Varicose Veins

Approximately 25 million Americans have varicose veins. For some, they're simply a cosmetic concern. But for many others, varicose veins can cause significant pain and discomfort. Sometimes they even lead to more serious problems. Exercise does not cause varicose veins. In fact, exercise may help prevent the problem, while excessive sitting or standing is more likely to aggravate it. The underlying cause is malfunction of the
valves in the veins that normally allow blood to flow only toward your heart. If the valves are defective, blood may pool in the veins, causing them to dilate and become varicose (meaning twisted and swollen).

Most varicose veins develop in the legs near the surface of the skin; they are more common in women than in men. Factors that may contribute to their development include an inherited tendency to defective valves, increased pressure in the veins during pregnancy, obesity and past episodes of clots in the veins (thrombophlebitis).

Fortunately, treatment usually doesn't mean a hospital stay or a long, uncomfortable recovery. New and less invasive techniques generally allow varicose veins to be dealt with on an outpatient basis.

Arteries carry blood from your heart to the rest of your body tissues. Veins return blood from your body to your heart so the blood can be recirculated. To return blood to your heart, the veins in your legs must work against the natural effect of gravity. This is accomplished with the help of muscle contractions in your lower legs (which act as pumps), and elastic vein walls with tiny one-way valves in the veins. The valves open as blood flows toward your heart and close to stop blood from flowing backwards.

As you get older, though, your veins can lose elasticity, causing them to stretch and balloon out. When that happens, the one-way valves may not function properly. Blood that should be moving toward your heart may flow backward, stretching the walls of the veins that may then become visible as varicose veins (varicose comes from the Latin root varix for "twisted").
Varicose veins usually appear between ages 30 and 70 and progressively get worse. Frequently they're hereditary. Women are more likely than men to have them, in part because female hormones tend to relax vein walls. Other contributing factors can include pregnancy, illness, injury and being overweight.

You may have symptoms even before varicose veins appear. Symptoms can include an achy or heavy feeling in your legs and burning, throbbing, muscle cramping and swelling in your lower legs. Prolonged sitting or standing tends to make your legs feel worse.

Bulging varicose veins are often accompanied by itching around the vein. In more advanced stages, open sores (ulcers) may develop around the ankle area. Ulcers represent a severe form of vascular disease and require immediate attention.

In addition, any sudden leg swelling that may or may not be accompanied by pain and redness warrants urgent medical attention, as it may indicate a blood clot.

Unfortunately, once varicose veins start, they don't get better on their own. The best advice if you have them (even small ones), or suspect you have them, is see your vascular specialist. Your doctor may first recommend that you wear compression stockings. In addition, lifestyle recommendations might include:

• Exercise — Get your legs moving. Walking is a great way to encourage blood circulation in your legs. Your doctor can recommend an appropriate activity level for you.
• Weight control — Shedding excess pounds takes unnecessary pressure off your veins.
• Watching what you wear — Avoid high heels. Low-heeled shoes work calf muscles more, which is better for veins.
• Elevating your legs — Take three or four 10- to 15-minute breaks daily to elevate your legs above the level of your heart (for example, by lying down with your legs resting on three or four pillows) as well as elevating your legs at night while sleeping.

Avoiding long periods of sitting or standing — Make a point of changing your
position frequently to encourage blood flow. Wearing of compression hose to assist in returning the blood to the heart and decrease the pressure in varicose veins.

If these methods fail to bring relief of symptoms, newer methods of treating the refluxing greater saphenous vein (large vein in the inner part of your leg) have been very effective. Unlike vein stripping, these methods are relatively painless, done as an outpatient, and result in practically no downtime. Using either a laser probe or a radiofrequency ablation probe, the vein can be collapsed resulting in complete resolution of symptoms in many cases. In addition, bulging varicosities will also resolve once the main refluxing saphenous vein is treated producing much cosmetic improvement.

Albert D. Sam II, MD is a board certified vascular surgeon with Vascular Surgery Associates of Baton Rouge and Total Vein Care.