When veins become enlarged, the leaflets of the valves no longer meet properly, and the valves do not work. Varicose veins are abnormally bulging, gnarled and lumpy-looking veins that have become enlarged and twisted.
Any vein may become varicose, but the veins most commonly affected are those in the thighs, legs and feet.
For many people, varicose veins and spider veins (a common, mild variation of varicose veins) are simply a cosmetic concern.
Chronic venous disease of the legs is one of the most common conditions affecting people of all races. The American College of Phlebology (ACP), a group of dermatologists, plastic surgeons, gynecologists, and general surgeons with special training in the treatment of venous disorders, comments that more than 80 million people in the United States suffer from spider veins or varicose veins. Society of Plastic Surgeons (ASPS) estimates that 50 percent of women over 21 in the United States have spider veins. Women are more likely to develop spider veins than men, but the incidence among both sexes increases with age.
According to the ASPS, there were 616,879 sclerotherapy procedures performed in the United States in 2001; 97 percent were performed on women and 3 percent were done on men. Varicose veins are distinguished from reticular veins (blue veins) and telangiectasias (spider veins), which also involve valvular insufficiency, by the size and location of the veins. Telangiectasias (red spots) are small clusters of dilated blood vessels near the surface of the skin or mucous membranes that look similar to spider veins. Venous lakes are another type of varicose veins in which blood collects in the veins of the face and neck. Normally, blood flows to the testicles through an artery, and flows out via a network of tiny veins that drain into a long vein that goes up through the abdomen. The force of gravity, the pressure of body weight, and the task of carrying blood from the bottom of the body up to the heart make legs the primary location for varicose and spider veins. An aching, pressure sensation, or heavy feeling in your legs, often worse at night and after exercise.
Itching, redness, and dryness of skin area or irritated rash around one or more of your veins.
Skin ulcers near your ankle, ulceration of the skin overlying the veins, or thrombophlebitis (formation of a blood clot within the varicose vein) can mean you have a severe form of vascular disease that requires medical attention promptly.
In some people the skin above the ankle may shrink (lipodermatosclerosis) because the fat underneath the skin becomes hard. Restless legs syndrome appears to be a common overlapping clinical syndrome in patients with varicose veins and other chronic venous insufficiency. Many people find they need to sit down in the afternoon and elevate their legs to relieve these symptoms of discomfort. Varicose veins can be more prominent or first appear during menstruation or pregnancy, and they may be more bothersome during these times. Varicose veins are prone to developing superficial thrombophlebitis, which is a blood clot along with inflammation of a segment of vein. A varicose vein with deformed valves, abnormal blood flow, and thin, dilated (stretched) walls. In some instances, the absence or weakness of valves in the veins may cause the poor venous circulation (blood flow in the veins and pooling of blood in the veins) and lead to varicose veins. POOR CIRCULATION: Because poor circulation contributes to the formation of varicose veins, they are more common in people who sit or stand in one position for prolonged periods of time, people who habitually sit with their legs crossed, and those who lack proper regular exercise. OBESITY: Excess weight, obesity or distended belly may increase pressure inside veins and increased pressure on the legs, increasing the likelihood of developing varicose veins.
MENOPAUSE: Like pregnancy, hormonal changes occur effecting the vein walls and aging contributes to varicose veins in older women. PROLONGED STANDING: Prolonged standing or sitting contributes to the formation of varicose veins by increasing the pressure from pooled blood in the legs.
ABDOMINAL STRAINING: Chronic constipation, urinary retention from an enlarged prostate, chronic cough, or any other conditions that cause you to strain for prolonged periods of time causes an increase in the forces transmitted to the leg veins and may result in varicose veins. EXISTING HEALTH CONDITIONS: Heart failure, liver disease, and abdominal tumors can also play a role in the formation of varicose veins. NUTRITION DEFICIENCY: A deficiency of vitamin C and bioflavonoids (mainly rutin) can weaken the collagen structure in the vein walls, which can lead to varicose veins. HORMONE REPLACEMENT THERAPY: Some experts believe that hormone replacement therapy (HRT) and birth control pills (or other forms of hormonal-based contraceptions) can contribute to the formation of varicose veins. INCREASING AGE: Varicose veins occur most often in people ages 30 to 70, with your risk increasing as you age.
PREGNANCY: During pregnancy there is a huge increase in the amount of blood (blood volume) in the body, which increases blood pressure in the venous system.
GENETICS: Having family members with vein problems or were born with abnormally weak vein valves or if other family members had varicose or spider veins, there is an increased tendency you will too. CIRCULATION PROBLEMS: Standing for long periods of time, leg injury, heart conditions, and other circulatory problems can weaken vein valves. SUN EXPOSURE: Sun exposure can cause spider veins on the cheeks or nose of a fair-skinned person. LACK OF EXERCISE: A sedentary lifestyle without regular proper exercise increases the risk of developing varicose veins.
