Varicose veins

Definition

Varicose veins are swollen, dilated and tortuous veins on the lower legs. Veins involved are mostly the superficial ones particularly the long saphenous vein and its tributaries. The dilation of the veins is usually permanent.

Etiology (cause)

The most common cause of varicose veins is a weakness in the valves and walls of the veins. Other causes include:

  1. Elavated pressure in the lumens of veins due to inadequate circulation of blood in the affected area. The inadequate blood circulation usually occurs because of prolonged hours of standing or sitting, for example in a matatu when traveling a long journey.
  2. Exertion of excessive pressure on the iliac veins by a thrombus, pregnant uterus or a growing tumour.
  3. Obesity
  4. Effects of hormones on the smooth muscles in the body.

The occurrence of varicose veins can also be influenced by heredity factors.

Pathogenesis (Pathophysiology)

All the causes stated above cause the superficial veins especially in the lower extremities to dilate and become tortuous.

Risk factors

  1. Long periods of standing or sitting.
  2. Not exercising or inactivity.
  3. Pregnancy
  4. Growing tumours
  5. Obesity

Clinical features (Symptoms and signs)

  1. Pain in the legs
  2. Itching of the affected veins
  3. Swelling of the superficial blood vessels of the legs
  4. Bruising or blue colour on the swollen veins
  5. A feeling of heaviness in the affected leg

Diagnosis

Varicose veins can be diagnosed by observing any of the signs and symptoms stated above. After diagnosis is made, it can be confirmed by conducting phlebography. Phlebography is the injection of a radio-opaque substance into the veins. The radiographs from the injected area are then taken and analysed.

Management

Management of Varicose veins involves treatment such as:

  1. Medications to relieve pain
  2. Laser treatments to eliminate or block small veins and spider veins
  3. Minor surgery to remove the varicose veins if large
  4. Injection of chemical substances into the small varicose veins to induce scar formation which eventually blocks the affected Veins. This process is called sclerotherapy.
  5. Use of radio-frequency energy to block or close the varicose veins. This process is known as radio-frequency ablation.

Management can also involve taking of the necessary prevention measures such as:

  1. Regular exercising
  2. Avoiding long periods of standing or inactivity
  3. Control of weight gain

Complications

Varicose veins may lead to:

  1. Secondary infection which may also cause chronic varicose ulcers
  2. Venous stasis of blood
  3. Dermatitis
  4. Cellulitis
  5. Thrombophlebitis