Varicose Veins – Simple Explanations & Answers from the Leg Pain Guide

Varicose Veins WWW Guide

The Only Web Resource You Will Need for Varicose Veins – from Leg Pain Guide

Comprehensive Details on Varicose Veins, Over a Dozen Videos & 100+ Useful Links

In Simple Terms, What are Varicose Veins? Varicose veins occur when your veins become enlarged, dilated, and overfilled with blood. Varicose veins typically appear swollen and raised, and have a bluish-purple or red color. For many people, varicose veins are simply a cosmetic concern. For others, varicose veins can cause aching pain and discomfort. Sometimes varicose veins lead to more-serious problems. Any vein may become varicose, but the veins most commonly affected are those in your legs and feet. That’s because standing and walking upright increases the pressure in the veins of your lower body. Varicose veins are a relatively common condition, and for many people they are a family trait. Women are at least twice as likely as men to develop them. In the U.S. alone, they affect about 25% of all Americans. Tell Me Some More Relevant Details about Varicose Veins Varicose veins usually present themselves as bulging, bluish cords running just beneath the surface of your skin. They almost always affect legs and feet. Visible swollen and twisted veins are considered superficial varicose veins.

An image of a varicose affected vein before and after treatment

Image Credit: Fitness Health 101

Veins, which transport blood to the heart, have pairs of leaflet valves to prevent blood from flowing backwards. Leg muscles pump the veins to return blood to the heart, against the effects of gravity. When veins become varicose, the leaflets of the valves no longer meet properly, and the valves do not work. This allows blood to flow backwards and they enlarge even more.

The image below explains this better

Image Credit: Advanced Vein Center

Varicose veins are most common in the superficial veins of the legs, which are subject to high pressure when standing. Besides the surface network of veins, also called the superficial veins, your legs also have an interior, or deep, venous network. On some occasions, an interior leg vein becomes varicose. Such deep varicose veins are usually not visible, but they can cause swelling or aching throughout the leg and may be sites where blood clots can form. Varicose veins are distinguished from blue veins and spider veins by the size and location of the veins.

An excellent video that gives a detailed explanation of varicose veins

https://www.youtube.com/watch?v=XvSqZJhKUTo How Serious a Problem is Varicose Veins? In many cases, varicose veins are harmless. When inflamed, they become tender to the touch and can hinder circulation to the point of causing swollen ankles, itchy skin, and aching in the affected limb. But they can become more harmful in some cases, and result in the following:

• Ulcers – Extremely painful ulcers may form on the skin near varicose veins, particularly near the ankles. Ulcers are caused by long-term fluid buildup in these tissues, caused by increased pressure of blood within affected veins. A discolored spot on the skin usually begins before an ulcer forms. See your doctor immediately if you suspect you’ve developed an ulcer.
• Blood Clots – Occasionally, veins deep within the legs become enlarged. In such cases, the affected leg may swell considerably. Any sudden leg swelling warrants urgent medical attention because it may indicate a blood clot.
• Bleeding – In some cases, veins very close to the skin may burst. This usually causes only minor bleeding. But, any bleeding warrants medical attention because there’s a high risk it can happen again.
• Pain, tenderness, heaviness, inability to walk or stand for long hours, thus hindering work
• Development of Carcinoma or Sarcoma in Longstanding Venous Ulcers – These are however relative rare.
• Acute Fat Necrosis – this, referring to damaged or dead tissues, can occur especially at the ankle of overweight patients with varicose veins. Females are more frequently affected than males.

How are Varicose Veins Formed? To help circulate oxygen-rich blood from the lungs to all parts of the body, your arteries have thick layers of muscle or elastic tissue. To push blood back to your heart, your veins rely mainly on surrounding muscles and a network of one-way valves. As blood flows through a vein, the cup-like valves alternately open to allow blood through, then close to prevent backflow. In varicose veins, the valves do not work properly — allowing blood to pool in the vein and making it difficult for the muscles to push the blood “uphill.” Instead of flowing from one valve to the next, the blood continues to pool in the vein, increasing venous pressure and the likelihood of congestion while causing the vein to bulge and twist. Because the superficial veins have less muscle support than deep veins, they are more likely to become varicose. Varicose veins often affect the legs, as the veins there are the farthest from your heart, and gravity makes it harder for the blood to flow upward.

