What Are Varicose Veins?

By Meghal R. Antani, MD

If you're over 40, you probably see them; those little purple veins that suddenly seem to appear on your legs. Veins return blood from the arms and legs to the heart. Because veins work against the force of gravity, they have valves that allow forward blood flow, but not reverse. Your legs and arms have two major types of veins superficial and deep. The superficial veins are near the surface of the skin and are often visible. The deep veins are located near the bones and are surrounded by muscle. Contraction (squeezing) of the muscles in the arms and legs with exercise helps blood flow in the veins.

Varicose veins are enlarged, bulging superficial veins. They are usually located on the inside of the calf or thigh and develop due to weakness of the vein wall and loss of valve function. Under the pressure of gravity, they continue to enlarge, and in the course of time, they may become elongated, twisted, pouched, and thickened.

Spider veins are tiny dilated, veins, usually less than one millimeter in diameter, located at the skin surface.

How Common Are Varicose Veins?

Venous problems are among the most common chronic conditions, and occur in as many as 30% of women and 20% of men. It is estimated that at least 20-25 million Americans have varicose veins.

Symptoms of Varicose Veins

Varicose veins may be entirely symptom-free and cause no health problems. When symptomatic, varicose veins may cause ankle and leg swelling, heaviness or tension, aching, restlessness, cramps, and itching. After a long time, some people develop skin ulcers.

Causes of Varicose Veins

Varicose veins and the associated symptoms are most often the result of venous reflux disease, which refers to blood flow going downwards, instead of upwards, in the veins of the leg.

Risk Factors

The most important factors leading to the development of varicose veins include

Heredity
Prolonged standing
Increasing age
Female gender
Multiple pregnancies.

How Is Venous Reflux Diagnosed?

An ultrasound examination of the leg veins will find venous reflux. Your doctor may recommend an ultrasound if he or she suspects that you have venous reflux disease.

Varicose Veins Treatment Options

New minimally invasive treatments have been developed to reduce the need for surgery. A catheter is threaded into the great saphenous vein at the level of the knee, and passed up to the groin level. Release of radiofrequency or laser energy at the tip of the catheter, as it is shifted from the groin to the knee under ultrasound guidance, results in an effective, long-term closing of the great saphenous vein opening, replacing surgical venous stripping.

Sclerotherapy is an injection of a sclerosing solution into spider veins (telangiectases), reticular, or small varicose veins to block these veins. It is considered a minimally invasive outpatient procedure offering best results in limbs with localized areas of valvular incompetence.