By appreciating the impact of varicose veins on quality of life and by recognizing vein health as an important component of general health, individuals can implement practices to reduce severity of symptoms and prevent disease progression. The greater awareness and consideration for prevention of chronic venous disease serve as the reasons for increased discussion of the importance of vein health in overall wellness.
Current management of varicose vein is quite effective at controlling symptoms and limiting disease progression. However, treatment does not prevent varicose veins from recurring and new veins from forming. Understanding how to advocate for overall vein health is a long-term prevention strategy that will benefit millions of people at risk for chronic venous disease. This potential impact exists because it is known that the natural history of varicose veins can lead to various symptoms and complications that have a substantial effect on quality of life.
Recent advances in medical technology and a vastly changing health care landscape require a solid understanding of both the current management of varicose veins and the importance of vein health in overall wellness. This paper serves to encourage recognition of varicose veins as a chronic disease and to stir conversation regarding its interplay with systemic health.
Varicose veins are a perennial problem. They affect people across the globe. Healing practices date back to antiquity, yet health care providers and researchers are still learning about the causes and possible management of varicose veins. People with varicose veins may endure painful symptoms, such as aching, swelling limbs, and skin changes in the lower extremities. Also, patients with varicose veins are at risk for venous disease progression and, in some of the worst-case scenarios, the sores or skin ulcers on the lower legs.
Understanding Varicose Veins
Although the cause of varicose veins is not clear, there are many contributing factors. Heredity is the most significant factor in the development of varicose veins. If other family members had varicose veins, it increases the chance of developing the condition. Another leading cause of varicose veins is age. Over time, the wear and tear on the valves in the veins can cause them to weaken. While there is nothing that can be done to prevent varicose veins related to heredity and age, there are many preventive measures that can decrease the chance of developing the condition. The most effective preventive measure is exercise. Since weak muscles can increase the risk of varicose veins, it is important to keep legs toned and maintain a healthy weight. This can be done through many forms of exercise including walking, swimming, and cycling. Another measure to prevent varicose veins is the avoidance of prolonged standing and sitting. When standing or sitting for long periods of time, it is important to change positions and not remain stagnant. This helps to keep blood flowing evenly. Compression stockings are another resource widely used to prevent and manage varicose veins. These stockings are aimed to squeeze legs, helping to prevent the build up of excess blood.
Varicose veins are a condition very prevalent among adults, especially those over the age of 45. Over time, the walls of the veins become thicker and lose their elasticity. When the valves are weak or damaged, blood can back up and pool in the veins, causing them to swell. This can happen in any vein, but it most commonly occurs in the legs. The many long hours of standing and increased pressure on the legs seem to make varicose veins more prevalent. These symptoms are much more severe than symptoms of pre-surface veins. Those with the condition are likely to develop it further, and a small percentage of these veins lead to more serious conditions.
Causes of Varicose Veins
Damaged valves are not the only cause of varicose veins. Just as habits and lifestyles can affect your heart health, they can also affect your vein health. Again, obesity can put unnecessary added pressure on the veins and weakens them. This also applies to posture, as standing and sitting for extended periods of time can cause the veins to work harder to pump blood to your heart. This can result in higher pressure on the veins, potentially causing vein damage and hence varicose veins.
Abnormal or damaged valves can cause varicose veins. Arteries carry blood from your heart to the rest of your tissues and cells throughout your body, so they are subjected to pumping from the heart. Veins return the blood from the rest of your body to your heart, with valves in these veins preventing blood from flowing backwards. If the valves are damaged or not functioning correctly, blood can flow in a backward movement and begin to pool in the vein. This is called venous insufficiency. This backed up pressure causes the veins to become weak and is a leading cause of varicose veins.
Symptoms and Risk Factors
The primary cause for the existence of varicose veins is venous reflux or pooling, which is caused by incompetent or faulty valves within the veins. In order to understand how this comes about, we first need to understand how our vascular system functions. Deep within our muscles lie an intricate web of veins and venules that have the job of returning deoxygenated blood back to our hearts and lungs for it to be oxygenated once more. This vascular system combines the intertwining of our deep and superficial veins, which are linked by perforators: small but important veins that run through the muscles, connecting the superficial veins to the deep veins.
The long, irregular, bulging, blue or purple swollen blood vessels seen within our skin are widely recognized as varicose veins. However, there is more to understanding varicose veins than being aware of their existence and appearance. In this lecture, we will discuss what varicose veins are, how they come about, their symptoms, and their risk factors. We will try to go into as much detail as possible. At the end of this lecture, you should have a firm understanding of what this condition is all about.
Complications Associated with Varicose Veins
– Venous Eczema: This is a common complication and is actually a skin disease in its own right. It is caused by a buildup of pressure in the veins and is often seen in the ‘gaiter area’ of the leg. The gaiter area is located at the bottom of the leg just above the ankle and extends up to the mid-calf. The name is given to an area which is prone to skin changes as it is often irritated by shin pads and boots. The eczema is due to the fact that white blood cells release an enzyme into the skin to try and break down the iron deposits and, in doing so, cause damage to the skin tissue. This results in a red, brown, and/or purple discoloration of the skin in addition to itching and dry skin.