A video that tells in a nice way how varicose veins are formed

https://www.youtube.com/watch?v=hI3O-aPZwk8

Another nice video on how varicose veins are formed – from BUPA

https://www.youtube.com/watch?v=Ce2TjGY-r1o What are the Key Causes and Risk Factors for Varicose Veins? Any condition that puts excessive pressure on the legs or abdomen can lead to varicose veins. The most common pressure inducers are pregnancy, obesity, and standing for long periods. Chronic constipation and — in rare cases, tumors — also can cause varicose veins. Being sedentary also may contribute to varicosity, because muscles that are out of condition offer poor blood-pumping action. The likelihood of varicosity also increases as veins weaken with age. A previous leg injury may damage the valves in a vein which can result in a varicosity. Genetics also plays a role, so if other family members have varicose veins there is a greater chance you will, too. Key Risk Factors and Causes for Varicose Veins Here’s a comprehensive list of causes of varicose veins:

• Old Age – Especially people over 50 years of age
• Pregnancy – Some pregnant women develop varicose veins. Pregnancy increases the volume of blood in your body, but decreases the flow of blood from your legs to your pelvis. This circulatory change is designed to support the growing fetus, but it can produce an unfortunate side effect — enlarged veins in your legs.
  • Women are much more likely to develop varicose veins during their pregnancy than at any other time in their lives. Pregnant women have much more blood in their body; this places extra pressure on the circulatory system. As the uterus (womb) grows, there is more pressure on the veins in the mother’s pelvic area. In the majority of cases, the varicose veins go away after the pregnancy is over; this is not always the case, and sometimes, even if the varicose veins improve, there may be some left visible.
• Heredity & Family History – Family history. If other family members had varicose veins, there’s a greater chance you will too.
• Menopause
• Obesity
• Leg Injury
• Abdominal Straining
• Standing or sitting for long periods of time – Your blood doesn’t flow as well if you’re in the same position for long periods.

Varicose Veins – Causes & Symptoms

https://www.youtube.com/watch?v=knnjxkP9t8A Which Parts of the Body are Most Affected by Varicose Veins? Any vein may become varicose, but the veins most commonly affected are those in your legs and feet. That’s because standing and walking upright increases the pressure in the veins of your lower body. Also, the veins in the leg are the farthest from your heart, and gravity makes it harder for the blood to flow upward. What are the Key Symptoms of Varicose Veins? The primary symptoms of varicose veins are highly visible, misshapen veins, usually on your legs. You may also have pain, swelling, heaviness, and achiness over or around the enlarged veins. In some cases, you can develop swelling and discoloration. In severe cases, the veins can bleed significantly, and ulcers can form. Here are the complete list of symptoms:

• Aching, heavy legs (often worse at night and after exercise).
• Appearance of spider veins in the affected leg.
• Ankle swelling, especially in the evening.
• Veins that are dark purple or blue in color
• Veins that appear twisted and bulging; often like cords on your legs
• Burning, throbbing, muscle cramping and swelling in your lower legs
• Worsened pain after sitting or standing for a long time
• Itching around one or more of your veins
• Bleeding around the veins
• A brownish-yellow shiny skin discoloration near the affected veins.
• Redness, dryness, and itchiness of areas of skin, termed stasis dermatitis or venous eczema, because of waste products building up in the leg.
• Color changes, hardening of the vein, inflammation of the skin or skin ulcers near your ankle
• Minor injuries to the area may bleed more than normal or take a long time to heal.
• Many people affected by Varicose Veins also have Restless Leg Syndrome as a common overlapping clinical syndrome.
• Whitened, irregular scar-like patches that appear at the ankles.
• Fat under the skin just above the ankle can become hard, resulting in the skin shrinking
• Eczema, in which the skin in the affected area is red, dry, and itchy

Symptoms & Signs of Varicose Veins

https://www.youtube.com/watch?v=rLT7CmSzLzo How are Varicose Veins Diagnosed? To diagnose varicose veins, your doctor will do a physical exam, including looking at your legs while you’re standing, to check for swelling. Your doctor may also ask you to describe any pain and aching in your legs. You also may need an ultrasound test to see if the valves in your veins are functioning normally or if there’s any evidence of a blood clot. In this noninvasive test, a technician runs a small hand-held device, about the size of a bar of soap, against your skin over the area of your body being examined. The device a transducer, transmits images of the veins in your legs to a monitor, so a technician and your doctor can see them. The two main types of ultrasound tests are:

• Doppler Test – an ultrasound scan to check the direction of blood flow in the veins. This test also checks for blood clots or obstructions in the veins.
• Color Duplex Ultrasound Scan – this test provides color images of the structure of veins, which helps the doctor identify any abnormalities; it can also measure speed of blood flow.

