Varicose Veins: An Overview

What are Varicose Veins?

Varicose veins are superficial veins that are swollen and dilated, and appear like a twisted chord close to the surface of the skin. They may feel warm and tender to the touch, and are associated with achiness, swelling and pain in the calf and ankle. A person with varicose veins may also present with skin discoloration of the ankle and lower calf.

What Causes Varicose Veins?

When the veins in the leg are not able to adequately return blood to the heart, the blood pools in the superficial veins, causing them to become swollen and twisted (varicose). The inability of the leg veins to return blood to the heart is termed venous insufficiency. This insufficiency is typically caused by malfunctioning vein valves, or valvular incompetence. The function of vein valves is to prevent backward/retrograde blood flow in the veins, and to assist forward blood flow to the heart. When the valves are incompetent, blood is allowed to flow backward toward the feet; this retrograde flow is known as venous reflux. Valvular incompetence can result from direct damage to the valves due to a blood clot. It can also be due to dilation or widening of the vein, which inhibits the vein valves from closing completely, and allows blood to pass backward through the opening.

Multiple risk factors can contribute to varicose vein development, including the following:

• History of blood clots in the legs
• Pregnancy
• Obesity
• Prolonged periods of standing over time (can be related to occupation).
• Family History of varicose veins

The risk factor that most strongly correlates with varicose vein development is family history. If one or both parents develop varicose veins it increases the likelihood that the child will also develop them in his or her lifetime.

Risks of Untreated Varicose Veins

If varicose veins are not treated, it increases the risk of developing blood clots in the superficial veins, and ankle wounds. A blood clot forms when blood in the veins is moving slowly or not moving at all, and becomes thick. The blood in varicose veins flows too slowly and collects in the veins in large quantities. This increases the thickness of blood within the varicose vein and greatly increases the risk of forming a blood clot. Wounds of the ankle due to venous insufficiency are caused by high venous pressure at the ankle. Pooling of blood in the veins increases venous pressure, which causes damage to the skin. As the skin damage worsens, an open wound forms, and until the pressure is relieved the wound will have a reduced ability to heal.

Treatment for Varicose Veins

Varicose veins are a symptom of valvular incompetence. To permanently treat varicose veins the superficial vein with incompetent valves, or the source, must first be treated. If the source is not treated, the likelihood is high that varicose veins will recur. Because veins valves are too delicate to be repaired, treatment involves closing the source vein.

The most common treatment for varicose veins is to close the source vein with a radiofrequency ablation procedure (RFA), or a venous closure. An RFA procedure is most often performed as an outpatient procedure, and typically does not require anesthesia. An RFA is an endovascular procedure, meaning the treatment is performed from within the vein. The ablation device cauterizes the wall of the vein and causes it to close, preventing any flow within the vein. This forces the blood to flow through different veins, as opposed to the incompetent vein.