HORMONE MEDICATIONS: Using birth control pills or other hormone therapy used for menstrual problems, hormone imbalances, or menopausal problems such as hormone replacement therapy (HRT) increases the risk of developing varicosities.
OCCUPATIONAL FACTORS: People whose jobs require standing or sitting for long periods of time without the opportunity to walk or move around are more likely to develop spider veins than people whose jobs allow more movement. DERMATITIS: Dermatitis is an itchy rash or irritation that can occur on the lower leg or ankle of a person with varicose veins in the legs.
ULCERS: Extremely painful ulcers (skin sores) may form on the skin near or around varicose veins, particularly near the ankles. Superficial thrombophlebitis is a blood clot that occurs in a superficial vein and usually causes only minor problems that are limited to the area of the affected vein. SEVERE VENOUS INSUFFICIENCY: This severe pooling of blood in the veins slows the return of blood to the heart. MOBILITY PROBLEMS: Pain, heaviness, inability to walk or stand for long hours thus hindering work and daily activities. ACUTE FAT NECROSIS: Acute fat necrosis can occur, especially at the ankle of overweight patients with varicose veins. Watching your weight and weight control is important and beneficial to avoid placing too much pressure on your legs. To prevent thrombophlebitis, quit smoking if you are a smoker because smoking increases your risk of a blood clot. If you are at increased risk of deep vein thrombosis, talk to your health care provider before your flight. If you are hooked up to intravenous lines (IV) either at home or at the hospital, routine changing of IV lines helps to prevent phlebitis related to IV lines.
If no, are there sores or a rash on the leg or near the ankle with the varicose vein, or do you think there may be circulation problems in your feet?
Try not to stand or sit in one position for more than 30 minutes, elevate your legs when you are seated, and avoid uncomfortable footwear and tight socks or hosiery. You can use a warm washcloth as a compress on the affected area, and elevate your leg to help with any discomfort.
If you decide to take any pain-relieving medications, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others), be sure to tell your health care provider.
Write down any symptoms you are experiencing, including any that may seem unrelated to varicose veins. Write down key personal information, including a family history of varicose veins or spider veins.
Make a list of all medications, as well as any vitamins and other dietary or herbal supplements, that you are taking. In addition to the questions that you have prepared to ask your health care provider, do not hesitate to ask questions during your appointment at any time that you do not understand something. Evaluation of varicose veins includes a thorough general physical examination by your health care provider. In addition, general inspection and palpation (feeling the veins) as well evaluation for any bleeding or ulcers are typically performed.
Standing up for about 5 to 10 minutes can make the veins more visible, and this may further aid the health care provider in assessing the extent of the varicose veins. To diagnose varicose veins, your health care provider will do a physical exam, including looking at your legs while you are standing to check for swelling or seated with your legs dangling.
Your health care provider may do any of several simple tourniquet tests to identify points of reverse blood flow. Another useful device aiding in localizing the extent of the problem is a Doppler ultrasound.
The doppler ultrasound test is used to see if the valves in your veins are functioning normally or if there is any evidence of a blood clot.
Duplex scanning, a similar but more detailed test, can also be done to rule out the presence of clots in the deeper veins. Magnetic resonance venography is another test performed when the Duplex scan test is unclear.
Rarely, your health care provider may order an angiogram to look at blood flow through your blood vessels. Fortunately, medical treatment usually does not mean a hospital stay or a long, uncomfortable recovery. In general, sclerotherapy and laser therapy are helpful in treating spider veins (telangiectasias), while sclerotherapy and surgery may be a better options for larger varicose veins.
Exercising, following a proper diet, losing weight, not wearing tight clothes, elevating your legs often provides temporary symptomatic relief, and avoiding long periods of standing or sitting can ease pain and prevent varicose veins from getting worse. Wearing compression stockings is often the first approach to try before moving on to other treatments. The wearing of graduated compression stockings with a pressure of 30 to 40 mmHg has been shown to correct the swelling, nutritional exchange, and improve the microcirculation in legs affected by varicose veins. The main problem with compression stockings is that the blood will return to the veins soon after the stockings are taken off. When it comes to treatment options for varicose veins, it pays to be a cautious health consumer. Active medical intervention in varicose veins can be divided into surgical and non-surgical treatments. Support Stockings help prevent recurrent swelling and reduce the chances of complications of deep vein thrombosis. In some instances, especially if you cannot take blood thinners, a filter may be inserted into the main vein in your abdomen (vena cava) to prevent clots that break loose in leg veins from lodging in your lungs. Varicose vein stripping is a procedure in which your health care provider can surgically remove varicose veins that cause pain or recurrent thrombophlebitis in a procedure called varicose vein stripping.
Sometimes, surgery is necessary to remove a clot blocking a vein in your pelvis or abdomen.
Non-surgical treatments include sclerotherapy, elastic stockings, elevating the legs, and exercise. For all of these procedures, the amount of pain an individual feels will vary, depending on the person's general tolerance for pain, how extensive the treatments are, which parts of the body are treated, whether complications arise, and other factors. Today, the substances most commonly used in the United States for sclerotherapy are hypertonic saline and sodium tetradecyl sulfate (Sotradecol).