Depending on the location, a venogram may be done to further assess your veins. During this test, your doctor injects a special dye into your legs and takes X-rays of the area. The dye appears on the X-rays, giving your doctor a better view of how your blood is flowing. Tests such as ultrasounds or venograms help ensure that another disorder like a blood clot or a blockage isn’t causing the pain and swelling in your legs. What Type of People are Usually Affected by Varicose Veins? Varicose veins are a relatively common condition, and the following types of people are more likely to get it:

• The likelihood of varicosity increases with age as veins weaken with age.
• Women are more likely to develop the condition. Hormonal changes during pregnancy, pre-menstruation or menopause may be a factor because female hormones tend to relax vein walls.
• Genetics also plays a role, so if other family members have varicose veins there is a greater chance you will, too.
• Those in select professions – jobs where the individual has to spend a long time standing up – may raise the probability of having varicose veins.

Duplex ultrasound for varicose veins – explanation and demonstration

https://www.youtube.com/watch?v=eZp-AFVKQ6A What is the Practical Step You Should Take Right Away if You Suspect You Have Varicose Veins? After meeting a general physician, if he suspects or diagnoses varicose veins, you should meet a vascular specialist/surgeon for treatment. What are the Suggested Treatments for Varicose Veins? In general, doctors are conservative when treating varicose veins. You’ll probably be advised to make changes to your lifestyle to begin with, instead of trying more aggressive treatments. Lifestyle changes The following changes may help prevent varicose veins from forming or becoming worse:

• Avoid standing for extended periods of time.
• Lose weight or maintain a healthy weight.
• Exercise to improve your circulation.
• You should elevate your legs whenever you’re resting or sleeping.

Compression Stockings & Other Compression Methods If simple lifestyle changes described above do not work, your doctor may advise you to wear special compression socks or stockings. These place enough pressure on your legs so that blood can flow more easily to your heart. They also decrease swelling.

• The level of compression varies, but most types of compression stockings are available in drugstores or medical supply stores.
• Compression stockings squeeze the patient’s legs and improve circulation. They work by:
• Being generally very tight around the ankles.
• Gradually getting looser higher up the leg.
• As a result, compression stockings encourage proper blood flow upwards – against gravity – back towards the heart.

Many patients find that compression stockings help with discomfort, pain, and swelling. No studies have convincingly demonstrated whether they stop the varicose veins from worsening, or even prevent them. Studies have had mixed and conflicting results. In this context, the wearing of intermittent pneumatic compression devices have also been shown to reduce swelling and increase circulation. Useful links on compression stockings for varicose veins

• Benefits of Compression Stockings for Varicose Veins – from HealthLine – Link
• Compression Stockings for Varicose Veins – a detailed guide from VariStock – Link
• How Wearing Compression Stockings Can Help Your Varicose Veins – Link
• Is your varicose vein treatment a complete waste of time? New evidence says compression stockings don’t do anything – am interesting report from the Daily Mail, UK  – Link

Surgery If lifestyle changes and compression methods aren’t working, or if varicose veins are causing a lot of pain or damaging your overall health, your doctor might try an invasive procedure.

• Ligation and stripping – Two incisions are made, one near the patient’s groin at the top of the target vein, and the other is made further down the leg, either at the ankle or knee. The top of the vein is tied up and sealed. A thin, flexible wire is threaded through the bottom of the vein and then pulled out, taking the vein with it. Ligation and stripping can sometimes result in bruising, bleeding, and pain. After surgery, most patients will need 1-3 weeks to recover before going back to work and other normal duties. During recovery time, compression stockings are worn.

