Everything You Need To Know About Varicose Veins [2020 Version]
No precise figures are known about the number of people with varicose veins. Some studies suggest that 3 out of 100 people suffer from it at some point in their lives. Other studies suggest that this figure could be much higher. Most people with varicose veins have no underlying disease and they usually arise for no apparent reason. Varicose veins do not cause symptoms or complications in most cases, although some people find them ugly. If a treatment is advised, or is desired for cosmetic reasons, a procedure is used that burns it up. There are different procedures: heating, laser techniques or injecting liquids into the varicose veins. These methods have largely replaced the old-fashioned surgical methods.
The normal veins in the legs
Veins are blood vessels that bring the blood back to the heart. Blood flows up through the leg veins into larger veins and towards the heart.
There are three types of leg veins:
Superficial veins, these are the ones just below the skin surface. You can often see or feel the larger superficial veins. The superficial veins in the legs are the ones that can turn into varicose veins.
1. Deep leg veins that run through the muscles. You cannot see or feel this.
2. Connecting veins (perforator veins), which carry the blood from the superficial veins to the deep veins.
3. Inside the larger veins are unidirectional valves in different places. These valves prevent the blood from flowing back in the wrong direction. When we stand there is quite a height of blood between the heart and the legs. Gravity tends to pull the blood back down, but this is prevented by the vein valves and the normal flow of blood to the heart.
What are varicose veins?
Varicose veins are enlarged (dilated) parts of veins that are located just below the surface of the skin, usually on the leg. They are often easy to see because they look thick and knobby. They can stand out less if you are overweight, because they are hidden by fatty tissue under the skin.
Other, smaller types of varicose veins that can become noticeable are:
1. Reticular veins - a closely grouped network of small veins.
2. Couperose or spinach - these look like a spider. They are not official varicose veins.
What are the causes of varicose veins?
It is believed that the wall of the vein becomes weaker in some places. These places widen as a result and increase their presence. If this happens near a valve, the valve may leak and the blood may flow back. As soon as this happens on a single valve there will be extra pressure on the vein. This can cause even more widening and leaking valves. Blood then clumps together (collects) in the enlarged vein and can be seen on the surface of the leg.
Who develops varicose veins?
About 3 in 10 adults develop varicose veins at some point in their lives. Women are more sensitive to developing varicose veins than men. Most people with varicose veins have no underlying disease and they come for no apparent reason. However, the chance of developing varicose veins is increased by:
Pregnancy. This is partly because the baby causes extra pressure on the veins and partly because the hormones that you make during pregnancy tend to relax vessel walls. The more children you have, the greater the risk of developing permanent varicose veins. Varicose veins tend to appear or worsen during pregnancy, but this often diminishes after delivery when the pressure on the veins decreases.
1. Age. Varicose veins occur more often as we get older.
2. Being overweight. This increases the chance of varicose veins.
3. Long standing. Standing occupations often cause varicose veins.
4. Sometimes an underlying disease causes varicose veins, for example:
5. An earlier blood clot (thrombosis) or injury in a deep leg vein.
6. Very occasionally a swelling or tumor in the pelvis (the lower part of the abdomen) which blocks the flow in the veins of the upper leg.
7. Very rarely, varicose veins are the result of abnormal blood vessels - if some veins or arteries are not formed in the normal way.
What are the symptoms of varicose veins?
Most people with varicose veins have no symptoms. Some people are worried about the appearance of the veins. Larger varicose veins can be painful, heavy to the touch or itchy.
Can varicose veins cause complications?
Most people with varicose veins do not develop complications, they only occur in a small number of cases. Complications can arise due to the higher pressure in the varicose veins, as a result of which the small blood vessels in the nearby skin change. If complications do develop, this is ma few years after the varicose veins first appeared. However, it is impossible to predict whether complications will occur. The visible size of varicose veins is not a predictive factor as to whether complications will occur.
Possible varicose veins complaints are:
1. Inflammation of the vein (thrombophlebitis).
2. Swelling of the foot or lower leg.
3. Changes in the skin above the prominent veins. The possible changes to the skin are discoloration, hypostatic eczema, skin ulcers, or lipodermatosclerosis (hardening of the fat layer under the skin, resulting in thickened, red skin).
4. In rare cases, varicose veins may bleed.
Do I need a treatment or referral for varicose veins?
Most people with varicose veins do not need treatment. But you may want a treatment for one of the following reasons:
If complications occur. These occur only in a small number of cases. If the leg swells or the skin changes over prominent veins, treatment is usually advised to prevent a skin ulcer from developing. If a skin ulcer does occur, the treatment of any varicose veins can help heal the ulcer. If you have a varicose vein that has bled, you must be urgently referred for treatment.
By symptoms such as itching or other discomfort.
Cosmetic reasons. You may feel that the varicose veins are ugly. Treatment purely for cosmetic reasons is usually not reimbursed by health insurers.
If you have a combination of both varicose veins that are both problematic and have an arterial condition (poor circulation, or peripheral vascular disease) of the legs. Or if an arterial disease is suspected.
What are the tests for varicose veins?
If varicose veins are problematic, you will usually be referred to a vascular doctor. This will see how the blood flows into the veins by means of an ultrasound scan, such as a Doppler or a Duplex examination. It can show whether one of the valves is damaged, which is needed to determine further treatment. Sometimes other tests are performed if the varicose veins prove to be complex. If you have arterial disease in the legs (poor circulation, or peripheral vascular disease), or if an arterial disease is suspected, the arterial circulation must be measured. This must be done before the treatment begins, as the treatment exerts pressure on the leg, such as support stockings. The arterial circulation is usually measured with an ultrasound machine such as a Doppler ultrasound, which is used to make a measurement called the single arm index. This test can be performed in specialized clinics, as well as by some nurses and general practitioners.
What different treatments are there for varicose veins?
There are various possibilities. Traditional treatments such as vein stripping have largely been replaced by procedures with heat, laser techniques or the injection of liquids.
Avoid standing or sitting still for long periods. Try to raise your feet regularly (sit or lie down and lift the feet above the level of the hips. For example, while lying on the bed you can use extra cushions under the feet). This helps to reduce blood clotting in the varicose veins. Use a moisturizing cream or ointment to protect the skin if it feels dry, flaky or itchy. It is unlikely that weight loss and exercise will make varicose veins disappear, but it can prevent them from occurring at all.
This method involves guiding a probe into one of the longer varicose veins by using ultrasound to guide the position. The laser or radiofrequency energy causes the vein to heat up, thereby sealing it.
Traditional surgery is recommended if treatment with heat, lasers or foam does not work. Different techniques can be used to remove varicose veins, depending on their location and severity. A vascular surgeon will advise you on this. The connecting veins (explained above) are usually tied off. Then the large varicose veins are removed or "stripped" from the leg. Many people can be treated in one day. It may be necessary to take one to three weeks of leave, depending on the work you do.
The varicose vein is injected with a chemical that can close and seal (sclerose) it. It was once used as one of the most important treatments, but it became clear that it often causes spots and sores on the skin. It is now mainly used for small veins below the knee that have not been treated properly or are coming back after surgery. The vein must be compressed afterwards, so that support stockings must be worn for a few days or weeks.