Ultrasound-guided sclerotherapy involves an interventional radiologist passing a thin tube called a catheter into the vein using ultrasound guidance and injecting substance that causes the veins to scar and close thus rerouting the blood to healthier veins.
In sclerotherapy, after the solution is injected, the vein's surrounding tissue is generally wrapped in compression bandages for several days, causing the vein walls to stick together.
Sclerotherapy is frequently used if people develop more varicose veins after surgery to remove the larger varicose veins and to seal spider-burst veins for people concerned about cosmetic appearance. In addition to the cosmetic purposes sclerotherapy serves, it is also performed to treat the soreness, aching, muscle fatigue, and leg cramps that often accompany small- or middle-sized varicose veins in the legs. For sclerotherapy, the degree of pain will also depend on the size of the needle used and which solution is injected. In about 10 to 30 percent of patients treated with sclerotherapy, dark discoloration of the injected area may occur (hyperpigmentation). Another problem may be the formation of new spider veins near the area that was treated with sclerotherapy. More rare complications may include the formation of an ulcer around the injection site and the formation of small blood clots in the small surface veins (superficial thrombophlebitis). Sclerotherapy is generally safe for most people for treatment of varicose veins and spider veins. A study by Kanter and Thibault in 1996 reported a 76 percent success rate at 24 months in treating saphenofemoral junction and great saphenous vein incompetence with STS 3 percent solution.
Because sclerotherapy is usually considered a cosmetic procedure, it is usually not covered by health insurance. Sclerotherapy as a general treatment modality is also performed to treat hemorrhoids (swollen veins) in the esophagus.
This minimally-invasive treatment is an outpatient procedure performed using imaging guidance.
Reflux within the great saphenous vein leads to pooling in the visible varicose veins below. Radiofrequency ablation is a similar technique to endovascular laser, but it uses heat to destroy the vein. Larger varicose veins may be treated with endovenous (inside the vein) catheter ablation or laser surgery.
Health care providers are using new technology in laser treatments to close off and destroy smaller varicose veins and spider veins. Laser surgery works by sending strong bursts of light onto the vein, which makes the vein slowly fade and disappear.
Redness or swelling of the skin right after the treatment that disappears within a few days.
Endovenous techniques (radiofrequency and laser) for treating the deeper varicose veins of the legs (the saphenous veins) have been a huge breakthrough. Two prospective randomized trials found speedier recovery and fewer complications after radiofrequency obliteration (AKA radiofrequency ablation) compared to open surgery. Endovenous laser and radiofrequency ablation require specialized training for health care providers and expensive equipment.
In one of these treatments, your health care provider inserts a thin tube (catheter) into an enlarged vein and heats the tip of the catheter. The VNUS Closure Procedure, an alternative treatment option to traditional vein stripping surgery, brings state-of-the-art technology to an age-old disease.
Following the procedure, a simple bandage is placed over the insertion site, and additional compression may be provided to aid healing. In medicine, a ligature is a device, similar to a tourniquet, usually of thread or string, tied around a limb, blood vessel or similar to restrict blood flow. This surgery requires either local or general anesthesia and must be done in an operating room on an outpatient basis. For vein stripping, a recovery period of 5 to 10 days is needed before returning to a regular routine.
Significant amount of bruising and possibly bleeding and congestion of blood can be a problem. Significant pain in the leg and recovery time of one to four weeks depending on the extent of surgery is typical after surgery. Traditionally, surgical ligation or vein stripping was the treatment for varicose veins, but these procedures can be quite painful and often have a long recovery time. Ambulatory phlebectomy is a minimally invasive surgical treatment for superficial varicose veins not caused by saphenous vein reflux. To be achieved properly,the CHIVA method needs a comprehensive knowledge of both hemodynamics and Ultrasound venous investigation.
The procedure generally consists in 1 to 4 small incisions under local anesthesia in order to disconnect the varicose veins from the abnormal flow due to valvular incompetence which dilates them. CHIVA is used to prevent varicose recurrence due to progressive enlargement of collateral veins which replace and overtake the destroyed veins.
Unfortunately at this stage, the best available publication of CHIVA outcomes that meets current methodological standards is a study by Carandina et al. You might need endoscopic vein surgical operation only in an advanced case involving leg ulcers.
Varicose veins that develop during pregnancy generally improve without medical treatment within three months after delivery. Several surgical procedures are available to relieve varicose veins, but not everyone with varicose veins is a candidate for surgery. If you are pregnant or recently pregnant, it is advisable to wait at least 6 weeks after delivery before considering this option, because many of the varicose veins you have during pregnancy will fade. If your veins bother you only because of the way they look, and you are not bothered by pain or inflammation, then surgery may not be your best option.