Ligation & Stripping of Varicose Veins Surgery

https://www.youtube.com/watch?v=XN7Z9ibBagY

A shorter, simpler video of ligation & stripping

https://www.youtube.com/watch?v=VVjHFapkX2w

• Cryosurgery– A cryoprobe is passed down the long saphenous vein following ligation. Then the probe is cooled to −85^o The vein freezes to the probe and can be stripped after 5 seconds of freezing. This is a variant of Stripping, and the main goal of this technique is to avoid a distal incision to remove the stripper. Cryosurgery – from Skin Care Guide; Review of Cryosurgery for Varicose Veins from Korean Vein Treatment Center
• Laser Surgery – Laser treatments are often used to close off smaller veins. A catheter is inserted into the patient’s vein. A small laser is threaded through the catheter and positioned at the top of the target vein; it delivers short energy bursts that heat up the vein, sealing it shut. With the aid of an ultrasound scan, the doctor threads the laser all the way up the vein, gradually burning and sealing all of it. This procedure is done under local anesthetic. There may be some nerve injury, which is usually brief. Laser Treatment for Varicose Veins from WebMD; Varicose Veins – Endovenous Laser Therapy – from Circulation Foundation; Endovenous Laser Varicose Veins Surgery from John Hopkins
• Transilluminated powered phlebectomy – An endoscopic transilluminator (special light) is threaded through an incision under the skin so that the doctor can see which veins need to be taken out. The target veins are cut and removed with a suction device through the incision. A general or local anesthetic may be used for this procedure. There may be some bleeding and bruising after the operation. Transilluminiated Powered Phlebectomy for Varicose Veins – from NICE, UK; also this from NICE; Transilluminated Powered Phlebectomy FAQ – from Vein Directory

Endovenous Laser Treatment – Live Case Video

https://www.youtube.com/watch?v=oQQVrVjTeyo

Cutting Edge Varicose Veins Treatment

https://www.youtube.com/watch?v=7Qs6iWSGzZE Other treatment options Currently, some minimally invasive treatment options for varicose veins are available. These include:

• Sclerotherapy, using a liquid or foam chemical injection to block off a larger vein
  • Microsclerotherapy, using a liquid chemical injection to block off smaller veins
• Endovenous ablation therapy, using heat and radiofrequency waves to block off a vein
• Gel applications

Sclerotherapy A commonly performed non-surgical treatment for varicose and “spider” leg veins is sclerotherapy, in which medicine is injected into the veins to make them shrink. Sclerotherapy is often used for spider veins and varicose veins that persist or recur after vein stripping. Sclerotherapy can also be performed using foamed sclerosants under ultrasound guidance to treat larger varicose veins, including the great saphenous and small saphenous veins. A variation of sclerotherapy is microsclerotherapy. More about sclerotherapy from WebMD, MedicineNet, Circulation Foundation & Mayo Clinic.

A nice video that shows foam sclerotherapy to treat varicose veins

https://www.youtube.com/watch?v=ySb9Wxd3A1A Radiofrequency Ablation A small incision is made either above or below the knee, and with the help of an ultrasound scan; a narrow tube (catheter) is threaded into the vein. The doctor inserts a probe into the catheter, which emits radiofrequency energy. The radiofrequency energy heats up the vein, causing its walls to collapse, effectively closing it and sealing it shut. This procedure is preferred for larger varicose veins. Radiofrequency ablation is usually done with a local anesthetic. More about Radiofrequency Ablation from – WebMD, Vein Health Medical & Cosmetic, MedScape

A Video of Radiofrequency Ablation of the Great Saphenous Vein

https://www.youtube.com/watch?v=fUQsaY1oY2M Gel Applications There are many over-the-counter treatments. These commonly take the form of topical creams and emollients. These can help soothe pain, and improve comfort and the general appearance of varicose veins. Topical gel application helps in managing symptoms related to varicose veins such as inflammation, pain, swelling, itching, and dryness.

Other Useful Varicose Veins Resources Online

Forums

• Varicose Veins Forum @ Patient Info – Link
• Varicose Veins Forum @ MedHelp – Link
• Varicose Veins Discussions Forum from VariStop, the Varicose Veins Support Group – Link

Hubs & Portals

• Varicose Veins – from Society for Vascular Surgery – Link
• Varicose Veins – from Vein Health – Link
• Varicose Veins – from the Circulation Foundation – a Vascular Charity – Link
• VaricoseVeins.Org – The Varicose & Spider Veins Resource – Link

Aids & Equipments

• Compression Stockings & Sleeves
• Gels, Scrubs, Creams and Ointments
• Books & Guides

