Varicose Veins: Types, Causes, Symptoms, Complications, Diagnosis and Treatment

A varicose vein is a diseased vein whose walls have been permanently and irreversibly dilated in a certain location.

Varicose veins are hyper-dilated veins. They are observed in quite bluish or purple colors, sinuous and prominent.

It is a dilated and damaged vein, through which the blood is difficult to circulate properly and stagnates.

If left untreated, a varicose vein can be a source of very serious complications, such as ulcers, phlebitis, or clots.

Varicose veins are abnormally swollen and tortuous veins, which are often visible above the skin.

They can range in size from fairly small (2 to 3 mm wide) to very large (2 to 3 cm wide).

Very small veins are commonly referred to as ‘string veins’ or ‘ spider veins ‘.

These veins are different from varicose veins because they are much closer to or within the overlying skin.

Although they can be unsightly, they are not the same as varicose veins and can be more difficult to treat.

Reticular veins are obvious varicose veins that are present under the skin and are easily visible, but considerably smaller than the larger knotty veins.

Reticular veins can only bulge the skin slightly, if at all, whereas varicose veins tend to produce a marked bulge of the skin.

A varicose vein is not due to accelerated aging of the body:

  • It is a pathology that results from the progressive deformation of the vein.
  • This is the consequence of chronic venous insufficiency, which directly affects the blood vessel wall.

In a normal vein, the valves provide the anti-reflux function:

  • They guide the blood in the direction of the heart, so that it circulates in only one direction.
  • Thanks to their impermeability, the valves prevent blood from stagnating.

Unlike a normal vein, the valves of a vein no longer provide their antireflux and lose their impermeability.

When standing up, the blood tends to stagnate and pool in certain sections of the vein, forming a varicose vein.

The wall of a chickenpox when deformed, the varicose vein swells and twists, like a snake under the skin.

The affected vein wall presents hypertrophy and atrophy:

  • Each dilation of the vein corresponds to a pocket of blood.
  • Blood that stagnates in the pocket is no longer oxygenated and releases toxins that weaken the wall of the varicose vein.
  • Absorbed, the wall is refined and the vein swells.
  • The hyperdilated vein swells on the surface of the skin:
  • It appears blue or purple, forming a kind of cords.

Varicose veins are described as snakes under the skin.

They appear in different places, but the most common are those that form on the back of the calves, on the inside of the leg, or on the thigh.

Different types of varicose veins

There are different types of varicose veins, classified according to their size and location.

The most common varicose veins are those that affect the legs and thighs.

These are generally called large varicose veins, meaning that the diameter of the vein varies between 0.6 and 4 millimeters.

There are varicose veins:

On the legs and thighs

  • This is the most common type of varicose vein.
  • It mainly affects women.
  • They are in the form of protruding, bluish and twisted veins, along the lower extremities.

At the scrotum level

  • In this case we speak of varicocele.
  • This type of male varicose vein appears on a testicle in the form of a soft mass.

At the level of the vulva or perineum

  • This is a pelvic varix.
  • Pelvic varicose veins form in the lower abdomen in women, often during pregnancy.

In the esophagus

  • They are called esophageal varices.
  • They are difficult to diagnose and usually only appear after the break.

On the face, we talk about facial varicose veins

  • They are finer and more superficial than varicose veins on the legs.
  • On the skin, they look like trees or spider webs, red or blue.

At the level of the rectum

  • This is the case with what we commonly refer to as hemorrhoids.

Causes

The following factors may put you at increased risk of developing varicose veins or varicose veins.

Although the causes of venous disease are not yet clearly identified, taking into account the risk factors we must differentiate between varicose veins and chronic venous insufficiency.

Genetics

If in the family there are cases of members who have suffered from varicose veins, then there is a fairly high possibility that a person may also develop varicose veins.

Not all cases are genetic, of course, but the predisposition to develop varicose veins in families with a history of varicose veins is.

Gender

Women are much more likely to develop varicose or varicose veins (although 25% of cases occur in men).

Some research has indicated that increased levels of female hormones can cause relaxation of the vein walls and possible failure.

The pregnancy

The enlarged uterus can cause increased pressure on all of the veins.

In combination with elevated hormone levels, many women develop varicose veins for the first time during or shortly after pregnancy.

These veins generally get worse in later pregnancies, and may improve somewhat after delivery.

Age

As you age, the elasticity in the vein walls decreases, which increases the chance that the valves will fail and varicose veins will develop.

The obesity

Gaining or being overweight increases the risk of varicose veins or venous insufficiency.

This may be due to increased pressure on the venous system in obese individuals, or due to disruption of valve geometry in tissues.

Losing weight often helps relieve symptoms of venous insufficiency in obese patients.

The lifestyle

People whose occupations require them to stand or sit for long periods of time such as waitresses, hairdressers, are statistically more likely to develop varicose veins than those who do not have this type of job.

Injuries

Trauma can damage veins and cause valves to fail, leading to symptoms of venous insufficiency.

Trauma can mean anything from a broken leg in adolescence, to knee or hip surgery, to a blunt injury that never caused the broken bones.

It is important to share any history of past trauma with your doctor.

Symptoms of varicose veins

Varicose veins often cause no symptoms but can be cosmetically unattractive.

