What are the causes
What is the treatment for varicose veins
Surgical FAQ
View and print brochure
Varicose veins are a common disorder. They can be found in more than 50% of men and more than 66% of all women. They are the result of a higher than normal pressure in the venous tree; underscoring the fact that varicose veins are a manifestation of venous disease and not just a cosmetic problem.
Early venous hypertension may present with tiny, dilated veins (spider veins), particularly common on the sides of the legs. Dilated tortuous veins begin to appear with time. These veins may ache, burn, itch, or cause mild swelling, heaviness, or fatigability. Gradually, over years, symptoms become worse with the development of larger and more varicose veins with eventual thickening of the skin of the lower leg above the ankle. These changes are associated with bronze pigmentation. Eventually, the skin begins to break down forming painful ulcers. Increasing swelling of the leg is usually found. These progressive changes are related to increasing pressure in the venous system.
What are the causes?
Varicose veins are related to genetic background, female hormones and life style or job. There are basic defects in the strength of vein walls in patients with a genetic history of varicose veins. Progesterone, the hormone of pregnancy and found in the second phase of the menstrual cycle, causes dilatation of varicosities when varicose veins are present. The presence of the fetus in late pregnancy leads to pressure on the veins in the pelvis and abdomen and subsequent high vein pressure.
Jobs where one stands for long periods each day (waitress, nurse, dental technician, surgeon) leads to passive dilatation of the superficial veins of the legs. The veins of the legs have valves to prevent blood from flowing backward toward the feet under the influence of gravity. Dilatation of the veins cause the valves to become incompetent or leaky, and as a consequence leads to a higher pressure further down the leg. Like dominos, more veins become dilated with failure of more valves and higher pressure. Eventually, veins underneath the skin connecting to the veins deep within the leg, called perforating veins, dilate with failure of their valves. At this point, symptoms can get much worse, because the muscles of the calf can force blood through these perforating veins at a much higher pressure than that of gravity. Normally this will not happen because of the protective valves. It is at this time that advanced changes begin to occur.
What is the treatment for varicose veins?
Treatment is directed toward eliminating the venous hypertension. This is achieved in a number of ways, such as injection of smaller dilated reticular veins and varicose veins or surgical removal of the veins. Often, the source of the high pressure is an incompetent greater saphenous vein in the thigh. This vein may not become varicosed because it is located beneath a firm sheath of tissue. The greater saphenous vein is removed along with the varicose veins. The procedure is often referred to as “ligation and stripping.” Obliteration of the greater saphenous vein can also be achieved using catheters that have hot tips, heated by laser or radio frequency.
Surgical FAQ
“Don’t I need the greater saphenous vein for possible coronary artery bypass in the future?
The greater saphenous vein is usually dilated and too large to be used as a bypass. Also, varicose veins will usually reoccur rapidly if the incompetent greater saphenous vein is not removed.
“What happens to the circulation of blood when the saphenous vein is removed?
Remember, the incompetent saphenous vein is leaky. It permits blood flow backward, down the leg, rather than in the normal fashion toward the heart. There are major veins deep in the muscle compartments of the leg which provide the primary pathway for blood flow out of the leg. These vessels are unaffected by the operation and continue to allow return of blood. Removal of the greater saphenous vein actually improves the efficiency of the venous return.
Back to top