23 February 2012

Being vain about varicose veins

Q: What causes varicose veins? How are they treated? I have some in my legs and they are very unsightly. — joan_rc@yahoo.com
 A: Veins are the blood vessels that carry blood from the different parts of the body to the heart. In the extremities where the direction of blood flow to the heart is generally upwards, the veins are provided with one-way valves to prevent the back flow of blood. If these valves become defective and incompetent, blood pools, causing the superficial veins to stretch and swell, forming tortuous, cord-like and unsightly masses called varicose veins.
Varicose veins afflict about 15 percent of adults. They tend to run in families, suggesting a possible genetic predisposition to the disease. They are also more common in women especially among those who had been pregnant. Varicose veins first appear in many women during pregnancy. This is because during pregnancy the blood volume expands, the increased level of female hormones relaxes the veins, and the enlarging uterus and fetus compress the veins. Thus, pregnancy is one of the important predisposing factors for the development of varicose veins. The others are obesity, menopause, aging and abdominal straining (e.g., in people who are chronically constipated).

Varicose veins worsen with time, i.e., they become more prominent, engorged and swollen, but they usually present no symptoms and most patients who seek treatment do so for cosmetic reasons.  When symptoms occur, the more common ones include fatigue and edema (swelling) of the legs especially in the afternoon and after prolonged standing; itchiness and/or discoloration (usually hyperpigmentation) of the skin that overlies the varicose veins; and, occasionally, ulceration of the skin (i.e., a wound appears). Noteworthy, however, is the fact that the severity of the symptoms is independent on the number or size of veins that are involved. Some patients have severe symptoms even if only a few veins are varicosed.
In pregnant women, varicose veins can be prevented by always lying on the left side with the legs elevated on a pillow when resting or sleeping. This prevents the fetus from pressing on the leg veins.
In people whose veins that are just beginning to varicose, the veins,  together with the symptoms (if there are any), may disappear or at least improve with regular exercise (e.g., walking), avoidance of prolonged standing and intermittent rest during the day with the feet up. Additionally, elastic stockings that compress and provide support for the veins may be worn.
In people with severe symptoms or very unsightly lesions, several modalities are currently available to eliminate varicose veins. These modalities involve removal or destruction of the involved veins. Removal or destruction of the superficial veins does not impair blood circulation because the superficial veins play a minor role in returning blood to the heart. It is the deep veins that perform most of these functions.
One very popular modality is sclerotherapy, a procedure that involves injecting small and medium-sized varicosities with a sclerosing solution.
Another popular modality that is very effective in treating extensive varicosities is vein stripping. This is a surgical procedure that involves pulling out of the varicosed veins through a small skin incision.
Becoming popular is the use of ultrasound or laser in burning away the veins.
The modalities mentioned above are generally effective in affecting a permanent cure in the treated vein. However, it is not uncommon for new varicosities to appear in other veins after sometime.




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