In some cases, varicose veins cause heaviness in the legs, sometimes with symptoms of cramps and itching as well.

During pregnancy, many women notice that their varicose veins become more prominent and more symptomatic.

In many patients, these problems will resolve after the baby is born.

Unfortunately, the symptoms of varicose veins are quite nonspecific and it is difficult to relate the threat of symptoms to the severity of venous disease, but venous disease has been shown to have significant effects on quality of life.

In some cases where varicose veins are large, ulcers can form on the lower leg (venous ulcers), affecting quality of life.

These ulcers can often be cured with simple dressings and stockings, without the need for surgery or other interventions.

Many people think about the visual appearance of varicose veins: raised, curved, swollen, purplish, or knotted veins, but they may not realize that the feelings they are experiencing may be symptoms of vein disease.

They may think that what they feel is normal. When symptoms of vein disease occur they are the following:

  • Pain, throbbing or generalized in the legs.
  • Fatigue and heaviness in the legs, feeling tired or heavy.
  • Tingling, itching, and burning
  • Tenderness in the legs and around the veins.
  • Swelling in the legs Vein problems are 8 to 10 times more likely to cause leg swelling than other causes combined.

Varicose vein symptoms generally progress over time without treatment.

Complications of untreated varicose veins

Without treatment, symptoms can progress to more serious complications.

The most serious complications of vein disease are thrombosis or phlebitis.

Superficial thrombophlebitis

This is due to the formation of blood clots in the varicose vein.

Superficial varicose veins become red, hot, tender, and painful, and blood clots form in the superficial veins.

This can take many weeks to resolve. Sometimes when severe phlebitis has resolved, varicose veins can disappear.

deep vein thrombosis

It is a blood clot that forms in a vein deep in the body.

They can break off and cause a pulmonary embolism, heart attack, or stroke .

Chronic venous insufficiency

The development of brown discoloration of the skin at the ankle (pigmentation), varicose eczema, and thickening of the tissues around varicose veins are signs that more extensive tissue damage is occurring.

Ulceration of varicose veins

When the tissue damage becomes bad enough, ulcers can develop on the skin just above the ankle.

Many patients are concerned when they hear the term ulceration, but it only means that there has been a loss of skin and that the tissues under the skin are exposed.

They are later stages of vein diseases. These ulcers are sores that take a long time to heal or do not heal.

The skin may also turn reddish or brown.

Bleeding

Varicose vein bleeding is relatively uncommon, especially in large bulbous type varicose veins.

If bleeding does occur, it tends to be from very shallow and smaller venous blisters on the skin.

Vein bleeding can be difficult to control. It may even require hospital treatment.

Diagnosis

The diagnosis of venous diseases is simple and non-invasive. First, your health history is reviewed, and then a brief physical exam is performed.

When evaluating varicose veins or spider veins, it is important to know the root cause of the problem.

Venous ultrasound is the primary tool vascular surgeons use to evaluate leg veins.

Ultrasound works by measuring sound waves in tissue and generating images.

From these images, you can see which veins are working well and which are leaking blood into the legs, causing increased pressure.

Most commonly, the causative vein will be the greater saphenous vein, which runs under the skin from the ankle to the groin, on the inner leg and thigh.

The ultrasound will evaluate the greater saphenous vein as well as the other major veins in the leg to see if there is insufficiency.

Furthermore, this study can also tell us if there are blood clots in the veins, which can be potentially dangerous. The ultrasound should take approximately 30-45 minutes.

Duplex ultrasound is a type of vascular ultrasound procedure performed to evaluate the blood flow and structure of the veins in the legs.

The term “duplex” refers to the fact that two ultrasound modes are used: Doppler and B-mode.

Treatment

To a large extent, treatment will depend on where the main vascular problems in varicose veins occur, the distribution and tortuosity and severity of the veins.

Surgery

This is still a common form of treatment for varicose veins and is an effective way to remove veins.

Radiofrequency ablation

This is a newer method of treating varicose veins.

It is a replacement for surgery, but may need complementary treatment, either with injections or minor avulsions to the visible veins.

Ablation involves inserting a thin, flexible tube called a catheter into a varicose vein.

The tip of the catheter heats the walls of the varicose veins with radio frequency energy and destroys the tissue in the vein.

Once destroyed, the vein can no longer carry blood and is absorbed by the body.

Intravenous láser therapy

It is similar to radiofrequency ablation.

It is also a replacement for the surgical removal part, but may also not treat all visible varicose veins.

Laser treatment is a type of treatment for varicose veins.

Until recently, laser treatment was used primarily to treat spider veins on the face. However, newer laser technology can now also effectively treat varicose veins.

The vein closes and the body eventually absorbs it.

Injection sclerotherapy

It is used in all types of varicose veins and a micro injection technique can be used for the veins of the strands.

It may not be as effective as other techniques for larger varicose veins.

This procedure involves a saline or chemical solution that is injected into the veins and causes them to harden so that they do not fill with blood.

Compression socks

This may be all that is needed if pain and swelling are the main problems.

It is essential that the correct degree of storage is used after proper adjustment.

Many patients find it very effective for symptoms, although they can be inconvenient, especially in hot weather.

These elastic stockings compress the veins and prevent blood from flowing backward.