Harvard Health Letters
Varicose veins–those dark blue or purple leg veins that bulge just beneath the skin’s surface–leave many sufferers feeling self-conscious. But beyond the cosmetic considerations, pooling of excess blood in the lower extremities can cause painful leg swelling and skin ulcers.
Varicose veins, which affect about 25 percent of adults, are generally not life-threatening, but the condition can put a damper on your quality of life.
“It’s hard to get around and carry on with your life once you have a swollen and ulcerated leg,” says Dr. Marie Gerhard-Herman, a cardiologist at Harvard-affiliated Brigham and Women’s Hospital, Boston, Mass.
Backward blood flow
The condition occurs when your leg veins fail to keep blood flowing upward toward the heart. Most of the blood returning from your lower body moves through the deep veins within the muscles. Smaller amounts are delivered to the deep veins from the superficial system, which lies close to the skin’s surface.
Your veins are fitted with a series of one-way valves designed to keep blood moving toward the heart. When these valves fail, gravity forces blood toward the feet. This is called venous reflux. As volume and pressure in the veins builds up, overly full veins in the superficial system protrude, leading to a telltale web of vinelike blue lines on the skin’s surface.
Although heredity plays a role in faulty leg veins, having a job that demands long periods of standing can exacerbate the problem. Other factors that aggravate the problem include multiple pregnancies and obesity. Because the calf muscles help pump blood toward the heart when you walk, sitting for long periods can also make varicose veins more likely to occur.
Over time, blood can leak from the broken valves and pool in the ankles, causing swelling and skin changes characterized by a brown discoloration called hyperpigmentation. As the problem advances, the damaged layer of the skin breaks down to the point where even a tiny nick or scratch can result in an oozing, open wound, which can lead to an infection.
In addition to an unsightly appearance, varicose veins may also cause a heavy, achy feeling in your legs, burning, throbbing and swelling in your lower legs, and itching around one of more of your veins.
Sealing the veins
Treatment usually starts with compression stockings, which help squeeze blood from the legs back toward the heart. The stockings should exert force below the knee, where the pressure that distends and disrupts veins is the greatest. Gradient compression stockings have gotten a bad reputation because they can be hard to put on. But assistive devices that help the sock slide on more easily often solve that problem.
Some people feel better instantly once they put the stockings on and may not feel the need for other treatment, says Dr. Gerhard-Herman. Rest and elevating your legs when you sit also help reduce swelling and ease the discomfort of varicose veins.
If these measures don’t stop the problem from getting worse or provide enough relief from symptoms, distended veins can be closed off (ablated). This minimally invasive procedure is most often done in the doctor’s office using local anesthesia. The doctor threads a catheter into the faulty vein, then applies heat in the form of laser or radiofrequency energy to collapse the vein and seal it shut. Catheter ablation is safe and effective but can cause minor bruising.
A new ablation method called VenaSeal is also catheter-based but uses surgical glue rather than heat energy to close off the vein. Although only recently approved for use in the U.S., VenaSeal appears to be as effective as heat-based therapies and results in less bruising, a factor that’s likely to make it popular with patients.
Although varicose vein treatment is readily available in outpatient vein clinics, the quality of care varies widely, says Dr. Gerhard-Herman. Choose a clinic that’s accredited by the Intersocietal Accreditation Commission for vein centers and vascular laboratories. – Harvard Heart Letter