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varicose veins

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Circulatory System

Alternative Names 
venous varicosities

Normally, tiny one-way valves inside each vein keep blood from flowing backward. When valves are damaged or do not work properly, a vein may start to bulge and twist. This is called a varicose vein.

What is going on in the body? 
After blood filled with oxygen is pumped through the body, veins bring oxygen-depleted blood back to the heart. Normally, one-way valves inside veins keep gravity from pulling the blood toward the feet. When valves are not normal or have been damaged, blood pools in the vein. The kinks, bulges, and lumps of varicose veins then occur. Varicose veins are most often noticed on the thigh or calf, where they are close enough to the skin to be seen. Varicose veins can, however, occur in other parts of the body.

What are the signs and symptoms of the condition? 
Often, varicose veins close to the skin can be seen. They are often described as swollen, enlarged, snakelike, bluish veins that are most noticeable when standing. They are most commonly seen on the back of the calf or inside of the leg from the ankle to the groin. Other symptoms in the legs include:
  • pain
  • itching
  • swelling
  • fatigue
  • heaviness
  • aching
  • burning
  • throbbing
  • cramping
  • restlessness
  • ulceration, usually on the medial side of the lower leg.
What are the causes and risks of the condition? 
The cause of this disorder is failure of the valves in the veins to prevent the backward flow of blood. The following conditions increase the risk of this condition:
  • a family history of this condition
  • obesity
  • ageing
  • leg injury
  • occupations where people stand or sit most of the time
  • pregnancy, especially multiple pregnancies
Women are much more prone to varicose veins than men. In fact, one in two women develop varicose veins. This has been linked to changes in hormones that women experience at puberty, during pregnancy, and at menopause.

A woman is more likely to get varicose veins:
  • if she takes oestrogen or progesterone in birth control pills or oestrogen replacement therapy
  • during the first trimester of pregnancy as the uterus expands and more weight is put on the legs. When this occurs during a woman's first pregnancy, these veins often disappear when the baby is born. That may not happen with later pregnancies.
A permanent condition known as milk leg may sometimes occur during pregnancy. It happens when valves in the veins have been destroyed and the pressure of the pooled blood causes swelling.

What can be done to prevent the condition? 
Although varicose veins may be partly inherited, making certain lifestyle changes may help prevent this condition. The following activities should be avoided to help prevent this condition:
  • heavy lifting
  • standing for long periods of time
  • sitting with legs crossed for long periods of time
Avoidance of obesity and getting regular exercise is also advised to help prevent this condition.

How is the condition diagnosed? 
A history and physical examination makes the diagnosis of varicose veins. Other tests may be ordered to examine the veins more closely, such as:
  • ultrasound, a test that uses sound waves to look at tissues, organs, arteries, and blood flow
  • blood flow studies that can measure changes in the amount of blood passing through a vein
What are the long-term effects of the condition? 
Severe varicose veins can cause eczema, inflammation, or stasis dermatitis, which is skin breakdown in the lower legs. Also large prominent varicose veins are easily traumatised which can cause a profuse haemorrhage.

Inflammation of the deep veins can lead to blood clots. These clots may break off and block the artery that supplies the lungs, known as a pulmonary embolism.

What are the risks to others? 
Varicose veins pose no risks to others and are not contagious.

What are the treatments for the condition? 
Mild varicose veins need no treatment other than for cosmetic reasons. In most cases, people with symptoms can use support hose or heavier elastic knee-high stockings to manage their condition. Frequent rest periods with leg elevation can also help with leg swelling and the feeling of heaviness in the legs. Regular exercise is also advised to improve circulation to the legs.

If symptoms are severe or a person finds the appearance of the veins unacceptable, varicose vein surgery may be an option. A variety of surgery methods are used. These include cutting the veins out, injecting the veins with chemicals to destroy or shrink them, or using lasers or radio waves to destroy shrink the veins.

Treated varicose veins usually disappear with surgery. Problems do not return in the treated veins, but may develop in other veins. Once a varicose vein is closed or removed, nearby healthy veins take over the job of carrying blood back to the heart.

What are the side effects of the treatments? 
All the surgical techniques cause some bruising and discolouration, which generally goes away over time. Skin scarring may also occur. As with any surgery, infection, bleeding, and reaction to any pain medication used may occur.

What happens after treatment for the condition? 
After the procedure, a person usually needs to wear a bandage or compression hose, or both. The vein that was treated scars over and causes no further problems. Later, though, people may get varicose veins that need treatment in other parts of the leg.

How is the condition monitored? 
A doctor should examine varicose veins periodically.

Author: Terry Mason, MPH
Reviewer: eknowhow Medical Review Panel
Editor: Dr John Hearne
Last Updated: 7/03/2005
Potential conflict of interest information for reviewers available on request

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