What are Varicose Veins?

Varicose veins (also known as spider veins) are large, discoloured swollen and twisted blood vessels that can be seen on the skin's surface. They can occur along any veins located on the skin but most commonly along the legs and feet. According to the Royal College of General Practitioners, approximately 15% of Australians will have varicose veins [1]. The characteristics of varicose veins are best demonstrated in the image below.  

Varicose Veins Symptoms

Generally, the most common symptom of varicose veins is the change in the appearance of the blood vessels. Examples of these changes include discolouration, thickening and twisting protrusions of the veins. Asymptomatic individuals will have no or mild symptoms linked to their varicose veins [2]. However, some may experience more noticeable and severe symptoms, including [3][4]:

• Pain
• Swelling (particularly around the ankle)
• Eczema
• Discolouration on the skin
• Cramping
• Sores and/or ulcers around the affected area
• Itchiness

 

What Causes Varicose Veins?

There are many proposed causes of varicose veins. One proposed reason is the thinning and loss of elasticity of the veins. These changes affect the pressure and the ability of the valves inside the veins to work effectively. Over time, these changes can cause blood to pool inside the veins, which leads to varicose veins. There is no certainty why some people develop varicose veins, and others do not [3][5]. However, having a family history of deep vein thrombosis and genetic links may increase the risk of varicose veins. Other risk factors which may lead to these changes include [5]:

• Chronic venous insufficiency
• Aging
• Being overweight or obese
• Being pregnant
• Standing or sitting for long periods
• Having an inactive and/or sedentary lifestyle
• Hormonal changes

 

Varicose Veins Diagnosis and Tests

Physical Examination

Your GP can assess to inspect the affected area. Photos of the area might be taken to monitor the varicose veins progression, response to treatment and treatment planning [3].

Duplex Ultrasound Imaging

Ultrasound imaging can be used to detect varicose veins. Duplex ultrasound uses sound waves to measure the vessels' thickness, elasticity, and function [3]. Your GP will most likely refer you to a sonographer, a medical professional who specialises in ultrasound imaging. These findings may help guide the treatment plan recommended by your GP.  

Varicose Veins Treatments

Recommended treatment for varicose veins may vary depending on the patient's symptoms, general health, age, etc. For some individuals, varicose veins will not threaten their long-term health (outside of the physical appearance of the veins) [3]. Under those circumstances, advanced medical treatments may not be required.

Lifestyle Changes

Your GP may advise the best way to manage your varicose veins. Weight management, regular physical activity and monitoring your symptoms can help the long-term management of varicose veins [[2].

Compression Stockings

Wearing medical-grade compression stockings for varicose veins may help reduce swelling and improve blood flow. Those who are pregnant and do not require or want to pursue other treatment options may consider wearing compression stockings to manage symptoms [3]. Additionally, they may also be recommended after a varicose vein removal treatment for a short period. Your GP will guide you about which type of stockings are the most effective and the best way to wear them.

Endovenous Thermal Ablation

Endovenous thermal ablation uses laser and electromagnetic technology to help seal off the varicose veins [6]. As a result, the blood is re-directed through the healthy veins instead of the enlarged and tangled section. The procedure may be performed under ultrasound guidance for accuracy and local anaesthetic to minimise discomfort.

Sclerotherapy

Similar to endovenous thermal ablation, the purpose of sclerotherapy is to seal off varicose veins. Under ultrasound guidance, chemicals are injected into the varicose veins, which causes the vessel to collapse [3]. These sealed vessels will slowly be absorbed by the body and disappear over time.

Varicose Vein Surgery

Vascular surgeons can perform open surgery to remove the segment of varicose veins. After using a local anaesthetic to ease discomfort, the surgeon makes a series of incisions before performing a phlebectomy (removing varicose veins) [1].  

Recovery

Without treatment, varicose veins are unlikely to resolve. For some people, the only impact of these veins is the cosmetic appearance. While for others, these veins can lead to symptoms (e.g. leg aches, swelling, etc.) and long-term health complications. However, varicose veins that appear during pregnancy may disappear after delivery. Treatments, such as sclerotherapy, endovenous thermal ablation and surgery can help remove and/or reduce varicose veins. However, success is not always guaranteed after these treatments [3][7]. Additionally, there is a chance that these varicose veins can reappear and require further treatments.  

Complications

Varicose veins do not always lead to complications. For some people, it can increase the risk of developing deep vein thrombosis (DVT), bleeding, skin changes, ulcers and thrombophlebitis (blood clots forming in the vein(s)) [6]. However, compared to complications with deep veins, clotting in the superficial veins found closer to the skin is less likely to clot [5]. While generally safe, treatments to remove varicose veins (e.g. ablation, sclerotherapy, surgery, etc.) can also lead to complications, including:

• Bruising
• Clotting
• Bleeding
• Pain
• Infection
• The reappearance of varicose veins

Always discuss the potential complications of your varicose veins and treatment options with your GP.

When to Worry about Varicose Veins?

Continually monitor any potential symptoms that are related to your varicose veins. Report and consult your GP about your concerns and symptoms. Not all veins are different, which means that treatment can vary. However, if you notice any of the following, please consult your GP or seek medical treatment immediately:

• Skin ulcers or sores
• Hyperpigmentation or darkening around the skin
• Thickened and scaly skin
• Bleeding veins
• Painful and/or hot sensations over the vein(s)
• Swelling around the area, particularly the calf and ankles

   

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References

1. References
   1. Kemp, N. (2017). A synopsis of current international guidelines and new modalities for the treatment of varicose veins. Australian Family Physician, 46(4), 229-233.
   2. https://www.nice.org.uk/guidance/cg168/resources/varicose-veins-diagnosis-and-management-pdf-35109698485957
   3. Wright, N., & Fitridge, R. (2013). Varicose veins: Natural history, assessment and management. Australian family physician, 42(6), 380-384.
   4. https://www1.racgp.org.au/newsgp/clinical/reminder-that-varicose-veins-are-not-just-a-cosmet
   5. Antani MR, Dattilo JB. Varicose Veins. [Updated 2021 Aug 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470194/
   6. https://www.radiologyinfo.org/en/info/varicoseabl\
   7. Badri, H., & Bhattacharya, V. (2008). A review of current treatment strategies for varicose veins. Recent Patents on Cardiovascular Drug Discovery (Discontinued), 3(2), 126-136