Surgery is usually reserved for people who either do not get relief from the home care techniques or lifestyle changes, or who for cosmetic reasons want to try methods other than sclerotherapy or laser treatment to make their veins less prominent. Health care providers providing surgical treatments (stripping and laser ablation) include general and vascular surgeons. Patients considering surgical treatment should also get a second opinion from an interventional radiologist to ensure they know all of their treatment options. A patient should carefully question the health care provider about the safety and side effects for each type of treatment.
For surgical removal of veins, the side effects are those for any surgery performed under anesthesia, including nausea, vomiting, and the risk of wound infection. Many studies have found that varicose veins are more likely to recur following sclerotherapy than following surgery. As noted above, small spider veins cannot be surgically removed and can only be treated with sclerotherapy.
If you have deep vein thrombosis, injection of a blood-thinning (anticoagulant) medication, such as heparin, will prevent clots from enlarging.
Thrombolysis requires the use of thrombolytic drugs, which are either derived from Streptomyces spp. Formation of blood clots lies at the basis of a number of serious diseases, such as myocardial infarction (heart attack), stroke (ischemic stroke), massive pulmonary embolism, acute limb ischemia. All thrombolytic agents work by activating the enzyme plasminogen, which clears the cross-linked fibrin mesh (the backbone of a clot). Thrombolytics are contraindicated in bleeding disorders, active bleeding and when there has been recent surgery.
Limiting your fat intake will allow your liver to adapt to the gallbladder’s absence. Fiber may also help you control the diarrhea symptoms that may be experienced after surgery. When the different organs use oxygen from the blood to perform their functions, they release the used blood containing waste products (such as carbon dioxide) into the veins.
This storing capacity is due to the elasticity (flexibility to expand) of the walls of the veins. The largest veins are in the center of the body; these collect the blood from all the other smaller veins and channel it into the heart.
Varicose veins are the result of malfunctioning valves inside the veins and venous insufficiency, a very common condition resulting from decreased blood flow from the leg veins up to the heart, with pooling of blood in the veins.
If the valves do not work properly, circulation is impaired and blood accumulates in the veins, stretching them and they allow blood to flow backward, a condition called reflux.
This is because standing and walking upright increases the pressure in the veins of the lower body. During pregnancy, varicose veins called hemorrhoids can form in the vagina or around the anus. However, for others, varicose veins are often associated with swelling, heaviness in the legs, dull, nagging aches and pains, especially when standing or walking and can be a source of discomfort. Hispanics are less likely than Caucasians but more likely than either African or Asian Americans to develop spider veins. The results of a recent survey of middle-aged and elderly people in San Diego, California, show that 80 percent of the women and 50 percent of the men had spider veins. Large varicose veins can be visible, bulging, palpable (can be felt by touching), long, and dilated (greater than 4 millimeters in diameter). Medically known as telangiectases, they are dilated capillary veins less than 2 millimeters in diameter. They measure between 0.5 and 1 millimeter in diameter and are red, purple or blue in color. Compared with other veins in the body, leg veins have the toughest job of carrying blood back to the heart.
This is termed stasis dermatitis or venous eczema, because of waste products building up in the leg.
The symptoms can arise from spider veins as well as from varicose veins, because, in both cases, the symptoms are caused by pressure on nerves by dilated veins.
In more severe cases, venous insufficiency and reflux can cause skin discoloration and ulceration which may be very difficult to treat. Blood clots in the superficial veins are easy to detect and troublesome but are usually harmless. Veins return blood from the rest of your body to your heart, so the blood can be recirculated. Valves inside veins normally act to ensure that blood in the veins does not go the wrong direction (or backwards) away from the large (deep) veins and the heart. The walls of the blood vessels can become weaker and less competent than normal, causing the volume of blood in the veins to increase, leading to varicose veins.
It is estimated that approximately 50 percent of all middle-aged Americans have at least some varicosities. Pregnancy increases the volume of blood in a woman's body, but decreases the flow of blood from her legs to her pelvis. These mechanisms also contribute to the formation of hemorrhoids, which are varicosities located in the rectal and anal area. Venous disease (disease of the veins) is generally progressive and may not be prevented entirely. Varicose and spider veins can occur in men or women of any age, but most frequently affect women in the childbearing years and older people. If you do a lot of standing or sitting, your blood does not flow as well if you are in the same position for long periods. Most varicose veins are relatively benign, but severe varicosities can lead to major complications, due to the poor circulation through the affected limb. Secondary infection (infection that occurs after the ulcers have formed) can cause severe health problems and need to be treated.
It can be life threatening if the clot breaks off and travels to the lungs, which is called pulmonary embolism. There have been over 100 reported cases of malignant transformation and the rate is reported as 0.4 to 1 percent.
You cannot change your genes and if you are genetically destined to develop varicose veins, they may appear despite all your best efforts. Wear elastic support stockings and avoid tight clothing that constricts your waist, groin, or legs.
One concern many people have is that blood clots can be caused by sitting for hours at a time, as when you are traveling by car or airplane.
