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Varicose Veins - Causes, Symptoms And Varicose Veins Laser Treatment

Alternative names :- Varicosity; Varicosis

Varicose veins are dilated, tortuous veins engorged with blood that results from improper venous valve function. They can be primary, originating in the superficial veins, or secondary, occurring in the deep veins.

About 10% to 20% of Americans have primary varicose veins, which account for approximately 90% of varicose veins. They're twice as common in women as in men. Primary varicose veins also tend to be familial and affect both legs. Usually, secondary varicose veins occur in one leg. Both types are more common in middle adulthood.

Without treatment, varicose veins continue to enlarge. And, although there's no cure, certain measures, such as walking and using compression stockings, can reduce symptoms. Surgery may remove varicose veins; however, the condition can occur in other veins.

Causes of Varicose veins

Veins are thin-walled, distensible vessels with valves that keep blood flowing in one direction. Any condition that weakens, destroys, or distends these valves allows blood back flow to the previous valve. If a valve can't hold the pooling blood, it may become incompetent, allowing even more blood to flow backward. As the volume of venous blood builds, pressure in the vein increases and the vein becomes distended. As the vein is stretched, its wall weakens and it loses its elasticity. As the vein enlarges, it becomes lumpy and tortuous. As hydrostatic pressure increases, plasma is forced out of the vein and into the surrounding tissue, resulting in edema.

Primary varicose veins can result from:

• congenital weakness of the valves or venous wall
• conditions that produce prolonged venous stasis or increased intra abdominal pressure, such as pregnancy, obesity, constipation, wearing tight clothes, or standing for prolonged periods
• occupations that necessitate standing for an extended period
• family history of varicose veins.

Secondary varicose veins can result from:

• deep vein thrombosis
• venous malformation
• arteriovenous fistulas
• trauma to the venous system
• occlusion

Signs and symptoms of Varicose veins

Signs and symptoms of varicose veins may include:

• dilated, tortuous, purplish, ropelike veins, particularly in the calves, due to venous pooling
• edema of the calves and ankles due to deep vein incompetence
• leg heaviness that worsens in the evening and in warm weather (caused by venous pooling)
• dull aching in the legs after prolonged standing or walking, which may be due to tissue breakdown
• aching during menses as a result of increased fluid retention.

Possible complications of varicose veins include blood clots second3IY to venous stasis, venous stasis ulcers, and chronic venous insufficiency.

Diagnosis of Varicose veins

Tests used to help diagnose varicose veins include:

• manual compression test to detect a palpable impulse when the vein is firmly occluded at least 8" (20 cm) above the point of palpation, indicating incompetent valves in the vein
• Trendelenburg's test (retrograde filling test) to detect incompetent valves in deep and superficial veins
• photoplethysmography to characterize venous blood flow by noting changes in the skin's circulation
• Doppler ultrasonography to detect the presence or absence of venous back flow in deep or superficial veins
• venous outflow and reflux plethysmography to detect deep venous occlusion (invasive; not routinely used)
• ascending and descending venography to demonstrate venous occlusion and patterns of collateral flow.

Varicose veins treatment

• treatment of the underlying cause, such as abdominal tumor and obesity, if possible
• antiembolism stockings or elastic bandages to counteract swelling by supporting the veins and improving circulation
• regular exercise program that promotes muscular contraction to force blood through the veins and reduce venous pooling
• injection of a sclerosing agent into small to medium-sized varicosities
• surgical stripping and ligation of severe varicose veins
• phlebectomy (removing varicose vein through small incisions in the skin), which may be performed in an outpatient setting.

Additional treatment measures include:

• discouraging the patient from wearing constrictive clothing that interferes with venous return
• encouraging the obese patient to lose weight to reduce increased intra abdominal pressure
• telling the patient to elevate her legs above her heart whenever possible to promote venous return
• instructing the patient to avoid prolonged standing or sitting because these actions enhance venous pooling.

Varicose veins removal by laser treatment

Laser ablation is a new non-surgical way to cure varicose veins which has been developed over the past five years at centres in USA, Spain and Germany. It is performed as an outpatient "walk in, walk out" procedure with no requirement for general anaesthetic or overnight stays in hospital.

The laser treatment involves the insertion of a laser fibre into the varicose vein of the thigh from the knee to the groin using ultrasound imaging to guide the way. The laser fibre is then withdrawn along the vein, heating it from within to close it, using local anaesthetic to minimize discomfort. The treatment session lasts in the region of one hour. A pressure stocking is applied and must be worn for a week. The majority of patients can return to normal activities including work the next day.

Complications

• Phlebitis (chronic inflammation of the vein)
• Formation of leg ulcers
• Rupture of a varicose vein

Special considerations and Prevention

After stripping and ligation or after injection of a sclerosing agent, administer analgesics, as ordered, to relieve pain.

• Frequently check circulation in toes (color and temperature), and observe elastic bandages for bleeding. When ordered, rewrap bandages at least once per shift, wrapping from toe to thigh with the leg elevated.
• Watch for signs and symptoms of complications, such as sensory loss in the leg (which could indicate saphenous nerve damage), calf pain (which could indicate thrombophlebitis), and fever (a sign of infection).
• Encourage the patient to ambulate after surgery and elevate her legs whenever possible to reduce swelling.
• Avoid prolonged standing if personal or family history indicates you are at risk of developing varicose veins.
  

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