Most of us know what varicose veins look like - those unsightly, knobbly lumps and lines on the legs. Yet nobody is born with varicose veins, and not everyone gets them - so what makes them develop?
To understand this, we need to know a bit more about how these veins work. Veins carry blood back towards your heart. Whenever you're sitting or standing, the blood in your leg veins is going upwards, against gravity, which tries to pull it back downwards. Your veins have one way valves that should stop this blood flowing the wrong way.
Over the years, the walls of your veins may get weaker and stretch at some points. If this happens near a valve, the valve may become leaky, allowing blood to flow backwards with gravity. This puts extra pressure on the next valve back, causing it to become leaky. Over time, these veins become enlarged and blood pools in them, making them stand out - these are what we know as varicose veins.
Nobody is quite sure why some people (about one in three over a lifetime) develop varicose veins. Some people inherit a tendency to weak veins, which is why varicose veins sometimes run in families. Pregnancy and being overweight, which put extra pressure on the veins as they run back to the heart, can make you prone to varicose veins. Standing for long periods might be a risk factor, although there's less evidence for this - walking a lot definitely does not carry the same risks.
Varicose veins may look unsightly, but they don't often cause complications. They may ache, especially as the day goes on, and the skin over them can itch or get inflamed and sore. However, they can make you more prone to leg eczema or leg ulcers. They can also get inflamed, cause skin changes such as thickening and redness of the skin, and occasionally bleed.
It's estimated that three to six per cent of people with varicose veins will get one or more of these complications at some point (1). Unfortunately, it's impossible to predict who will run into problems - the likelihood of these complications isn't related to how big your varicose veins are. We do know that most people don't develop any of these problems for several years at least after their varicose veis first become noticeable.
Over recent years, there has been enormous variation across the UK in terms of treatments offered and how severe your varicose veins need to be for you to qualify for referral. That's why the National Institute for Health and Clinical Excellence (NICE) issued guidance in July to try and increase consistency of the services offered. (1)
They recommend that people should be referred if:
They are having significant symptoms from their varicose veins
They have skin changes (like eczema or changes to skin colour or texture) thought to be related to blood supply to the superficial veins being inadequate
They have hard, painful veins due to a clot in one of the varicose veins
They have a venous leg ulcer.
NICE recommend that surgical procedures should only be carried out if ultrasound assessment confirms you have varicose veins and that blood is flowing backwards in the main deep veins as a result.
Surgery can help with varicose veins that cause severe aching or swelling of your legs. However, it can cause complications and the problem may come back. It's probably not worth considering surgery unless you're very troubled by your veins. In the past, a standard treatment for varicose veins was to strip the veins out of the leg under general anaesthetic. This has now been relegated under the new NICE guidelines to 'third line therapy'.
The first line treatments, which should be used for any patient they're suitable for, are now endothermal ablation or endovenous laser treatment of one of the long leg veins called the long saphenous vein. A probe is passed up the vein, under ultrasound control, and heat from radiowaves or laser are used to close off the vein. If this procedure isn't suitable, foam can be injected into the vein to seal it off.
Support tights can relieve the pressure on your leg veins, and are worth trying if your legs get achy or swollen. In the past stronger versions of support tights, called compression tights, were widely used. NICE says there's not much evidence of how effective they are - and they can be uncomfortable to wear.
Walking regularly helps to pump blood more effectively back along your leg veins, and can reduce the aching and swelling. It can also reduce your risk of deep vein thrombosis, or DVT - as if you needed another excuse to get out there and keep active. If you're overweight, losing weight can improve symptoms such as aching and swelling and may improve the appearance of varicose beins. If you get eczema or soreness around your varicose veins, it's important to see your GP so that you can get treatment to avoid leg ulcers.
Most of us know what varicose veins look like - those unsightly lines or bulging knots on the legs. Yet there has never been a documented case of varicose veins at birth and we know that not everyone gets them - so what makes them develop?
We need to know more about how these veins work to understand this a little more. Veins carry un-oxygenated blood back towards your heart. Whenever you are sitting or standing, the blood in your leg veins needs to go upwards, against gravity, which is trying to pull it back downwards. Your veins have one way valves that should stop this blood flowing the wrong way.
Over time the walls of your veins may get weaker and stretch at some points due to increased pressure in the venous system. If or when this happens near a valve, the valve can become leaky, allowing the blood to flow backwards or towards the feet. This increased pressure on the next valve back, causing it to become leaky. Over time there becomes a domino effect, these veins become enlarged making them stand out. This is what we know as varicose veins. Essentially they offer us a visual sign of an underlying problem called venous insufficiency.
There is great debate on why some people (about one in three over a lifetime) develop varicose veins. Some people inherit a tendency to weak veins, which is why varicose veins often runs in families. Pregnancy and being overweight, especially with increased stomach girth, which put extra pressure down the venous system, can increase your risk to develop varicose veins. Standing for long periods is also associated with this as in the pressure in veins naturally increases when standing. Exercise and walking do not prevent varicose veins but can limit the symptoms. Actually runners can develop varicose veins due to the amount of pressure and increased volume of blood pumped through the venous system. Sports injury and trauma to the leg can cause damage to the veins walls. Walking a lot definitely does not carry the same risks.
Varicose veins may cause your legs to ache, especially at the end of the day or at night. They can also cause burning or itching and if they thrombus can become inflamed and sore. The disease process is progressive in nature and symptoms can be so gradual that many people with varicose veins will tell you that they don't have problems. It is my experience that these individuals have a change of heart once they try conservative therapy or support hose. Three to six percent of varicose vein patients end up having one or more of the more serious symptoms such as discoloring and scarring of the fat under the skin or ulceration. Unfortunately, it is impossible to predict who will develop these type of complications as the size of the vein is related.
Traditionally the only options for individuals who suffered from the symptoms of varicose veins was to have the vein stripped or to wear compression stockings or hose. Since 1999 endovenous ablation has allowed for the treatment of this condition in an outpatient setting with minimal discomfort and very high success rates. You should seek a vein specialist if you are having significant symptoms from varicose veins, have skin changes thought to be related to blood flow or inflammation and pain associated with varicose veins. If you don't know who to contact you can take an online screening via eveinscreening.com.