Varicose Veins: Causes, Symptoms, and Treatment

What are they?

Varicose veins are dilated, twisted veins close to the skin's surface. They form because they have abnormally functioning valves and damaged muscle layers, making the valves in varicose veins floppy. 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 the 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, which causes 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 the formation of scar tissue. Unfortunately, in severe cases, the skin can break open and form 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 every single year.

Who do they affect?

Between 20-30 million Americans have varicose veins. Contributing factors include heredity, gender, age, weight, pregnancy, history of deep vein thrombosis (DVT and blood clots), and standing or sitting for prolonged periods of time. By age 50, 41% of women will suffer from varicose veins. Similarly, by the time they reach their 60s, 42% of men will suffer from venous insufficiency.

In addition:

  • Varicose veins are an inherited genetic disorder. The gene is an autosomal dominant with variable penetrance. This means the gene is passed down to every generation, but certain environmental factors are required to activate the gene. For example, estrogen and progesterone–different female hormones–activate the gene. And, heavy labor, obesity, and prolonged standing can also 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: 55% of women and 45% of men.
  • An estimated 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 three times as likely to develop varicose veins.
  • Pregnancy increases the risk for developing spider and varicose veins.

How are they diagnosed?

To diagnose varicose veins your doctor will take a look at your medical history for any 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, which determines if the veins are functioning normally. Specifically, the ultrasound technologist and your doctor are looking for blood going in the wrong direction–a phenomenon known as reflux. They're also looking for any evidence of a blood clot or residual damage from an old blood clot.

Some veins are difficult to examine with a simple physical or with ultrasonography, specifically veins in your abdomen and pelvis. Those may very well 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 with a more detailed landscape of how and where your blood is flowing and whether or not there are any blockages to blood flow that can be corrected.

Ways to Test for Varicose Veins

Duplex ultrasound

A type of vascular ultrasound done to check blood flow and the structure of the leg veins.

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. An MRV can also help 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.

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