire chapter to pharmacological treatment. The treatment guidelines of the Italian College of Phlebology has now also included oral drug treatments. This is because these groups of drugs were originally developed in the 1960s and 1970s when lesser standards of scientific proof were required than in the case today and doctors were hesitant in prescribing them. More recently, however, more rigid double-blind studies have now confirmed the efficacy of some of these drugs against the symptoms of venous disease.

In particular, studies have shown that micronized diosmin (Daflon 500) for example, in a twice a day daily dose, was effective in helping control the symptoms of heaviness, discomfort, itchiness, cramps, pain and swelling. It also significantly improved functional and organic insufficiency by 71 percent and 66 percent respectively, compared with 36 percent and 38 percent for placebo. Today, pharmacological agents have become accepted adjunctive therapy in the treatment of venous diseases.

MINIMALLY INVASIVE APPROACHES

However, if your varicose veins don’t respond to these treatments, or if your veins are causing severe problems, your doctor may suggest one or more of these minimally-invasive procedures:

•Sclerotherapy. In this procedure, a chemical is injected into a varicose vein to cause irritation and scarring. Several treatment sessions may be needed to completely close off a vein and allow it to fade from view.

•Laser therapy. With this procedure, strong bursts of light are directed at a vein, making it slowly fade and disappear. This therapy is mostly used to close off smaller varicose veins.

•Endovenous thermal ablation. This therapy involves using the heat from lasers or radio waves to close off larger varicose veins. For this procedure, a tiny cut is made on the skin, near the vein. A small tube (catheter) is then inserted into the vein and a device at the tip is heated up. As the

• Vein stripping. This older, surgical treatment for varicose veins is no longer as popular as before as it has been largely replaced by less invasive options that include injections, laser and radiofrequency energy. This old technique consists of removing leg veins through incisions.

•Ambulatory phlebotomy. For this procedure, tiny cuts are made to remove small veins close to the skin’s surface. It’s often done at the same time as endovenous thermal ablation or vein stripping.

•Endoscopic vein surgery. With this surgery, small cuts are made on the skin and a tiny camera, at the end of a thin tube (endoscope), is inserted inside and moved through a vein. A surgical device at the end of the camera is used to close the vein, which is then removed through small cuts. The procedure typically is used only for varicose veins that are causing skin ulcers.

Get the facts

Although most of the procedures used to treat varicose veins can be done on an outpatient basis, be sure to ask about health risks, possible side effects and needed recovery time. It’s also important to know what you can expect in terms of results. Even though most procedures are effective, it’s possible for varicose veins to recur or require several treatments.

You may also want to inquire about your health insurance coverage. Most policies don’t cover the cost of purely cosmetic procedures. However, your health insurance may cover treatments used to relieve pain, swelling, or other signs and symptoms of varicose veins.