What are the causes of varicose veins?

Varicose veins are bulging, twisting veins that are frequently blue or dark purple in color.

They occur when defective vein valves enable blood to pool or flow in the incorrect direction.

Varicose veins are believed to affect more than half of all individuals. Varicose veins affect around one out of every four individuals in the United States.

What are they?

Varicose veins
Credit: Getty Images

Varicose veins are bulging, large veins that most commonly develop on the legs and feet. They occur when the valves in the veins fail to function correctly, causing blood to flow inefficiently.

Treatment for varicose veins is seldom necessary for health reasons, but if swelling, aching, and painful legs occur, as well as significant discomfort, treatment is accessible.

There are a variety of choices available, including some natural therapies.

A varicose vein can burst or develop into varicose ulcers on the skin in extreme circumstances. These will need to be treated.

Causes

One-way valves in the veins allow blood to flow only in one direction. The valves may get weaker when the vein walls expand and become less flexible (elastic). Blood can leak backwards and eventually flow in the other way if a valve is damaged. When this happens, blood can build up in the veins, causing them to swell and expand.

diagram of varicose veins
Figure A shows a normal vein with a properly working valve. In Figure B, the varicose vein has a faulty valve, the walls of the vein are thin and stretched.
Image credit: National Heart Lung and Blood Institute.

The veins in the legs, which are the furthest from the heart, are the most commonly impacted. This is due to the fact that gravity makes blood flow back to the heart more difficult. Varicose veins can be caused by any condition that causes strain on the abdomen, such as pregnancy, constipation, and, in rare circumstances, tumors.

Risk factors

Experts are baffled as to why vein walls expand and valves malfunction. It often happens for no apparent reason. However, the following are some possible risk factors:

  • standing for long periods
  • family history of varicose veins
  • obesity
  • menopause
  • pregnancy
  • being aged over 50

The following risk factors have been related to an increased risk of varicose veins:

  • Obesity: Being overweight or obese increases the risk of varicose veins.
  • Age: The risk increases with age, due to wear and tear on vein valves.
  • Some jobs: An individual who has to spend a long time standing at work may have a higher chance of varicose veins.
  • Gender: Varicose veins affect women more often than males. It may be that female hormones relax veins. If so, taking birth control pills or hormone therapy (HT) might contribute.
  • Genetics: Varicose veins often run in families.

Varicose veins and pregnancy

Varicose veins are far more likely to form during pregnancy than at any other period in a woman’s life. Pregnant women have significantly more blood in their bodies, putting additional strain on the circulatory system.

Additionally, changes in hormone levels might cause the blood vessel walls to relax. Both of these variables increase the likelihood of developing varicose veins.

The strain on the veins in the mother’s pelvic region increases as the uterus (womb) expands. The varicose veins usually disappear when the pregnancy is ended; however, this is not always the case, and even if the varicose veins heal, some may remain noticeable.

Treatment

Treatment may not be essential if the patient has no symptoms or discomfort and is unconcerned about the appearance of varicose veins. If there are symptoms, however, therapy may be necessary to relieve pain or discomfort, as well as to address problems such as leg ulcers, skin discoloration, or swelling.

Some patients may seek treatment for cosmetic reasons, such as the removal of “ugly” varicose veins.

Surgery

Varicose veins that are big may need to be surgically removed. This procedure is frequently performed under a general anesthesia. In most circumstances, the patient may go home the same day; however, if surgery on both legs is necessary, the patient may need to stay in the hospital for one night.

Smaller veins, as well as spider veins, are frequently treated using laser treatments. The vein is illuminated with powerful bursts of light that fade and dissipate over time.

Ligation and stripping

The procedure involves two incisions: one in the patient’s groin at the top of the target vein, and the other farther down the leg, possibly at the ankle or knee. The vein’s top is tied off and sealed. A thin, flexible wire is put into the vein’s bottom and pulled out, along with the vein.

This operation normally does not necessitate a hospital stay. Bruising, bleeding, and discomfort are all possible side effects of ligation and stripping. Deep vein thrombosis can occur under exceedingly uncommon circumstances.

Most patients may require 1-3 weeks to heal after surgery before returning to work and other typical activities. Compression stockings are worn throughout the healing period.

Sclerotherapy

Small and medium-sized varicose veins are injected with a substance that scars and shuts them. They should diminish within a few weeks. It’s possible that a vein will need to be injected many times.

Radiofrequency ablation

A tiny incision is made above or below the knee, and a thin tube (catheter) is inserted into the vein with the assistance of an ultrasound scan.

A probe with radiofrequency radiation is inserted into the catheter by the doctor. The radiofrequency radiation warms the vein, forcing its walls to collapse and effectively close and seal it shut. For bigger varicose veins, this surgery is suggested. A local anesthetic is frequently used for radiofrequency ablation.

