Varicose veins are enlarged and tortuous veins with damaged valves that allows blood to get stale, affecting circulation. They affect most commonly subcutaneous veins which lie under the skin, while deep veins which lie within the muscle remains normal.  The condition that result in valve weakness is often hereditary, affecting  close relatives, but can also occur due to prolonged and extreme exertion of the legs causing valves damage. Pregnancy and hormonal changes in women can induce or exacerbate varicose veins. It is more prevalent in women and by the time they reach their sixties, estimate suggest that 72% of women in the US will have varicose veins.

Diagnosis

Varicose disease cause a variety of symptoms that include any of following symptoms:  aching or pain that varies in intensity from mild to severe, cramps, heaviness, fatigue, burning or itching, swelling in the legs throbbing, numbness, skin discoloration and skin thickening. Symptoms usually get worse with prolonged sitting and standing and improve with leg elevation or walking. If left untreated, varicose disease can progress causing ulceration of the legs, usually in the areas of the ankle. Other possible complications include superficial and deep venous thrombosis.

Physical exam

During physical examination, physician will assess appearance and size of varicose veins in standing and lying positions. Examination will demonstrate enlarged superficial veins, discoloration of the skin if present, severity of swelling and presence or absence of ulcers. Deep veins are lying deep within the muscle and not directly accessible for examination.

Tests

Doppler ultrasound considered to be a gold standard in assessing degree of venous insufficiency, presence of deep vein thrombosis and characterize blood flow within the arteries. Ultrasound can be readily performed in the clinic and results will be available immediately.

Treatment

Treatment often required if condition is painful, interfere with patients lifestyle, causing skin ulcers and not responding to conservative therapy. Self-care may help decrease mild symptoms. Whenever possible, the individual should elevate the legs, preferably at the level above the heart, wear elastic stockings or bandages to compress the varicose veins, avoid prolonged standing or sitting, exercise regularly by walking or running. Individuals may be counseled to avoid crossing their legs when sitting, reduce or avoid alcohol intake, and to lose weight if obese. Varicose veins associated with pregnancy may spontaneously regress after childbirth, requiring no treatment.

Severe varicosities may be treated by injection of a chemical into the vein that causes internal scarring (sclerosis), thus blocking the vein (sclerotherapy). This procedure may have to be repeated one or more times.

Surgical correction (vein stripping and ligation) of varicose veins may be done if pain, vein inflammation with formation of blood clots (thrombophlebitis), or skin changes persist; it can also be done for cosmetic reasons. The procedure is performed under general or spinal anesthesia. The surgeon makes a small incision in the groin, and one in the ankle or calf. The surgeon then inserts a wire-like instrument into the large superficial vein in the groin, until the wire comes out the lower incision. The vein is attached to the wire at the groin, and as the surgeon pulls back on the wire, the large vessel that supplies blood to the varicose vessels, along with the wire, is removed. Some additional small incisions may be made to cut away some of the tributary veins.

Other surgical approaches can include ultrasound-guided thermal ablation using radiofrequency or laser therapy (endovenous laser) to close the varicose vein by heating of the tissue. Following any surgical procedure treating varicose veins, a 30 to 40 mm Hg gradient compression stocking typically is used to assist the stoppage of blood flow and to decrease the risk of a deep vein thrombosis.

Prognosis

Varicose veins are not curable, but treating early symptoms results in an excellent outcome. Individuals who undergo sclerotherapy or vein stripping also have excellent outcomes provided they follow postoperative treatment instructions, and no complications develop. Overall, up to 90% of symptomatic varicose veins are successfully treated with removal or obliteration of the vein . The two-year recurrence rate of a varicose vein after radiofrequency treatment is 14%; recurrence after vein stripping is 21%. No treatment can prevent the occurrence of new varicosities.