Flex your ankles, or carefully press your feet against the floor or foot rest in front of you at least 10 times each hour. Aspirin therapy is generally not recommended and could thin your blood too much if you are also taking warfarin (Coumadin). These medications can interact with other blood clot-dissolving medications your health care provider prescribes.
Your health care provider will need to look at your bare legs and feet to diagnose varicose veins and figure out what treatment might be best for your condition.
Sometimes it can be difficult to soak up all the information provided to you during an appointment. Your time with your health care provider is limited, so preparing a list of questions will help you make the most of your time together. Being ready to answer them may reserve time to go over any points you want to spend more time on. This will include asking about family history of varicose veins, duration, presence of any symptoms, and any worsening or expansion of the varicose veins. Your health care provider may also ask you to describe any pain and aching in your legs or any other symptoms. This handheld device is skimmed back and forth over the surface of the leg (or other affected area) to map out the veins and faulty valves and to evaluate the flow of blood in your veins. During an ultrasound, a technician trained in ultrasound imaging (sonographer) presses a small hand-held device (transducer), about the size of a bar of soap, against your skin over the area of your body being examined, moving from one area to another as necessary. An interventional radiologist, a practitioner specially trained in performing minimally invasive treatments using imaging guidance, will use duplex ultrasound to assess the venous anatomy, vein valve function, and venous blood flow changes, which can assist in diagnosing venous insufficiency. Thanks to less invasive procedures, varicose veins can generally be treated on an outpatient basis. These treatments are offered based upon the size of the varicose veins, the presence of any symptoms, and the location of the veins.
Compression stockings work simply by reducing the amount of blood and pressure in the veins. With the variety offered, you are likely to find a stocking that you are comfortable wearing.
Using a tape measure, you or your pharmacist can measure your legs to ensure you get the right size and fit according to the size chart found on the stocking package. They also may be uncomfortable for some people, and therefore, they may not worn for long enough to have any benefit. Some health care providers favor traditional open surgery, while others prefer the newer methods. This procedure, typically done on an outpatient basis, involves removing a long vein through small incisions. To treat a persistently blocked vein, your health care provider may recommend surgery to bypass the vein, or a non-surgical procedure called angioplasty to open up the vein. It is recommended for varicose veins that are causing pain or are very unsightly, and when hemorrhaging or recurrent thrombosis appear. Sometimes, they disappear when the larger varicose veins feeding the spider veins are removed. Injection therapy is also called sclerotherapy and is a commonly performed non-surgical treatment.
Aethoxyskerol (Polidocanol) is undergoing FDA testing but has not yet been approved in the U.S. Sclerotherapy is typically used for spider veins and varicose veins that are less than 6 millimeters in length.
The chemical causes the vein to become inflamed, which leads to the formation of fibrous tissue and closing of the lumen, or central channel of the vein. It is most often done to improve the appearance of the legs, and is accomplished by closing down spider veins-small veins in the legs that have dilated under increased venous blood pressure. Most people find hypertonic saline to be the most painful solution and experience a burning and cramping sensation for several minutes when it is injected. This usually happens because of disintegration of the red blood cells in the treated blood vessel.
This can happen in about 20 percent of patients, but these new vessels also typically disappear within 6 months. However, in certain groups of people, sclerotherapy needs to be avoided, including non-ambulatory people (those unable to walk).
People who are being treated for cramps and discomfort in their legs, however, should ask their insurance companies whether they are covered for sclerotherapy. After applying local anesthetic to the vein, the interventional radiologist inserts a thin catheter, about the size of a strand of spaghetti, into the vein and guides it up the great saphenous vein in the thigh.
By closing the great saphenous vein, the twisted and varicosed branch veins, which are close to the skin, shrink and improve in appearance. The probe is placed in the vein under ultrasound and once in position, the vein is heated along the entire length. This basically involves inserting a probe (or catheter) into the large vein in the lower leg (saphenous vein) and closing the vein by applying heat generated through laser. The laser applies an intense energy that essentially destroys the small blood vessels in the surface of the skin.
Laser surgery is more appealing to some patients because it does not use needles or incisions. The procedure is relatively new and except for some mild bruising and a numbing sensation, no other effects have been seen in the short term.
This is generally less invasive than sclerotherapy and vein stripping (no insertion of needles or catheters are required). In comparison, radiofrequency ablation has been shown to control 80-percent of cases of small saphenous vein reflux at 4 years. Endovenous laser treatment is performed as an outpatient procedure and does not require the use of an operating theater, nor does the patient need a general anesthetic. As the catheter is pulled out, the heat destroys the vein by causing it to collapse and seal shut.
Your health care provider may encourage you to walk, and to refrain from extended standing and strenuous activities for a period of time. Surgery involves making an incision through the skin at both ends of the section of vein being removed.
But the collected blood usually settles on its own and does not require any further treatment. A possibility of persistent numbness from damage to the nerves in the skin exists (for this reason, usually only the vein to the knee is stripped, not the vein below the knee).