Images & Visuals

• Valvular Dysfunction – a nice image of how a poor valve leads to varicose veins – Image, Source Page – Wikipedia
• Stages of Vein Diseases – from Spider Veins to Leg Ulcers – Excellent image – Image, Source Page – The Secret Vein Clinic
• All aspects of varicose veins explained in one image – Image, Source Page – Zwivel

Guidance for Comprehensive List of Leg & Foot Related Pain from Leg Pain Guide. (During this stressful period of COVID-19, here’s our research review of the uncommon and unusual symptoms of corona virus disease.) A

• Achilles tendon rupture (Achilles tendinitis)
• ACL Injury (Anterior Cruciate Ligament Injury)
• Ankylosing Spondylitis
• Anterior Ankle Pain
• Anterior Knee Pain
• Anterior Thigh Pain
• Anteromedial Knee Pain
• Atherosclerosis
• Arthritis

B

• Broken Bone
• Blood Clot or DVT
• Bunion
• Bone Fracture
• Baker’s cyst
• Bone Cancer
• Bursitis
• Buckling Knee
• Burning or Aching Pain in Feet or Toes

C

• Chronic Exertional Compartment Syndrome
• Claudication
• Cancerous Bone Tumors

D

• Deep Vein Thrombosis (DVT)
• Dorsal Forefoot Pain
• Dorsal Toe Pain
• Diabetic Neuropathy

G

• Gout
• Growth Plate Fractures

H

• Hair Loss on Legs
• Hairline Crack in the Bone
• Hamstring Injury
• Heel Pain
• Herniated Disk
• Hip Pain

I

• Inflamed Tendon (Tendinitis)
• Infection of the Bone (Osteomyelitis)
• Infection of Led Skin and Soft Tissue (Cellulitis)
• Inflammation of Leg Joints

J

• Joint Sprain
• Juvenile Rheumatoid Arthritis

K

• Knee Pain
• Knee Bursitis

L

• Lateral Ankle Pain
• Lateral Hip Pain
• Lateral Knee Pain
• Lateral Thigh Pain
• Leg Muscle Cramp
• Leg Muscle Fatigue
• Leg Muscle Strain
• Legg-Calve-Perthes Disease
• Lower Extremity Peripheral Arterial Disease

M

• Metatarsal Heel Pain
• Meralgia Paresthetica

N

• Night Leg Cramps
• Narrowed Spinal Canal (Stenosis)
• Numbness in Legs
• Nerve Damage in Legs
• Benign Tumors of Femur or Tibia (Osteoid Osteoma)

O

• Osgood-Schlatter Disease
• Osteoarthritis
• Osteochondritis Dissecans
• Osteomyelitis

P

• Paget’s Disease
• Patellar Tendinitis
• Patellofemoral Pain Syndrome
• Peripheral Artery Disease
• Peripheral Neuropathy
• Peripheral Vascular Disease
• Posterior Cruciate Ligament Injury
• Pseudogout
• Psoriatic Arthritis
• Plantar Toe Pain
• Plantar Midfoot Pain
• Posterior Ankle Pain
• Posterior Calf Pain
• Posterior Knee Pain
• Posterior Thigh Pain

R

• Restless Leg Syndrome
• Rheumatoid Arthritis
• Reactive Arthritis

S

• Sacroiliitis
• Sciatica
• Septic Arthritis
• Shin Splints
• Skin Infections
• Slipped Capital Femoral Epiphysis
• Sores on Legs or Foot
• Spinal Stenosis
• Stress Fractures

T

• Tendinitis
• Thigh Pain
• Thrombophlebitis
• Tight Achilles Tendons
• Tingling in Legs
• Torn Meniscus
• Torn Muscle

V

• Varicose Veins – 1
• Varicose Veins – 2

W

• Weak Ankles
• Weakness in Legs

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Top 20 Web Sites & Guides for Health, Illnesses & Diseases

Bupa – BUPA UK, BUPA Global	Cleveland Clinic – Link
Cedars-Sinai – Link	Centers for Disease Control & Prevention (CDC) – Link
Drugs.com – Link	eMedicine Health – Link
Everyday Health – Link	HealthLine – Link
John Hopkins Medicine Health Library – Link	LiveStrong – Link
Mayo Clinic – Link	Medical News Today – Link
MedicineNet – Link	MedlinePlus – Link
MedScape – Link	Merck Manuals – Link
NHS UK – Link	NIH – Link
Patient Info – Link	WebMD – Link