Varicose Veins: Complications, Treatment and Prevention

Varicose veins are swollen, twisted, blue-in-colour blood vessels under the skin. They most commonly occur in the legs and feet.

Veins have one-way valves inside of them that open and close to keep blood flowing toward the heart. When weakened or damaged, valves or walls in the vein cause blood to pool or even to flow backwards (reflux). Varicose veins occur when veins have grown larger and have become distorted (NIH n.d.).

Note that while they mainly appear in the legs, varicose veins can also occur in the:

• Rectum (haemorrhoids);
• Testicles (varicoceles);
• Oesophagus, stomach or liver.

(NIH n.d.)

Spider Veins

Closely associated with varicose veins are ‘spider veins’. Spider veins occur when blood that collects in varicose veins leaks into smaller blood vessels (capillaries) and enlarge them. Spider veins are smaller and closer to the surface of the skin, they are often found on the face or legs (Healthdirect 2018).

Why are Varicose Veins Most Common in the Legs?

As veins in the legs are far away from the heart, blood is working against gravity for a long distance, making it more difficult for blood to flow upwards (Brazier 2017; Office on Women’s Health 2019.

What Are the Complications of Varicose Veins?

Any situation in which blood flow is restricted or undermined is cause for concern. Complications of varicose veins include:

• Bleeding
• Thrombophlebitis (blood clots that cause inflammation)
• Chronic venous insufficiency

(Brazier 2017)

Why Do People Get Varicose Veins?

The exact reason why varicose veins occur in certain people is unknown. However, there is considerable evidence to support the claim that genetic links and a past history of deep vein thrombosis (a blood clot that occurs in a deep vein) are predictors for this condition (Wright & Fitridge 2013).

Risk Factors

Women are more likely to get varicose veins than men (Office on Women’s Health 2019), it may be that female hormones dilate veins. If this is the case, birth control pills or hormone therapy could contribute to the likelihood of developing varicose veins (Brazier 2017).

Other risk factors include:

• Pregnancy;
• Having a family history of varicose veins;
• Being over 50; and
• Obesity.

(Brazier 2017; Healthdirect 2018)

Varicose Veins Symptoms

• Bulging, bluish veins;
• Aching, throbbing or burning leg pain;
• Heaviness, cramping or restless legs;
• Swollen ankles;
• Varicose eczema or venous eczema;
• Skin ulcers;
• Blood clots; and
• Bleeding from the affected vein.

(Healthdirect 2018; Better Health Channel 2018; Brazier 2017; NIH n.d.)

Diagnosing Varicose Veins

To diagnose varicose veins, a general practitioner (GP) will do a physical examination and request the following information:

• Symptoms;
• Family history;
• Activity levels; and
• Lifestyle.

(NIH n.d.)

A GP might assess the health of the leg veins using ultrasound or other imaging tests such as an x-ray or computed tomography (CT) scan (NIH n.d.).

Varicose Veins Treatment

Treatment options range from conservative to surgical approaches. Varicose veins are a progressive disease, so they will steadily worsen. Complications develop in a relatively small number of cases and may prompt the patient to seek medical care (NIH n.d.).

Treatment options include:

• Lifestyle changes: aiming for a healthy weight; avoiding standing or sitting in the same position for long periods; being physically active.
• Sclerotherapy to close off a vein: injecting medication to seal or close veins. Complications include changes to skin colour and in rare cases, venous thromboembolism, nerve damage, serious allergic reaction, or stroke.
• Endovenous ablation: uses lasers or radiofrequency energy to seal the appropriate vein.
• Complications include bruising, pain and changes in skin colour. Serious complications including numbness, venous thromboembolism, and skin burns can occur but are uncommon.
• Surgery: removing veins near the surface of the skin by making small cuts or punctures.

(Healthdirect 2018; NIH n.d.)

The aim of treatment is to relieve symptoms and improve appearance, and prevent complications such as serious skin ulcers or sores; deep vein thrombosis; skin colour changes; and bleeding (NIH n.d.).

Note that bleeding from varicose veins is considered a medical emergency (NIH n.d.).

Age, general health condition, and symptomatology will be deciding factors for the route of treatment for people living with varicose veins (NIH n.d.).

Varicose Veins Prevention

While it is not entirely within a person’s control to prevent varicose veins, the following may help to reduce the risk of developing them or developing more:

• Wear compression stockings;
• Manage weight;
• Exercise often;
• Change sitting, standing positions regularly;
• Avoid wearing high heels for extended periods of time;
• Elevate legs when resting;
• Avoid crossing legs while sitting.

(Healthdirect 2018; Better Health Channel 2018)

References

• Better Health Channel 2018, Varicose Veins and Spider Veins, Better Health Channel, viewed 9 December 2019, https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/varicose-veins-and-spider-veins
• Brazier, Y 2017, ‘What Can I Do About Varicose Veins?’, Medical News Today, viewed 9 December 2019, https://www.medicalnewstoday.com/articles/240129.phphttps://www.medicalnewstoday.com/articles/240129.php
• Healthdirect 2018, Varicose Veins, Healthdirect 2018, viewed 9 December 2019, https://www.healthdirect.gov.au/varicose-veins
• National Heart, Lung, and Blood Institute (NIH) n.d., Varicose Veins, NIH, viewed 9 December 2019, https://www.nhlbi.nih.gov/health-topics/varicose-veinshttps://www.nhlbi.nih.gov/health-topics/varicose-veins
• Office on Women’s Health 2019, Varicose Veins and Spider Veins, Office on Women’s Health, viewed 9 December 2019, https://www.womenshealth.gov/a-z-topics/varicose-veins-and-spider-veins
• Wright, N and Fitridge, R 2013, ‘Varicose Veins: Natural History, Assessment and Management’, Australian Family Physician, viewed 9 December 2019, https://www.racgp.org.au/afp/2013/june/varicose-veins/

(Answers: b, e, e)