For traditional surgery, reported recurrence rates, which have been tracked for 10 years, range from 5 to 60-percent. CHIVA relies on an hemodynamic impairment assessed by data and evidences depicted through Ultrasound dynamic venous investigations. It is used to preserve the superficial venous capital for unpredictable but possible need for coronary or leg artery and vital by-pass which increases with ageing. The authors estimate that only 30 to 35-percent of patients with varicose veins can be treated with CHIVA. Your surgeon uses a thin video camera inserted in your leg to visualize and close varicose veins. Be sure to ask the health care providers about their experience in performing the procedure you want.
You can ask for a referral from your health care provider, call the radiology department of any hospital and ask for interventional radiology or to locate a health care provider near you. Thoroughly review any "informed consent" forms your health care provider gives you explaining the risks of a procedure. Surgery also results in scarring where small incisions are made and may occasionally cause blood clots.
These include the underlying diagnosis, the method used and its suitability for treating a particular condition, and the skill of the practitioner. However, no treatment method has been scientifically established as being free from recurrences. On the other hand, larger varicose veins may, according to many studies, be more likely to recur if treated with sclerotherapy.
After the heparin treatment, taking the anticoagulant warfarin (Coumadin) for several months continues to prevent clots from enlarging. By breaking down the clot, the disease process can be arrested, or the complications reduced. This makes the clot soluble and subject to further proteolysis by other enzymes, and restores blood flow over occluded blood vessels. The gallbladder may be affected by conditions such as gangrene, abscesses, gallstones and inflammation. Refrain from consuming bologna, potted meat, bacon, hot dogs, sausages, ham, salami and other processed meats; these are high in fat. Blood in the veins is then transported to the heart and returned to the lungs, where the waste carbon dioxide is released and more oxygen is loaded by the blood and taken back to the rest of the body by the arteries. Varicose veins are common in the superficial veins of the legs, which are subject to high pressure when standing. Men are less likely to seek treatment for spider veins for cosmetic reasons, however, because the discoloration caused by spider veins is often covered by leg hair. They are most often branches from the saphenous trunk veins, and have enlarged due to the excess pressure in the saphenous system. They are commonly found on the upper body, including the face around the nose, cheeks and chin, and can be found on the upper chest, neck and on other parts of the body.
A series of one-way valves in the vein prevent the reverse flow of blood back to the testicles. This condition is not to be confused with a deep vein thrombophlebitis (DVT), which is a blood clot in a deep vein.
This circulatory change is designed to support the growing fetus, but it can produce an unfortunate side effect - enlarged veins in her legs (and sometimes in the groin area). Some experts think inherited problems cause some people to have too few valves or valves that do not function properly. Ulcers are caused by long-term fluid buildup in these tissues, caused by increased pressure of blood within affected veins. Infections, chemical irritation, or other conditions that cause irritation and inflammation of the veins also can lead to superficial thrombophlebitis. Blood clots can be very dangerous because they can move from leg veins and travel to the lungs. But improving your circulation and muscle tone can reduce your risk of developing varicose veins or getting additional ones. If you must stand for a long time, shift your weight from one leg to the other every few minutes. While sitting for long periods can promote a blood clot that can lead to thrombophlebitis, this occurs relatively rarely. Your primary care practitioner may recommend that you see a health care provider who specializes in vein conditions (phlebologist) or a practitioner who treats skin conditions (dermatologist or dermatology surgeon). Your health care provider most likely will take a thorough medical history and examination looking not only for the extent of your varicose veins, but also for potential risk factors.
A computer converts sound waves into a picture of the blood flow in the arteries and veins. The practitioner will map the great saphenous vein and examine the deep and superficial venous systems to determine if the veins are open and to pinpoint any reflux. Symptom relief includes such measures as wearing support stockings, which compress the veins and hold them in place. These stockings typically lose their pressure if washed a few times, so they may need to be replaced from time to time.
Before undergoing any procedure, ask your health care provider about any health risks and possible side effects. Newer, less invasive treatments, such as radiofrequency ablation and endovenous laser treatment, are slowly replacing traditional surgical treatments.
Sclerotherapy involves using a fine needle to inject medicinal solution directly into the small and medium-sized varicose veins to make them shrink, closing those veins.
Although the same vein may need to be injected more than once, sclerotherapy is effective if done correctly.
This is generally offered to patients who have tried compression stockings and leg elevation without much success.
A spider vein is one type of telangiectasia, which is the medical term for a reddish-colored lesion produced by the permanent enlargement of the capillaries and other small blood vessels. Some health care providers mix a mild local anesthetic with the saline solution to minimize the pain. Other contraindications for sclerotherapy include obesity, blood clots in the deeper veins, allergy to the sclerosing agent, pregnancy, and arterial obstruction (blocked blood flow in the artery near the varicose vein). Once the diseased vein is closed, other healthy veins take over to carry blood from the leg, re-establishing normal flow.
