Varicose veins are a medical condition in which superficial veins become enlarged and twisted. Although usually just a cosmetic ailment, in some cases they cause fatigue, pain, itching, and nighttime leg cramps. These veins typically develop in the legs, just under the skin. Their complications can include bleeding, skin ulcers, and superficial thrombophlebitis. Varices in the scrotum are known as varicocele, while those around the anus are known as hemorrhoids. The physical, social, and psychological effects of varicose veins can lower their bearers' quality of life. Varicose veins have no specific cause. Risk factors include obesity, lack of exercise, leg trauma, and family history of the condition. They also develop more commonly during pregnancy. Occasionally they result from chronic venous insufficiency. Underlying causes include weak or damaged valves in the veins. They are typically diagnosed by examination, including observation by ultrasound. By contrast, spider veins affect the capillaries and are smaller. Treatment may involve lifestyle changes or medical procedures with the goal of improving symptoms and appearance. Lifestyle changes may include wearing compression stockings, exercising, elevating the legs, and weight loss. Possible medical procedures include sclerotherapy, laser surgery, and vein stripping. However, recurrence is common following treatment. Varicose veins are very common, affecting about 30% of people at some point in their lives. They become more common with age. Women develop varicose veins about twice as often as men. Varicose veins have been described throughout history and have been treated with surgery since at least the second century BC, when Plutarch tells of such treatment performed on the Roman leader Gaius Marius.
Signs and symptoms
Aching, heavy legs Appearance of spider veins (telangiectasia) in the affected leg Ankle swelling A brownish-yellow shiny skin discoloration near the affected veins Redness, dryness, and itchiness of areas of skin, termed stasis dermatitis or venous eczema Muscle cramps when making sudden movements, such as standing Abnormal bleeding or healing time for injuries in the affected area Lipodermatosclerosis or shrinking skin near the ankles Restless legs syndrome appears to be a common overlapping clinical syndrome in people with varicose veins and other chronic venous insufficiency Atrophie blanche, or white, scar-like formations Burning or throbbing sensation in the legs People with varicose veins might have a positive D-dimer blood test result due to chronic low-level thrombosis within dilated veins (varices).
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 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% 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
Causes
Varicose veins are more common in women than in men and are linked with heredity. Other related factors are pregnancy, obesity, menopause, aging, prolonged standing, leg injury and abdominal straining. Varicose veins are unlikely to be caused by crossing the legs or ankles. Less commonly, but not exceptionally, varicose veins can be due to other causes, such as post-phlebitic obstruction or incontinence, venous and arteriovenous malformations. Venous reflux is a significant cause. Research has also shown the importance of pelvic vein reflux (PVR) in the development of varicose veins. Varicose veins in the legs could be due to ovarian vein reflux. Both ovarian and internal iliac vein reflux causes leg varicose veins. This condition affects 14% of women with varicose veins or 20% of women who have had vaginal delivery and have leg varicose veins. In addition, evidence suggests that failing to look for and treat pelvic vein reflux can be a cause of recurrent varicose veins. There is increasing evidence for the role of incompetent perforator veins (or "perforators") in the formation of varicose veins and recurrent varicose veins. Varicose veins could also be caused by hyperhomocysteinemia in the body, which can degrade and inhibit the formation of the three main structural components of the artery: collagen, elastin and the proteoglycans. Homocysteine permanently degrades cysteine disulfide bridges and lysine amino acid residues in proteins, gradually affecting function and structure. Simply put, homocysteine is a 'corrosive' of long-living proteins, i.e. collagen or elastin, or lifelong proteins, i.e. fibrillin. These long-term effects are difficult to establish in clinical trials focusing on groups with existing artery decline. Klippel–Trenaunay syndrome and Parkes Weber syndrome are relevant for differential diagnosis. Another cause is chronic alcohol consumption due to the vasodilatation side effect in relation to gravity and blood viscosity.
Diagnosis
Clinical test Clinical tests that may be used include:
Trendelenburg test – to determine the site of venous reflux and the nature of the saphenofemoral junction
Investigations
Traditionally, varicose veins were investigated using imaging techniques only if there was a suspicion of deep venous insufficiency, if they were recurrent, or if they involved the saphenopopliteal junction. This practice is now less widely accepted. People with varicose veins should now be investigated using lower limbs venous ultrasonography. The results from a randomised controlled trial on patients with and without routine ultrasound have shown a significant difference in recurrence rate and reoperation rate at 2 and 7 years of follow-up.
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