VARICOSE VEINS

General Information

DEFINITION--Veins, usually in the legs, that become permanently dilated and twisted.

BODY PARTS INVOLVED--Veins in the legs, including superficial veins, deep veins and veins that connect superficial and deep veins. Veins in the vaginal lips during pregnancy and those around the anus (hemorrhoids) also may become varicose.

SEX OR AGE MOST AFFECTED--Adults of both sexes.

SIGNS & SYMPTOMS

• Enlarged, disfiguring, snakelike, bluish veins that are visible under the skin upon standing. They appear most often in the back of the calf or on the inside of the leg from ankle to groin.
• Vague discomfort and aching in the legs, especially after standing.
• Fatigue.

CAUSES--The veins of the legs contain one-way valves every few inches to help blood return against gravity to the heart. If the valves leak, blood pressure in the veins prevents blood from draining properly. Valves may fail because of: previous vein disease, such as thrombophlebitis; prolonged standing; or pressure on veins in the pelvis from pregnancy, tumors or fluid in the abdomen.

RISK INCREASES WITH

• Pregnancy.
• Menstrual cycle. Symptoms worsen before and during menstruation.
• Family history of varicose veins.
• Occupations that require prolonged standing.

HOW TO PREVENT--Exercise regularly, especially by walking, swimming or bicycling, to promote good circulation.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.
• X-rays of veins (venogram).

APPROPRIATE HEALTH CARE

Self-care after diagnosis. Doctor's treatment. > Surgical and other methods (if there is pain, recurrent phlebitis, skin changes, or for cosmetic improvement): Ligation and stripping of the saphenous vein; injection of sclerosing solution; stab evulsion phlebectomy (newer procedure with shorter

recovery time). For scars, excision of the entire area, followed by skin graft, may be necessary. (See Varicose Vein Removal in Surgery section.)

> Spider veins (idiopathic telangiectases) which may be extensive and unsightly: Intracapillary injections of 1% solution of sodium tetradecyl sulfate (or hypertonic saline 23.4%) using a fine-bore needle. Subsequent treatments may be required until

optimal results attained.

POSSIBLE COMPLICATIONS

• Ulcer near the ankle (stasis dermatitis) caused by poor circulation to the skin. This may be slow to heal.
• Deep-vein blood clot.
• Bleeding under the skin or externally.
• Skin problems adjacent to the varicose veins that resemble eczema.

PROBABLE OUTCOME--Symptoms can be controlled with treatment or cured with surgery.

How To Treat

GENERAL MEASURES----Conservative treatment methods: Frequent rest periods with legs elevated; lightweight, elastic compression hosiery (best put on before getting out of bed); avoid girdles and other restrictive clothing; if itching occurs, use warm, wet dressings.

MEDICATION--Medicine usually is not necessary for this disorder. However, your doctor may inject a chemical into small varicose veins to make them clot and scar (sometimes). Other veins will take over circulation in the area.

ACTIVITY--

• Avoid long periods of standing.
• Appropriate exercise routine as part of conservative treatment.
• Walking regimen after sclerotherapy is important to help promote healing.

DIET--

• No special diet.
• Weight loss diet recommended, if obesity a problem (see Weight-Loss Diet in Appendix).

Call Your Doctor If

• You have varicose veins.
• After diagnosis, varicose veins begin causing circulation problems in your feet, especially stasis dermatitis.