Overview

What are Varicose Veins?

Varicose veins are dilated, twisted, veins that are close to the surface of the skin. Veins differ from arteries in two primary ways. The muscular layer of veins is smaller than arteries. As a result, veins do not contract as forcefully as arteries. Veins also have small structures called valves on the inner surface of the vein. Valves ensure that blood flows towards the heart and not away from it. Varicose veins have abnormally functioning valves and damaged muscle layers. The valves in varicose veins are floppy and do not come together properly. As a result, blood reverses direction and tends to pool in the vein. This pooling of blood increases the pressure within the vein forcing fluid out of the vein and into skin of lower extremity. Increasing the pressure in the veins are abnormalities in the vein wall musculature. These abnormalities lead to poor vein contraction leading to further increases in venous pressure. The end result of this increased pressure is fluid in the legs leading to heaviness, a constant dull ache, leg fatigue, cramps and itchiness. If the pressure becomes too great, blood leaks into the skin causing the skin to turn brownish black. Over time the skin loses its suppleness and becomes woody hard due to scar tissue formation. Finally, in severe cases, the skin can break open forming a venous ulcer. Up to 4% of Americans over the age of 65 suffer from venous ulcers and over one million work days are lost to issues related to venous insufficiency.

Who is Affected by Varicose Veins?

It has been reported that up to 80 million Americans have some form of venous insufficiency. Between 20-30 million Americans have varicose veins. Contributing factors include heredity, gender, age, weight, pregnancy, history of deep vein thrombosis (blood clots), and standing or sitting for prolonged periods of time. By age 50, 41% of women will suffer from varicose veins.

Likewise, by the time they reach their 60s, 42% of men will suffer from venous insufficiency as well.

In addition:

  • Varicose veins are an inherited genetic disorder. The gene is an autosomal dominant with variable penetrance. This means that the gene is passed down to every generation but certain environmental factors are required to activate the gene. For example estrogen and progesterone, female hormones, activate the gene. Heavy labor, obesity and prolonged standing activate the gene over time.
  • Almost 50% of varicose vein patients have a family history of the disease
  • Your chances of developing varicose veins are over 90% if both parents have the disease
  • Daughters have a 60% chance and sons have a 25% chance of developing varicose veins if only one parent has the disease
  • Varicose veins affect women more than men – a breakdown of 55% women and 45% men
  • An estimates 41% of women over the age of 50 have varicose veins
  • Moderately overweight women have a 50% increased risk of developing varicose veins
  • Women with a BMI greater than 30 are 3x as likely to develop varicose veins.
  • Pregnancy increases the risk for developing spider and varicose veins.

How are Varicose Veins Diagnosed?

To diagnose varicose veins your doctor will take a history looking for prototypical symptoms and perform a physical exam to identify the locations and extent of your disease. A critical part of the evaluation is the performance of a venous ultrasound. The ultrasound determines if the veins are functioning normally. Specifically, the ultrasound technologist and your doctor and looking for blood going in the wrong direction. This phenomenon is referred to as reflux. They are also looking for any evidence of a blood clot or evidence of damage from an old blood clot.

Some veins are difficult to examine with physical exam or with ultrasonography. Specifically veins in your abdomen and pelvis may require a more sophisticated examination like a CT scan or MRI. In some cases, an invasive test called a venogram is needed. During the venogram, your doctor injects a special dye into your legs and X-rays are taken of the area. This test provides your doctor a more detailed information of how and where your blood is flowing and whether or not there are any blockages to blood flow that can be corrected..

Sometimes a venogram may be used to further assess your veins. During the venogram, your doctor injects a special dye into your legs and X-rays are taken of the area. This test provides your doctor a more detailed view of how your blood is flowing.

Types of testing may include:

Duplex ultrasound. A type of vascular ultrasound done to check blood flow and the structure of the leg veins. Duplex means 2 types of ultrasound are used. The first type takes a black and white image. This is called B-mode ultrasonography. The second type is color flow imaging. This technique allows us to measure the direction of blood and the duration of the abnormal blood flow.

Color-flow imaging (also called triplex ultrasound).  A procedure similar to duplex ultrasound that uses color to show the direction of blood flow.

Magnetic resonance venography (MRV). A diagnostic procedure that uses a combination of large magnets and a computer to view the veins. Dye is injected into the veins to better see them. MRV can also help to diagnose other causes of leg pain.

CT Scan: Another diagnostic imaging tool that uses x-rays and a computer to create images of your body.