Show Symptoms of Varicose VeinsThe majority of individuals will complain of leg aches at the end of the day, especially after a period of prolonged standing. Symptoms may include: feelings of leg fatigue
With time, darkening or hyperpigmentation around the ankles becomes a classic feature of prolonged varicose veins, and eventually ulceration. Diagnosis of Varicose VeinsVaricose veins can usually be diagnosed by a simple physical examination; however, the cause of the varicose vein requires the use of Doppler (Duplex) ultrasound. This painless test assesses the valve function in the groin, and can also determine how much blood is flowing back into the legs. The test can also determine the structure of your leg veins, as well as the presence of blood clots in the veins. This test can take between 20-30 minutes for each leg. What are varicose veins?Varicose veins are enlarged (dilated) sections of veins which are located just under the surface of the skin - usually on the leg. They are often easy to see, as they look thick and knobbly. They may be less obvious if you are overweight, as they are hidden by fatty tissue under the skin. Varicose veins on legBy self, Public domain, via Wikimedia Commons Other, smaller types of veins which can be noticeable are:
What causes varicose veins?It is thought that the wall of the vein becomes weak in some sections. These sections then widen and become more prominent. If this occurs near a valve then the valve may become leaky and blood may flow backwards. Once this happens at one valve there is extra pressure on the vein. This can cause more widening and more leaky valves. Blood then pools (collects) in the enlarged vein and makes it stand out. About 10-20 out of 100 men and 25-33 out of 100 women develop varicose veins at some time in their lives. More women than men develop varicose veins. Most people with varicose veins do not have an underlying disease and they occur for no apparent reason. However, the chance of them developing is increased with:
Sometimes an underlying disease may cause varicose veins - for example:
What are the symptoms of varicose veins?Most people with varicose veins have no symptoms. Some people are concerned about the appearance of the veins. Larger varicose veins can ache, feel heavy or itch. Are there any complications of varicose veins?Most people with varicose veins do not develop complications. Complications develop in a small number of cases. Complications are due to the higher pressure in the varicose veins causing changes to the small blood vessels in nearby skin. Possible complications include:
First aid for bleeding varicose veins: bleeding happens only rarely. If a varicose vein does bleed then you need to stop the bleeding quickly by doing the following:
TreatmentMost people with varicose veins do not need any treatment. You may want to have treatment for one of the following reasons:
TestsIf varicose veins are problematic, you will usually be referred for assessment by a doctor who is a specialist. You may have a type of ultrasound scan called a Doppler or a duplex scan. This helps to show how the blood is flowing in the veins. It can show whether any of the valves are damaged - which is useful to know when planning treatment. Occasionally, other tests are needed if the veins are complex. If you have arterial disease (poor circulation, or peripheral arterial disease) in your legs, or if arterial disease is suspected, the arterial circulation needs to be measured. This needs to be done before you have treatment which puts pressure on the leg, such as compression stockings (below). The arterial circulation is normally measured by using an ultrasound machine called a Doppler ultrasound, which is used to give a measurement called the ankle brachial pressure index. This test can be done in specialised clinics and also by some nurses and GPs. Treatment optionsThere are several different options. Traditional operations such as vein stripping have largely been replaced by procedures which involve heat, lasers or the injection of chemicals into the vein. Self-help methods. Avoid prolonged standing or sitting still. Try to put your feet up frequently (sit or lie down and raise the feet above the level of your hips). You can, for example, use extra pillows under your feet on a bed or footrest). This helps to reduce blood pooling in the veins. Use a moisturising cream or ointment to protect the skin in the affected area if it is dry, flaky or itchy. Varicose vein treatment techniques have been developed which have a lower rate of complications, such as bruising, compared with traditional surgery. The National Institute for Health and Care Excellence (NICE) recommends that they be used in preference to traditional surgery for people who are having their veins treated for the first time. They include:
Surgery. Traditional surgery is recommended if treatment with heat, lasers or foam does not work. Different techniques can be used to remove the veins, depending on their site and severity. Sclerotherapy. The vein is injected with a chemical that can close and seal (sclerose) it. It was once used as a main treatment but it became clear that it commonly causes skin staining and ulcers. It is now mainly reserved for small veins below the knee which have not been treated properly or have come back after surgery. The vein needs to be compressed afterwards, which involves wearing bandaging or compression stockings for a few days or weeks. Support tights and compression stockings. These counter the extra pressure in the veins. They may help to ease symptoms such as ache, although there is little proof as to how well they work. They may be difficult to put on, particularly by people who have arthritis in their hands. Current guidelines do not recommend that they be used routinely unless treatments to seal the veins are not suitable or do not work. If you do need compression stockings, below-knee class 1 (light) or class 2 (medium) are usually the most suitable. Ideally, they should be put on first thing in the morning, before you get out of bed, then taken off when going to bed at night. Compression stockings are available on prescription or you can buy them. Note: if you have arterial disease in the legs, you will need a medical assessment of your circulation to decide if compression stockings are suitable (see above). |