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Introduction to Varicose Veins

Varicose veins affect approximately 25% of western adult population. The treatment of varicose veins and their complications accounts for 2% of the NHS expenditure. There are about 40,000 varicose vein procedures performed in the UK every year, up to 20% are re-operations. The very early stage of varicose veins is venous reflux.

Venous Reflux

Venous Reflux develops when the valves (within the veins) become ‘incompetent’ and the valve leaflets are no longer able to meet in the middle. Therefore, some of the blood being returned to the heart by the pumping action of the muscles simply returns down the leg.

With increasing reflux, the vein becomes progressively distended, tortuous, and therefore more visible. This process also makes reflux worse and as the vein increases in diameter it becomes varicosed.

What are the causes of venous reflux/varicose veins?

  • In many cases a cause is not found. It is thought that varicose veins are a penalty we pay as a species for walking on two legs; as far as we know, other animals do not develop varicose veins.
  • Age, female gender, family history of varicose veins, multiple pregnancies, obesity and having a profession which requires long periods of standing, all play a part in causation of varicose veins.
  • Varicose veins may also start at the site of any incompetent perforating vein.
  • It is also thought that hormonal factors such as progesterone in women might pre-dispose to varicose vein formation.
  • Varicose vein might also be caused by obstruction to venous return in conditions such as pregnancy, pelvic tumours and deep vein thrombosis (DVT).
  • Varicose veins in young people might suggest underlying congenital abnormalities.

What are the symptoms of varicose veins?

  • Most cases of varicose veins are asymptomatic.
  • The most common symptoms of varicose veins are aching sensation or tiredness in legs. Symptoms are especially in the calf towards the end of the day.
  • The ankles may swell towards the evening and the skin of the leg may itch or gradually discolour over a period of time.
  • Some patients may suffer cramps in the calf shortly after retiring to bed.
  • Other symptoms such as heaviness and fatigue and swollen limbs might occur as a consequence of varicose veins.
  • Symptoms of varicose veins can worsen over time if left untreated.

What are the complications of varicose veins?

  • Bleeding may occur from the varicose veins following relatively minor trauma.
  • Thrombophlebitis of the superficial varicose veins. This refers to thrombosis (blocked vein) associated with surrounding inflammatory reaction causing redness and tenderness of the tissues around the varicose veins. It is not an infection – merely the body’s reaction to blood clot within a vein.
  • Eczema or chronic dermatitis (inflammation of skin) with allergic manifestation itching and redness.
  • A small number of patients (1-2%) may develop the most advanced complication which is venous ulceration. This refers to open superficial wounds in the lower leg, typically at the ankles.

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