There may be minor soreness or bruising, which can be treated with over-the-counter pain relievers. This technique has proven to be less painful, and it also has a faster recovery time compared to the vein stripping surgery. Still, when the laser hits the skin, the patient feels a heat sensation that can be quite painful. Using ultrasound, your health care provider will position the Closure catheter into the diseased vein, through a small opening in the skin. Patients who undergo the Closure procedure typically resume normal activities within a day. A tunneling device is placed under the skin between the 2 points, and the saphenous vein is dragged or pulled out of the tunnel.
Stripping consists in a removal of all the saphena vein main trunk from the groin down to the ankle. Injections of heparin, a medicine that reduces blood clotting reduce the chance of these dangerous blood clots. Ambulatory phlebectomy involves your health care provider removing smaller varicose veins through a series of tiny skin punctures or incisions (small 2 to 3 mm incisions in the skin overlying the veins) using a special set of tools (surgical hooks) to pull the vein out of the leg.
This procedure is often used as an adjunct to endovenous laser treatment or other endovenous ablations of the greater saphenous vein. According to this new concept, the clinical symptoms of venous insufficiency are not the cause but the consequence of various abnormalities of the venous system. This study showed that there were recurrent varices in 18 percent of cases treated by CHIVA despite there being some bias in the selection of patients favoring CHIVA.
People who have this surgery must have some kind of anesthesia including epidural, spinal or general anesthesia. If your health care provider prescribes warfarin, follow the directions for taking the medication carefully.
It works by stimulating fibrinolysis by plasmin through infusion of analogs of tissue plasminogen activator, the protein that normally activates plasmin.
While other anticoagulants (such as heparin) decrease the "growth" of a clot, thrombolytic agents actively reduce the size of the clot. Apart from streptokinase, all thrombolytic drugs are administered together with heparin (unfractionated or low molecular weight heparin), usually for 24 to 48 hours. Consume no more than 7 percent of saturated fats and 1 percent of trans fat from your total daily calories.
There are also other veins that connect the superficial veins to the deep ones which are called the perforating veins. Also included in this category are the communicator or perforator veins, which connect the superficial veins with the deep veins. A common cause of varicose veins in the legs is reflux in a thigh vein called the great saphenous, which leads to pooling in the visible varicose vein below. On the other hand, men who are bothered by aching, burning sensations or leg cramps, can benefit from sclerotherapy.
Spider veins are commonly found on the legs and face, and they usually resemble fine lines, starburst clusters, a spider web-like maze or tree branch in shape.
They can also develop on the legs, specifically on the upper thigh, below the knee joint and around the ankles.
When these one-way valves fail, the reverse flow of blood stretches and enlarges the tiny veins around the testicle to cause a varicocele, a tangled network of blood vessels, or varicose veins.
Deep vein thrombophlebitis is more serious because of the clot's potential to travel toward the heart and lodge in the lung. Muscle contractions in your lower legs act as pumps, and elastic vein walls help blood return to your heart. When the muscles surrounding the deep veins contract, emptying the deeper veins, a build-up of pressure occurs. The valves in your veins may become weak, allowing blood that should be moving toward your heart to flow backward. Varicose veins may surface for the first time or may worsen during late pregnancy, when the uterus exerts greater pressure on the veins in the legs. Some estimates suggest that about 10 to 15 percent of men and 20 to 25 percent of women suffer from varicose veins. Taking hormone replacement therapy or birth control pills containing estrogen and progesterone may increase your risk of varicose veins or spider veins. In addition, hormonal changes of pregnancy cause the walls and valves in the veins to soften.
Any sudden leg swelling warrants urgent medical attention because it may indicate a blood clot. Blood clots in the lungs are life-threatening because they can block the heart and lungs from functioning. In the meantime, there are some steps you can take to prepare for your appointment and begin your self-care. The transducer transmits images of the veins in your legs to a monitor, so a technician and your health care provider can see them. This will help determine if the patient is a candidate for a minimally invasive treatment, known as vein ablation. They steadily squeeze your legs, helping veins and leg muscles move blood more efficiently. Removing the vein will not affect circulation in your leg because veins deeper in the leg take care of the increased volumes of blood. Because most of the blood in the legs is returned by the deep veins, the superficial veins, which return only about 10 per cent of the total blood of the legs, can usually be removed or ablated without serious harm.
Smaller tributaries of these veins also are stripped with this device or removed through a series of small incisions. This solution irritates the lining of the vein, causing the vein to swell and the blood to clot. Sclerosing agent or solution is the general term for the substances used for sclerotherapy.
There has been one reported case of stroke after ultrasound guided sclerotherapy when an unusually large dose of sclerosant foam was injected. No scars or stitches - because the procedure does not require a surgical incision, just a nick in the skin, about the size of a pencil tip. One 3-year study compared radiofrequency, with a recurrence rate of 33-percent, to open surgery, which had a recurrence rate of 23-percent.
Some practitioners also perform phlebectomy or ultrasound guided sclerotherapy at the time of endovenous treatment.