– Changed pigmentation: If there has been high pressure in the veins, this can cause leakage of red blood cells into the surrounding tissue. This, in turn, will cause the iron contained within the cells to separate from the hemoglobin. It is the iron which gives the pigmentation, and therefore this results in reddish-brown patches on the skin. In more severe cases, this can lead to dermatitis, which is an inflammation of the skin. This is due to the fact that the iron is an irritant to the skin tissue.
The complications associated with this condition are likely to develop after a longer period of time has elapsed. The more severe the vein, the higher the chance of reaction. The principal complications are:
Importance of Vein Health
Though varicose veins are the main target of treatment by most patients and physicians, it is important to recognize that they are only a single manifestation of chronic venous disease. There is evidence to suggest that the elimination of visible varicosities does not guarantee the patient freedom from symptoms or the progression of disease. This is due to the fact that varicose veins are a part of a complex network of superficial and deep venous systems, and often the source of bulging varicose veins is a more serious refluxing or obstructive valve in a higher, non-visible vein. It is therefore reasonable to originally address the status of vein health with any venous condition in order to improve the long-term health of the entire venous system.
Vein health is an undeniably significant field of study, but it is also well known that venous disorders are so common as to become almost ubiquitous. Whether a patient is seen regarding a potentially life-threatening pulmonary embolism, comparatively benign cosmetic spider veins, or aching varicose veins, the fact that they sought medical attention indicates a need for relief and treatment. It is widely understood that in the absence of suitable intervention, most venous conditions tend to worsen over time. Consequently, more severe symptoms such as edema, skin changes, and ulceration will inevitably take their toll. This will often lead to a decreased quality of life and possibly disability for affected individuals. Improvement in vein health can avert these consequences and is therefore an important goal for better overall health.
Impact on Overall Wellness
In addition, vein disease, varicose veins, and the more severe chronic venous disease affect job productivity and work absenteeism. Measures for lost productivity are not merely those of retirement age but significantly affect the working population. This lost productivity poses a significant economic impact on society and the relationship is not merely an effect to be noticed, the root cause of these symptoms must be identified and treated. The overall negative impact of venous disease states the promotion of venous health and well-being is an important way to minimize the personal and societal impact of venous disease. Quality of life can be restored to those suffering symptoms and simultaneously prevent progression of symptoms to a much severer state.
Women tend to be affected more than men. Chronic symptoms are likely to have a significant impact on physical functioning, emotional well-being, and overall quality of life. Limitations in walking, social function, and physical role functioning were significantly greater with an increasing pattern in those with more severe disease. Women with VV (varicose veins) also appear to have greater pain, general health, and disease severity compared to men. Measures for quality of life are notably lower with higher clinical class (CEAP) which correlates vein disease to impact on overall well-being.
Veins are blood vessels that carry deoxygenated blood from various parts of the body back to the heart towards oxygen and nutrient replenishment. A belief in Western culture has been that varicose veins are simply a cosmetic issue, that the twisted, bulging, sometimes painful veins are not harmful and there’s no reason to fix them. This belief could not be more incorrect. Multiple studies have shown varicose veins to have a significant damaging effect on quality of life. Symptoms may include a combination of painful, heavy, tired, restless or achy legs, swelling, night cramps, skin pigmentation changes and restless legs.
Preventive Measures for Vein Health
Exercise regularly. This helps maintain good overall health. Walking is the best and most relevant form of exercise for those with or at risk of developing varicose veins. Try to avoid excessive sunbathing, saunas or long spells of immobility (such as sitting at a desk for several hours) as high temperature environments and hip or waist constricting positions can provoke the dilation of veins and pooling of blood. This is because the function of the veins in the legs (to return blood to the heart) becomes compromised as the pressure in the veins increases and vein wall is weakened. Avoid tight clothes, especially those that are tight around the waist, groin, and legs. This can help to avoid the aforementioned pooling of blood caused by the constriction of veins. Treatment of chronic venous insufficiency at any stage can help to prevent the progression of the condition and development of more severe symptoms.
Eat properly. A high fiber diet low in fat and sugar is an important factor in managing your venous health. High fiber diets help to avoid constipation (a factor in varicose veins). Also, reducing sugar and fat intake will help to control your weight, thus preventing one of the many risk factors for varicose veins, obesity. Obesity-induced hypertension is also a key factor in the development of varicose veins, particularly during middle age.
Treatment Options for Varicose Veins
Surgery is the most invasive treatment for varicose veins. As technology has progressed over the years, vein stripping is becoming less common, and more modern surgical procedures are increasingly being used. Vein stripping is an older form of surgery. It is carried out by making incisions to tie off and remove veins. It is an effective treatment; however, there is a high likelihood for the varicose veins to return since the underlying problems that caused the veins still remain. Recovery times for vein stripping surgery can range anywhere from 1-4 weeks.
