Varicose Veins

Source: Adapted from Knowing Your Options: The Definitive Guide to Choosing The Medical Treatments, Reader’s

What are varicose veins?

Varicose veins aren’t exactly shy. These bluish, ropelike veins sit just under the surface of the skin, usually on the back of your calves or on the inside of your thighs. Their protruding presence is not only unsightly, it can also be uncomfortable, causing aching or throbbing, or a heavy feeling in your legs. In advanced cases of varicose veins, your skin can itch and become discoloured. Ulcers may form over a bulging vein. Also bothersome are spider veins, little webby starbursts of blue and red that often appear around your knees and ankles, but can also show up on your face. While spider veins, medically known as telangiectasia, are usually only a cosmetic problem, sometimes they can make your legs ache.

Varicose veins are due to a malfunction in your circulatory system. After blood has been pumped out to your extremities, it travels against gravity back to your heart, pushed along in rhythmic bursts by tiny valves inside the veins that open and close. When these valves malfunction or wear out, blood flows backward or pools in the veins. This causes varicose veins.

Who is at risk for varicose veins?

Varicose veins most frequently show up on your legs, but they can also appear on your feet. They eventually afflict about 50% of women. Aggravating factors for varicose veins include obesity, pregnancy, long-term heavy lifting, and jobs that require you to spend a lot of time on your feet, such as nursing or sales work. People of Irish and German ancestry have a greater risk of malfunctioning valves, as do those who have a family history of varicose veins. Aging is definitely a factor, because the skin’s connective tissue becomes less elastic as you get older. Spider veins can also be kick-started by hormonal surges, which are caused by puberty, pregnancy, and hormone replacement therapy.

Treatment options for varicose veins

If you have varicose veins, consult your doctor about the best treatment. Don’t delay: The earlier you intervene, the easier this condition is to treat. Many people can keep varicose veins from causing problems by making lifestyle changes, including wearing compression stockings, exercising, and taking certain nutrients and herbs. But if your varicose veins are painful or you’re sick of always covering up your legs, a number of surgical techniques, including a new procedure using radiowaves, can help. For spider veins, lasers are producing good cosmetic results.

Lifestyle Changes

You may be able to keep varicose veins under control and reduce the risk of getting additional veins by adopting some lifestyle measures. The following strategies are often quite helpful:

• Wear compression stockings to help nudge the blood back up to your heart. These knee-high stockings come in a range of sizes and must be fitted to the shape of your legs. You can get them at medical supply stores, or your doctor can prescribe them. Don’t worry that they’re fashion gone bad: They come in a variety of styles and colours. You may also benefit by having your doctor prescribe Velcro-closing elastic bands designed to go over the specific areas of the leg that cause you problems.
• Elevate your legs above your hips several times a day. Keep them there for 10 to 20 minutes. Try not to cross your legs when you sit.
• Avoid constriction. Toss out any girdles and other tight, binding garments (such as too-snug belts and too-tight shoes) that put undue pressure on veins anywhere in your body.
• Get regular exercise. Building up your calf muscles helps push blood back up to your heart. It’s best to stick with low-impact workouts. Swimming and water aerobics are the best activities for varicose veins. The water acts as a giant compression stocking. If the water is cold, it’s all the better to tone your muscles. Other good choices are walking (be sure to put on your compression stockings first) and easy bike riding.
• Lose weight if you need to. Excess pounds put extra pressure on your legs and veins.
• Don’t stand for long periods. Standing makes it harder for blood to flow back up to your heart. If you have to stand for a long time, do heel raises and stand on tiptoe to stimulate your calves.
• Resist the urge to scratch, even when your varicose veins bother you. Doing so may prompt a skin ulcer. Apply a moisturizing cream, or ask your doctor to prescribe something to soothe the itch.

Related Procedures for Varicose Veins

If the appearance of your varicose veins bothers you or they are very uncomfortable, it’s best to consult a specialist. General and vascular surgeons typically do major overhauls, such as removing large veins. Dermatologists specialize in spider and other smaller veins. Ask each specialist what the best procedure is for veins of your type. Check out the doctor’s success rate with the treatment.

To remove large veins, a procedure called vein stripping is traditionally used. This involves opening the largest superficial vein, the saphenous, which extends from your groin to your ankle. Several small incisions are made, and a flexible wire is used to remove the vein. Don’t worry that you’ll be increasing the load on adjacent veins: The damaged vein has already lost its ability to function, and blood flow has been naturally rerouted. This treatment is most likely to prevent the appearance of new varicose veins. It also requires the longest recuperation (up to two weeks) and leaves the most scarring.

An alternative treatment for large veins near the surface of the skin is ambulatory phlebectomy, also called the stab avulsion technique. This mini-stripping procedure involves pulling out large veins through a series of small incisions. It has become increasingly popular because it requires only local anesthesia, causes less discomfort than vein stripping, and involves just one day of rest.

The newest, most advanced procedure for treating large varicose veins is called the radiofrequency closure technique. Doctors insert a tiny catheter through a slit in the skin and deliver radiowaves to the vein wall. The vein shrinks and seals shut. Many people choose this method because it causes minimal bruising and normal activities can be resumed immediately.

If you have spider veins or other small veins on your legs, your doctor may recommend sclerotherapy. The veins are injected with an agent designed to irritate them, causing the vessel to collapse and glue itself shut. Over time, the veins will be absorbed by the body and disappear. Effectiveness of this procedure is greatly improved with the application of a compression bandage afterward.

Although they can’t be used for larger spider veins or varicose veins, lasers have revolutionized the treatment of small superficial spider veins on the face or legs. A laser is passed through a small tube inserted in the vein, and laser energy is applied. Many dermatologic surgeons are also using new polarizing scopes to see the veins in 3-D. That means they can zap your vascular firework display at its origin with enhanced accuracy.

Alternative Therapies for Varicose Veins

To boost vein health, take a daily multivitamin that contains vitamins C and E. Several herbs are also helpful. Gotu kola works to tone surrounding tissues, keep veins flexible, and encourage blood flow. Horse chestnut seed extract (sold as Venastat) may reduce vein swelling and inflammation. It’s often taken with bilberry, an antioxidant herb that appears to enhance blood flow and reinforce vein walls.

Questions for Your Doctor

• Why do you think the technique you‘re recommending is the best therapy for my varicose veins?
• What kind of scarring can I expect from this procedure?
• What is the likelihood that my varicose veins will recur or that new ones will appear?

Living with Varicose Veins

If you’re living with varicose veins, here are a few quick tips to help you take control:

• Beware of female hormones. The estrogen in birth control pills and hormone replacement therapy (HRT) can contribute to varicose and spider veins. If you’re taking either of these, ask your doctor about alternatives.
• Use a cover-up. Varicose veins can be difficult to eradicate. If you can’t get your limbs to look the way you’d like, try leg makeup or a self-tanning product.
• Pick a trustworthy practitioner. Lasering and using other techniques to eradicate veins can be tricky. Make sure your doctor has a good track record and is experienced in treating veins of your type.
• Raise the foot of your bed by two to four inches so you can sleep with your feet higher than your head. You can do this by placing blocks under the end of the bed. This helps blood flow back to your heart.