Introduction
Varicose veins are large dilated ropey veins that develop in the leg. They are often unsightly and cause a range of symptoms. They develop due to an abnormality in the normal one-way valves that usually direct blood flow from the feet toward the heart. These valves become leaky (incompetent) and allow blood to pool in the leg veins. This increases the pressure in the veins, and as veins are quite thin walled and not designed to deal with higher pressures, they slowly increase in size and become a varicosity.
Causes
The exact cause of the leaky valves is not clear. Varicose veins commonly run in families and a genetic pre-disposition clearly plays a role.
Pregnancy, prolonged standing and sedentary lifestyle do exacerbate varicose veins.
Symptoms
Varicose veins may cause a number of symptoms:
- Pain.
- Leg swelling or oedema.
- Unsightly large varicosities.
- Bleeding.
- Skin damage (brown discolouration).
- Eczema.
- Ulceration.
- Recurrent infection.
- Thrombosis (superficial thrombo-phlebitis – STP).
Tests
Ultrasound scan is the best assessment for varicose veins. This is performed standing and the sonographer will squeeze the calf muscles to augment blood flow and then assess the direction of blood flow through the veins. The aim is to identify abnormal blood flow to the feet to determine if the valves are competent or not.
Diagnosis
Diagnosis is made on clinical grounds and the results of ultrasound imaging. The imaging also then guides the most appropriate treatment option.
Treatment
A number of options are available to treat varicose veins. The most appropriate option depends on the symptoms associated with the varicose veins, their size and location and the results of the ultrasound imaging.
The main options are:
- Sclerotherapy (injection therapy) – for smaller isolated veins.
- Ultrasound guided foam sclerotherapy – for larger veins where the major truncal veins are normal.
- Glue – for the main truncal veins if relatively isolated or associated with smaller/fewer varicosities.
- Endovenous ablation (laser/radiofrequency) – for most situations with major vein incompetence.
- Surgical treatment (ligation/vein stripping) – for very large veins or recurrent varicose veins.
Related Information
Spider and Reticular Veins
Deep Vein Thrombosis
Pelvic Congestion Syndrome
Superficial Thrombosis
Venous Ulcers
Endovenous Ablation of Varicose Veins
Sclerotherapy
Vein Stripping