What are varicose veins?
Veins normally carry blood in the legs to the heart. As you walk your calf and thigh muscles squeeze the veins, massaging the blood towards the heart with every step you take. One-way valves inside the veins only allow the blood to move towards the heart.
In varicose veins these valves become weak and fail to allow the blood above the valves to reflux, falling back down into the veins below. The extra blood in the vein causes the vein to swell.
The swollen vein which before carried blood to the heart now allows the blood to sit inside the vein for a relatively prolonged period of time. The relatively high pressure within the vein leads to an inflammatory response causing symptoms of leg fatigue, swelling, restlessness, and pain.
In a minority of patients the slow moving blood may develop clot or inflammation from the vein may cause the overlying skin to thin, darken, and ulcerate.
Why do varicose veins form?
The cause lies primarily in heredity. It is believed a genetic defect leads to valve failure and vein swelling.
Also, women develop varicose veins twice as often as men because of the presence of the female sex hormones which relax the thin muscle layer in the walls of the vein thus aggravating the problem. Additional risk factors include pregnancy and occupations that require you to be on your feet for long periods of time.
What is the difference between spider veins and varicose veins?
The difference between varicose and smaller spider veins is primarily in size. It is basically the same disease affecting different size vessels. Small veins that fail become spider veins. Larger veins that fail become varicose veins. Some patients get only spider veins, some get only varicose veins, many get a combination of both.
Why did the veins start to appear or worsen during my pregnancy?
The pregnant mother’s circulating blood volume surges immensely during pregnancy to supply the baby and placenta and this stresses veins already genetically predisposed to fail. The baby pressing on the large vein in the abdomen (inferior vena cava) actually has not been shown to contribute to the development of varicose veins.
My varicose and spider veins are getting worse. Is there a reason for this?
Vein disease is a chronic and gradually progressive disease. As more and more valves fail within veins more and larger veins appear. The reason that it frequently appears that older individuals have worse vein disease is that they simply have had it longer.
Does wearing support hose help?
Compression stocking can improve symptoms of pain and swelling. Patients with prior leg ulcers reduce their risk of recurrent ulcers by wearing graduated medical compression stockings. Hose will not, however, prevent the development or progression of varicose or spider veins.
Isn’t there a pill or something I can take to make them go away?
No. However, horse chestnut seed extract can help some people’s symptoms of pain and swelling according to some small European studies. Aescin is the active ingredient and must be given in 50 mg doses twice a day for a month to see if it will help. This is found in the over the counter medication Venastat. Discontinue it if it gives stomach symptoms. Another over the counter supplement which may be tried is DiosVein whose active ingredient is diosmin and hesperidin. If you have other health issues or take prescription medicine don’t start it before asking Dr. Cook or your primary care physician.
What things raise my risk of developing varicose veins?
A family history of vein disease, being a woman, pregnancy, obesity, being tall, occupations where a great deal of time is spent on your feet such as teachers, nurses, cashiers and waitresses all raise your risk.
Don’t I need these veins? They are so large!
The veins are large because they have stopped functioning normally. When your body has large veins that aren’t helping to get blood back to the heart it simply takes another route through the extensive network of other normal veins that you have just as you would take another route home if your exit off the interstate was backed up. When these veins are gone your body doesn’t miss them because your body already had bypassed them and hadn’t used them for a long time to actually circulate blood.
I’ve been told that I needed to have these veins in case I needed to have a heart bypass some day.
Varicose veins are not used for bypass surgery. Other vessels are used instead.
What are the common symptoms of vein disease?
Perhaps 15% of patients have no symptoms other than appearance. The great majority of patients, however, have symptoms that may include aching, throbbing, restlessness, cramps, heaviness, swelling, itching, and burning though the extent of symptoms varies from patient to patient.
How do I know if my symptoms are from vein disease?
Symptoms of vein disease may worsen as the day progresses towards evening, the longer you are on your feet, and around the menstrual cycle. Symptoms may be helped by elevation, compression stockings (even Leggs and Hanes can soothe) or taking analgesics like Tylenol or Advil. Vein disease does not usually cause joint pain but rather tends to be more diffuse. Often, symptoms of vein disease creep up so gradually as more valves fail that patients assume symptoms are from just "getting older" but are pleased when they remit with treatment.
What kind of complications can come from untreated veins?
Only a minority of patients develop complications of untreated (representing approximately 10% of patients who present to our office at East Tennessee Vein Clinic.) Pain, chronic swelling, dermatitis (skin rashes), severe bleeding, venous leg ulcer, and phlebitis or blood clot are the most common complications of untreated vein disease. Blood that is slow moving in varicose veins relative to normally circulating blood is more likely to form blood clots.
Inflammation from the chronic high pressure within varicose veins first causes pain. Pain can occur in either spider vein or varicose vein disease. In large varicose vein disease, the constant irritation and inflammation lead to redness or darkening of the skin over the veins. The skin can then thin and ultimately ulcerate, i.e. venous leg ulcers.
Whenever there is chronic swelling or any skin changes or bleeding or clotting occurring in large vein disease the disease is already well advanced and should be treated.
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