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 09/01/2014

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University of Texas Southwestern Medical Center @ Dallas

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Varicose Veins
 
Basic Facts
Veins located close to the surface of the skin return blood that is low in oxygen to the heart. As people age, these veins may become stretched and distorted.
Varicose veins are unnaturally and permanently distended veins that are visible through the skin on a person's legs and typically appear as blue, bulging, and twisted veins.
When varicose veins become prominent, painful, or inflamed, treatment is usually necessary, especially when skin irritation or ulcers develop.
The word "varicose" refers to a vein that is unnaturally and permanently distended. Vein walls or vein valves near the skin can become damaged from natural stretching or weakening because of the pressure of the blood flowing through the veins. Varicose veins often appear through the skin on a person's legs as blue, bulging and twisted veins; in some cases the veins may be raised or stand out on the surface of the skin.

Spider veins, so called because they look similar to a spider or spider web, are a mild variation of varicose veins. Venules (tiny blood vessels) near the skin's surface may become permanently dilated because of the pressure of blood inside leg veins.

Left untreated, varicose veins can cause tiredness or heaviness in the legs. In severe cases, varicose veins can lead to swollen ankles and scaly dry skin.

RISK FACTORS

People tend to develop varicose veins:
  • Between the ages of 30 and 70;
  • During pregnancy; or
  • If a close family member has a history of varicose veins.
Varicose veins developed during pregnancy often disappear within a year after giving birth; however, multiple pregnancies may increase a woman's risk of developing varicose veins.

Other risk factors:
  • Obesity;
  • Smoking;
  • Leg injury; or
  • Prolonged standing (as in a work environment).
SYMPTOMS

Some of the symptoms of varicose veins may include:
  • A change in the appearance of the skin on the calf or leg;
  • The appearance of small clusters of veins on the leg;
  • An ache or heavy feeling in the affected leg;
  • A burning sensation in the affected leg;
  • A restless feeling in the affected leg; and
  • Night cramps.
People with significant varicose veins may be at a slightly increased risk of deep venous thrombosis (DVT). DVT may cause unusual and sudden leg swelling, which requires immediate medical attention.

DIAGNOSIS

Physicians diagnose varicose veins by asking about symptoms, work and lifestyle habits, and family history of varicose veins or blood clotting problems. The physician performs an examination of the legs, paying close attention to the texture and color of any prominent veins. A tourniquet or direct hand pressure may be used to observe how a person's veins fill with blood. A physician may also order a duplex ultrasound, which allows him or her to visualize vein structure and assess the flow of blood through the veins. This painless, non-invasive test may take up to 40 minutes.

TREATMENT APPROACH

Without treatment, varicose veins tend to worsen. The physician first attempts to treat the symptoms by prescribing non-surgical treatments, such as:
  • Leg elevation
  • Compression Stocking (elastic hosiery)
More extensive or complicated cases of varicose veins may require medical therapy or surgery. Most cases can be treated on an outpatient basis with local anesthetics.

Minimally invasive and surgical treatments may include:
  • Sclerotherapy: In sclerotherapy (chemical sclerosis), the physician injects a chemical substance into the affected veins to harden (sclerose) the veins from the inside out. The veins are no longer able to fill with blood and form a hardened cord, which breaks up naturally and is reabsorbed by the body.
  • Endovascular Ablation: In endovascular ablation (thermal or radio-frequency ablation), the tip of a catheter equipped with electrodes is inserted into an affected vein that has been exposed and pulled through an incision. These electrodes touch the inside of the vein wall, sending bursts of radiofrequency energy through the electrodes. The energy heats the vein walls and destroys the tissue along the length of the vein. The vein is then no longer able to carry blood, breaks up, and is reabsorbed by the body.
  • Vein Stripping: In Vein stripping (saphenectomy), physicians disconnect and tie off all vein tributaries associated with the great saphenous vein through a small incision at the groin crease. Through the incision a stiff but flexible length of wire with an attached head is inserted into the vein. The wire is threaded through the vein and out an incision in the upper calf. The wire is pulled downwards, and the attached head travels through the vein, inverting it and pulling it away from each tributary vein. In this way, the length of vein is removed through the incision in the upper calf.
  • Small incision avulsion: Performed alone or in conjunction with vein stripping, small incision avulsion (vein removal) uses special hooks to pull the veins through many microincisions. The incisions are so small that they can be closed with adhesive strips.
  • Transilluminated powered phlebectomy (TIPP): TIPP is a relatively new ambulatory phlebectomy procedure that uses an intense light to clearly see a person's superficial vein anatomy to pinpoint the location and extent of any varicose veins. The TIPP device allows doctors to suction out the length of the vein through one or two incisions. The procedure requires fewer microinsicions than small incision avulsion.
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