Only the parts of your leg that are being pricked are numbed under local or regional anesthesia, in this outpatient procedure. For example, a varicose vein being overloaded, may be dilated not only because of valvular incompetence (the most frequent) but because of a venous block (thrombosis) or arterio-venous fistulae and so the treatment has to be tailored according the hemodynamic feature. An injected vein that was not completely destroyed by sclerotherapy may reopen, or a new vein may appear in the same location as previous one. Warfarin is a powerful medication that can cause dangerous side effects if not taken properly. Streptokinase is contraindicated in patients who have been previously treated with streptokinase, as there is a risk of anaphylaxis (life-threatening allergic reaction) due to the production of antibodies against the enzyme.
Drug therapy is used to treat the condition, but sometimes a cholecystectomy -- removal of the gallbladder -- is necessary. This translates to 67 g of total fat, 16 g of saturated fats and 2 g of trans fat for a 2,000-calorie diet.
If you do not eat meat, select lean protein from vegetable sources such as tofu, beans and lentils. If gas and bloating are a problem, avoid eating raw vegetables; try cooked and canned vegetables and fruits instead.
Avoid carbonated beverages and beverages that may cause you pain, gas, bloating, discomfort or diarrhea. The deep veins are encased by muscle and connective tissue, which help to pump the blood in the veins and back to the heart. A cause of valve failure is deep vein thrombosis (DVT), which can cause permanent damage to the valves.
Of these, 20 to 36 percent of the women and 10 to 19 percent of men will have visible varicose veins. A clotted varicose vein causes the classic phlebitis, hot and red and painful skin at the site of the clot. They are small blue or red appearing blood vessels that lie close to the surface of the skin.
Some telangiectasia are due to developmental abnormalities that can closely mimic the behavior of benign vascular neoplasms.
This condition requires emergency admission to the hospital for treatment with blood thinning medications. Tiny valves in your veins open as blood flows toward your heart then close to stop blood from flowing backward.
This causes even more blood to go the wrong way from the deep to the superficial veins through faulty valves in the perforator veins. Changes in a woman's hormones (estrogen and progesterone) and their effect on the vein walls during pregnancy also may play a role in contributing to development of varicose veins. Blood clots are frequently isolated to the superficial veins, but can extend into deep veins becoming a more serious problem requiring immediate medical care and therapy. Other measures are sitting down, using a footstool when sitting, avoiding standing for long periods of time, and raising the legs whenever possible.
Most insurance policies do not cover the expense of elective cosmetic surgery for varicose veins. The vein turns into scar tissue that may eventually, within a few weeks, treated varicose veins should fade from view. Spider veins may also appear in two other common patterns-they may look like tiny tree branches or like extra-fine separate lines.
The procedure is usually performed in a health care provider's office and takes about 30 to 45 minutes.
Follow-up treatment to smaller branch varicose veins is often needed in the weeks after the initial procedure. As the RF energy is delivered and the catheter is withdrawn, the vein wall is heated, causing the collagen in the wall to shrink and the vein to close. Removing the vein will not affect circulation in your leg because veins deeper in the leg take care of the larger volumes of blood.
Some dietary modifications may be needed to allow the liver to compensate for the gallbladder’s absence. Beside the visible symptoms, physical symptoms are tiredness, restless legs at night, heaviness in the leg, pain, aching, itching, throbbing and swelling, burning or a cramping sensation.
Varicoceles may be linked to male infertility and should be checked by a health care provider. The veins appear blue because they contain deoxygenated blood, which is in the process of being recirculated through the lungs.
Eventually, that wear causes the valves to allow blood to flow back into your veins where it collects instead of flowing up to your heart.
Pregnancy, especially multiple pregnancies, is one of the most common factors accelerating the worsening of varicose veins.
Make sure your diet is rich with vitamins and minerals and sufficient proteins, especially Vitamin C with Bioflavonoids, including Rutin. However, in many cases, if you have signs or symptoms, such as swelling and bleeding, insurance may cover the treatment. Sclerotherapy is often used for telangiectasias (spider veins) and varicose veins that persist or recur after vein stripping. The procedure may be performed in hospital or outpatient settings and typically takes under an hour. Shop around and find a qualified practitioner experienced with the treatment of varicose veins. Sclerotherapy can also be performed using microfoam sclerosants under ultrasound guidance to treat larger varicose veins, including the great and short saphenous veins.
Many insurance carriers cover the vein ablation treatment, based on medical necessity for symptom relief. Depending on the severity of the veins, two to five treatments are generally needed to remove spider veins in the legs. As long as the deeper veins are still functioning properly, a person can live without some of the superficial veins.
In some settings, emergency medical technicians may administer thrombolysis for heart attacks in pre-hospital settings.
Varicose veins are bulging veins that are larger than spider veins, typically 3 mm or more in diameter. They can develop during pregnancy and in people who have certain genetic disorders, viral infections, and other medical conditions (such as liver disease). It never hurts to get a second or third opinion from other non-associated practitioners (health care providers not working in the same office or are affiliated with each other). This limits the amount of blood that collects in the varicose veins and reduces some of the symptoms.
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