The final and most high-tech non-surgical treatment is through Endovenous Laser Treatment (EVLT). This treatment is a very effective alternative to old-fashioned surgery. It is minimally invasive and highly effective. A thin fiber is inserted into a damaged vein to administer laser energy. This will cause the vein to close and seal shut. Blood flow will then naturally be redirected to other healthy veins. This treatment is fast, sometimes taking only 10 minutes, and is done as an outpatient procedure. EVLT has a 95% success rate and will relieve symptoms of varicose veins. Post-treatment, there may be some minor pain or bruising, but that should only last a few days.
The second non-surgical treatment is Sclerotherapy. This has been practiced since the 1930s and is still regularly used for the treatment of varicose and spider veins. It involves the injection of a solution into the vein. The solution will cause the vein to scar and collapse, forcing blood to reroute through healthier veins. The vein which is affected will fade within a few weeks, although in some cases it can take a month or more. Up to 15-20 injections can be administered in one session, although this varies from case to case.
“Before there was modern-day surgery, there were only a few options with very high recurrence rates. The introduction of newer technology to provide minimally invasive treatments has made a world of difference.” Under the non-surgical treatments, we are discussing three main treatments available. The first is through the use of support stockings. This form of treatment will not cure varicose veins; however, it will help ease symptoms. It is relatively inexpensive compared to other treatments and not invasive at all to the patient. Support stockings work by providing a level of graduated compression to the leg. It assists in preventing blood from re-accumulating in the veins, reduces swelling, and aids in preventing further damage to the veins.
Non-Surgical Treatments
High ligation and stripping, a more invasive surgical treatment for saphenous vein reflux, has potential for more serious complications and a painful recovery, and should be considered a last resort. This will not be covered in this essay, as these are surgical treatments, and the clear trend in modern treatment of varicose veins is to avoid surgery when possible.
High ligation and ambulatory phlebectomy are outpatient procedures often performed together to treat a vein that is causing symptoms or health problems. This is usually done on larger more symptomatic varicose veins, and is often a treatment for saphenous vein reflux. It is minimally invasive, requires only local anesthesia, and is very effective. With high ligation, the vein is tied off at its connection to the deep venous system, which is usually near the knee. This prevents the vein from causing further problems, and the blood that was once carried by the problematic vein will now be carried by other healthy veins. If the tied off vein is superficial, it may harden and become a bit tender before it fades away, and this might be helped by doing some of the foam sclerotherapy on the remaining varicosities. Phlebectomy involves removing the vein by making small punctures or incisions, and the incisions seldom need any stitches. This is accomplished by pulling the vein out with a special tool. The two procedures leave minimal scarring, promote rapid recovery, and a quick return to normal activity.
Another method of treating superficial varicose veins is with a technique called sclerotherapy. This procedure has been available for many years and is a time-proven treatment for spider and varicose leg veins. A solution is injected directly into the varicosities, causing the vein to clot and then become a scar that fades away with time. Newer techniques of foam sclerotherapy are more effective than older methods of saline or liquid sclerosants, and can be done under an ultrasound for better visualization of the targeted vein. With foam sclerotherapy, a small amount of a foam solution is inserted into the vein and causes the vein to spasm, shut its valve, and eventually become fibrous tissue. This method is useful for deeper larger veins as well.
Once the evaluation is complete and it has been determined that a patient would be served best by a non-surgical approach, there are several options that work well. Because mild varicosities tend to get worse with time, causing more symptoms and sometimes leading to blood clots or pigmentation changes, medical support hose are often prescribed. Hose work by applying external pressure to the leg muscles and veins, helping to keep the blood in the vein flow moving towards the heart. They minimize swelling in the lower legs and help prevent clots. Elastic bandages can be used in a similar fashion.
Surgical Procedures
Ambulatory phlebectomy is an outpatient surgical procedure that removes varicose veins on the surface of the legs. Local anesthesia is used while the patient is awake. This procedure involves making micro-incisions and using a tool to remove the affected veins. The incisions are so small that stitches are not needed. Elastic bandages are worn following the procedure, and normal activity can be resumed in one to two days. This procedure carries a high rate of patient satisfaction and is an effective treatment for large surface veins.
Radiofrequency ablation and endovenous laser treatment are newer procedures that are minimally invasive. Both procedures involve placing a catheter inside the vein to be treated. Using ultrasound guidance, your physician will direct the catheter into the correct location and then apply radiofrequency or laser energy to the vein. This will cause the vein to close, and the blood will initially reroute to other healthy veins. The procedure will take about an hour and is done in the doctor’s office. Patients are able to walk immediately after the procedure and can resume normal activity in one to two days. These procedures have a 90-95% success rate at one to five years of follow-up.
