Veins return blood to the heart from various parts of the body. Legs specifically have to overcome gravity in order to perform this function and receive help from muscles of the calf. There are valves that prevent the back-flow of blood. Sometimes, due to stretching of veins near the skin surface, the valves do not close properly leading to bi-directional blood flow (known as venous reflux). This reflux may result in varicose veins, which are tortuous, widened, bulging veins in the subcutaneous tissues.
Prevalence of varicose veins is approximately twice as high in women when compared to men. The reason for this could be attributed to more frequent hormonal changes in women through puberty, use of birth-control pills, pregnancy and menopause.
Varicose veins are usually harmless but are often a common cause of cosmetic concern in patients. Few patients may experience heaviness and ache in legs. Swelling and pain may occur after prolonged periods of standing. In advanced cases, brown spots/patches may appear on the skin that ultimately turns reddish/bluish due to altered blood flow. Itching and scaling of the skin occur in tender areas.
For testing to be done, while it is advisable to consult a healthcare provider at the onset of symptoms, medical treatment may not always be essential. Pay attention to the advancing stages of the condition. Visit your doctor immediately if you notice ulceration, eczematous changes as these may lead to serious chronic sequelae such as lipodermatosclerosis, thrombophlebitis, and superficial vein thrombosis.
Varicose veins are usually diagnosed with the patient in a standing position, which causes the veins to fill and become more visible. In cases where further treatment is required, a vascular ultrasound is used. It is a non-invasive test that uses sound waves, is conducted to detect veins with valves showing reflux.
Look for sensations like aches, tightness, burning, itching, tingling, etc. in legs and calf muscle. Symptoms are usually worse at the end of the day after the patient has been sitting or standing for long periods of time. Pay attention to skin discoloration in legs/feet.
In early stages, patients may be advised to use compression stockings or bandages (tight and stretched). However, such stockings only temporarily relieve the associated symptoms but do not treat the condition. Conventional treatments involve venous stripping, which is a surgical approach to the treatment of the tortuous veins.
Recently, minimally invasive options such as endovenous ablation using LASER, ultrasound-guided foam sclerotherapy are gaining popularity and becoming a choice of treatment.
Dealing with it
Maintain a healthy weight. Regular exercise such as walk is important to maintain blood flow to the legs. If pain and swelling make exercising difficult, basic leg movements-like moving the foot up and down at the ankle and leg lifts may be done at home. Keep legs raised while sitting and avoid letting the affected leg hanging down.
As previously mentioned, self-care by maintaining optimal weight, exercising, not wearing tight clothes, high heels will prevent occurrence of or worsening of varicose veins. However, it is important to understand that while light to moderate physical activity benefits the condition, strenuous exercise might make varicose veins worse.
Courtesy: this article is given by Dr Rajan Modu, M.S. Consultant, Vein clinic, Zen Hospital, Mumbai.