Treatment with an endovenous laser

The catheter is placed into the vein of the patient. A tiny laser is put through the catheter and positioned at the top of the target vein; it emits brief bursts of radiation that heat the vein and seal it shut.

The doctor threads the laser all the way up the vein with the help of an ultrasound scan, eventually burning and sealing it. This treatment is performed with the use of a local anesthetic. There may be some nerve damage, although it is typically minor.

Transilluminated powered phlebectomy

A special light called an endoscopic transilluminator is put via an incision beneath the skin to allow the doctor to see which veins need to be removed. A suction instrument is used to cut and extract the target veins through the incision.

This treatment can be done with either a general or local anesthesia. After the procedure, there may be some bleeding and bruises.

Home remedies

There are things you may do at home to relieve discomfort and prevent varicose veins from getting worse.

These are some of them:

  • raising the legs
  • avoiding prolonged standing or sitting
  • exercising
  • losing weight

There are several over-the-counter natural therapies available, most of which are topical lotions and emollients.

These can aid with pain relief and comfort, as well as improving the look of varicose veins.

Stockings with compression

Compression stockings help to enhance circulation by compressing the patient’s legs.

They fit snugly around the ankles and loosely up the leg. Compression stockings help blood flow higher, against gravity, and return to the heart in this way.

Compression stockings may relieve discomfort, pain, and swelling, but there is no evidence that they prevent or even slow the progression of varicose veins. The outcomes of studies have been inconsistent and contradictory.

Some people’s skin becomes dry and flaky as a result of wearing pantyhose. It is important to notify a doctor if this occurs.

Symptoms

The majority of the time, there is no discomfort, although varicose veins can cause the following indications and symptoms:

  • the veins are blue or dark purple
  • veins look twisted, swollen, and lumpy (bulging)

Some people may also have the following symptoms:

  • venous eczema (stasis dermatitis) – skin in the affected area is red, dry, and itchy
  • when suddenly standing up, some individuals experience leg cramps
  • a high percentage of people with varicose veins also have restless legs syndrome
  • atrophie blanche – irregular whitish patches that look like scars appear at the ankles
  • aching legs
  • legs feel heavy, especially after exercise or at night
  • a minor injury to the affected area may result in longer bleeding than normal
  • lipodermatosclerosis – fat under the skin just above the ankle can become hard, resulting in the skin shrinking
  • swollen ankles
  • telangiectasia in the affected leg (spider veins)
  • there may be a shiny skin discoloration near the varicose veins, usually brownish or blue in color

Complications

There is a danger of consequences in any condition when adequate blood flow is disrupted. Varicose veins, on the other hand, rarely cause difficulties. If difficulties arise, they may include the following:

  • Chronic venous insufficiency .– Because blood flow is poor, the skin does not effectively exchange oxygen, nutrients, and waste products with the blood. Varicose veins do not cause chronic venous insufficiency, however the two are closely connected.
  • Thrombophlebitis: Inflammation of the vein in the leg is caused by blood clots.
  • Bleeding.

Varicose eczema, lipodermatosclerosis (hard and tight skin), and venous ulcers are all people of chronic venous insufficiency. Venous ulcers usually develop around the ankles and are preceded by a discolored area. It is important to get medical help if you have chronic venous insufficiency.

Prevention

To lower your chances of getting varicose veins, do the following:

  • avoid standing still for too long
  • do not sit with the legs crossed
  • sit or sleep with your feet raised on a pillow
  • get plenty of exercise, for example, walking
  • maintain a healthy weight

Anyone who needs to stand for a long period of time should aim to get up at least once every 30 minutes.

Diagnosis

A doctor’s physical examination, which is primarily visual, will determine whether or not a patient has varicose veins. While the doctor examines the patient for symptoms of swelling, the patient will be invited to stand.

  • Color duplex ultrasound scan: This produces color photos of the vascular anatomy, allowing the clinician to spot any irregularities. It can also determine the rate at which blood flows.
  • Doppler test: An ultrasound scan of the veins to determine the direction of blood flow. This test also looks for blood clots or vein obstructions.

Questions concerning the symptoms may also be asked of the patient. A doctor may recommend a patient to a vascular specialist in some instances.

Sources:

  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1756838/
  • http://dx.doi.org/10.1161/circulationaha.113.008331
  • https://www.medicalnewstoday.com/articles/240129
  • http://www.nhs.uk/Conditions/Varicose-veins/Pages/Treatment.aspx
  • https://www.nice.org.uk/guidance/ipg440
  • http://www.nhs.uk/Conditions/Varicose-veins/Pages/Whatarevaricoseveins.aspx
  • https://www.nhlbi.nih.gov/health/health-topics/topics/vv/atrisk