What are varicose veins?
Veins are the blood vessels that return blood to the heart; arteries carry blood from the heart to the tissues. Varicose veins (varices) are widened veins that usually occur on the legs. We speak of varicose veins when clearly visible blue, thickened, usually winding veins are present on the legs.
What do varicose veins look like?
- Small varicose veins often occur in clusters (“spider veins”). By far the most varicose veins are of this type and usually cause no complaints, though they can be felt as cosmetically bothersome.
- Medium varicose veins are up to a few millimetres thick and can be many centimetres long; these too usually give only cosmetic complaints.
- Large varicose veins are often thick “cables”. The best known runs on the inner side of the leg (officially the great saphenous vein).
What complaints do varicose veins cause?
Even very thick varicose veins do not always cause complaints, but when they do these can include a tired, heavy feeling; restless legs; pain; and bleeding from the varicose vein (for example after a knock). When there are complaints, it is important to have further investigation done.
Who gets varicose veins?
Several factors matter. Hereditary predisposition: varicose veins are often hereditary; an inborn weakness of the vein walls can lead to them. Because humans stand upright, gravity puts a lot of pressure on the walls of the veins in the lower legs; normally the valves in the veins absorb this pressure, but if the walls are not firm enough the valves cannot function well and their function decreases or disappears. Standing: people who must stand a lot (for work) have an increased chance. Sex: women develop varicose veins more often than men. Pregnancy: changed hormone levels can make the vein walls slacker, the growing womb can hinder the return of blood, the circulating blood volume is greater, and the risk of thrombosis is higher. Thrombosis: a clot in the (usually deep) veins can destroy the valves at that spot, raising pressure on the valves below, which can then also fail, eventually leaving a long stretch of vein without working valves; the pressure passes to the superficial veins, which widen into varicose veins, often with skin changes such as dark spots, eczema and ankle swelling — a possible precursor of a leg ulcer.
Is further investigation needed?
Before treatment it is important to establish which form of varicose veins is involved. Often the doctor can already see with the naked eye whether further investigation is needed. The main additional investigations are Doppler (ultrasound making the blood flow audible, quick and simple) and duplex (the current gold standard, which makes the blood flow visible so leaky valves can be traced better).
How are varicose veins treated?
- Sclerotherapy (“injecting shut”). A kind of “glue” is injected into the vein, which is then pressed shut, closed off and eventually cleared by the body. Mainly small and medium varicose veins are suitable. A pressure bandage must be worn for a period (usually 1–2 weeks), possibly with a compression stocking.
- Surgery (“stripping”). Large varicose veins can be removed surgically. Since the arrival of endovenous techniques this classic method is used much less. It is done under general or spinal anaesthetic, followed by wearing a fitted compression stocking for a few weeks.
- Endovenous laser therapy (EVLT). The vein is elegantly closed from the inside with laser instead of being stripped out. A big advantage is that general anaesthetic is usually not needed, as it can be done under local anaesthetic via a small skin incision; the remnants are then cleared by the body.
- Radiofrequency closure. A modern, proven, minimally invasive method: through one small incision a catheter is advanced into the vein, checked with ultrasound, and high-frequency radio waves heat and shrink the vein wall as the catheter is withdrawn, closing the whole vein. It is a short treatment (30–60 minutes) with generally good results.
- Ambulatory phlebectomy. Essentially the “stripping” technique applied to smaller varicose veins not suitable for sclerotherapy or classic stripping, especially medium veins at the knee and on the top of the foot; it can be done under local anaesthetic.
- Transcutaneous laser therapy. The very smallest varicose veins (spider veins) do not always respond well to sclerotherapy and can now be treated with sufficiently powerful lasers.
How do I prevent varicose veins?
Prolonged standing encourages varicose veins, so plenty of movement is important — especially exercises that regularly tense the calf muscle, such as walking and cycling, which promote good circulation and reduce pressure in the veins. People with a predisposition can wear compression stockings as a precaution when they have to stand or sit a lot.
When to see a doctor
See a doctor if varicose veins cause pain, heaviness, swelling, skin changes at the ankles, or bleeding, or if you would like advice on treatment options.