Diagnose-Me: Condition: Varicose Veins

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	Varicose Veins

Varicose Veins
Conditions that suggest it
Contributing risk factors
Conditions suggested by it
It can lead to...
Treatment recommendations
Prevention

A bulging section of blue, twisted vein on the back of a person's calf or thigh is a common sight. This is a varicose vein. They often ache, sometimes itch, usually cause swelling and pain in the feet and ankles, and are more obvious when standing up. Even though they're usually painless, nobody likes the way they look. After the blood has delivered oxygen throughout the body, veins carry it back toward the heart. Veins have one-way valves to keep gravity from pulling the blood downward. Varicose veins affect humans because we stand upright rather than run around on all fours. This means that gravity puts pressure on the veins in the legs, and they have to work harder to pump blood back upwards to the heart. Sometimes this pressure can cause the veins to leak. Accumulated blood at these leak sites stretches the vein, and pools of it cause lumps and kinks. The veins affected are just under the skin, so you can clearly see the enlarged and twisted portions.

Incidence; Causes & Development; Risk Factors

Varicose veins are more common with advancing age, but can strike in youth as well, most commonly during pregnancy. Up to 50% of all women eventually get them.

Varicose veins run in families and are more common in women. Sometimes varicose veins first occur during pregnancy because of hormonal changes and increased pressure in the veins caused by the expanding uterus. Obesity, menopause, aging, constipation and repeated abdominal strain, as well as heavy lifting, may contribute. Long periods of standing and sitting with the legs bent and crossed make them worse.

Taking hormones adds to the risk, as does excess weight. Varicose veins develop when blood flow slows or backs up, causing veins near the surface of the leg to swell and bulge. About two-thirds of all people with varicose veins have a close relative who has them too. Some risk factors may be inherited, such as missing or malfunctioning valves within the veins, or unusually "stretchy" veins. Jobs that require long periods of standing can make matters worse.

Treatment & Prevention

The most widely-used treatment for varicose veins is sclerotherapy, which consists of injecting a solution into the varicose vein. The solution causes irritation, inflammation, and eventually scarring, which permanently blocks the vein. The body absorbs the accumulated blood from the varicose vein, and the lumps flatten out over time. The treatment can be performed in a physician's office, though several visits may be required for complete removal. When performed by an experienced doctor, this procedure is effective and low-risk. But beware of "mills" dedicated to nothing but varicose vein treatment. These practitioners, some of them none too skilled, have given something of a bad name to varicose vein therapy.

A new sclerosing procedure called Varisolve is very successful. The procedure is cheaper than surgery and boasts that 81% of patients are completely cured, with an addtional 10% seeing significant improvements.

Major varicose veins can be surgically tied off and removed, a procedure called stripping. The vein is tied off above the varicose section; one end of a tiny wire is attached at the varicose section and the other end is threaded through the vein to a small incision at the calf or ankle. There, the wire, along with the varicose section of vein, is pulled out. After stripping, the smaller veins nearby are eliminated with sclerotherapy. The results are usually satisfactory, although there's no guarantee that other varicose veins won't show up elsewhere.

The newest techniques for surgical removal require only a few tiny incisions and stitches, and leave only minor scars. These operations can be performed under local anesthesia as same-day outpatient surgery. Among these new approaches is one called the closure technique. In this procedure, a special catheter is inserted into the affected vein. The catheter delivers radiofrequency energy to the vein wall, causing it to seal shut. Once the vein is closed, neighboring veins pick up the slack and restore normal blood circulation from the legs. Yet another new technique is called ambulatory phlebectomy, which involves the removal of varicose veins through small needle punctures on the skin. With this procedure, bruising and scarring are minimal.

Be suspicious if offered laser therapy. Lasers are generally effective only for tiny capillaries, not big veins.

If you have varicose veins:

Minor problems may improve if you take regular walks, avoid long periods of standing, don't use high heels, don't sit with crossed legs, and rest with your feet elevated.
Don't wear tight garters, jeans, or other garments that cut off circulation to the groin or legs.
The aching, burning, tingling, or fatigue that sometimes accompanies varicose veins can be relieved by elevating the leg or wearing support hose. Try wearing elastic or support hose -- the kind sold in pharmacies, not just "support" pantyhose sold in department stores. Look for graduated-compression stockings, which are tightest at the ankle and looser higher up the leg. Put them on right away in the morning before blood and fluid have pooled in your feet and ankles.
Avoid constipation, preferably with a high-fiber diet. Straining can worsen varicose veins.

If you have a genetic tendency toward varicose veins, you can improve your odds by maintaining a healthy weight, keeping your legs elevated whenever possible, exercising regularly, and seeing a doctor at the first sign of a problem.

Along with a high fiber diet and regular exercise, enhancing fibrinolytic activity can help. The use of cayenne, garlic, onion, ginger, and bromelain are suggested. Also, flavonoids are useful in strengthening connective tissue (especially capillaries). They help keep tissues from falling apart. Varicose veins, hemorrhoids, bleeding between periods, and lymphedema can be aided by flavonoids. The anthocyanidins and proanthocyanidins should be supplemented as they are the strongest acting of the flavonoids. Rutin has only a little collagen-stabilizing effect. Since increasing the integrity of the wall of the vein may also reduce the risk of developing varicose veins, it appears that flavonoid-rich berries, such as hawthorne berries, cherries, blueberries, and blackberries are beneficial in the prevention and treatment of varicose veins. These berries are very rich sources of proanthocyanidins and anthocyanidins.

The most effective agents, though harder to find are aortic GAGs (glycosaminoglycans) from highly purified bovine sources. These contain dermatan sulfate, heparan sulfate, hyaluronic acid, chondroitin sulfate and other GAGs. Two double-blind studies have compared aortic GAGs to bilberry and HER (a flavonoid preparation like rutin and citrus bioflavonoids). The aortic extract produced far better results in both hemorrhoids and varicose veins.

Dosages
HER 1,000-3,000mg per day (better than rutin and citrus bioflavonoids).
Bilberry (Vaccinium myrtillus) (25% anthocyanosides) 80-160mg tid.
Butcher's broom (Ruscus aculeatus) (9-11% ruscogenin) 100mg tid.
Horse chestnut (aesculus hippocastanum) extract for 50mg of escin per day.
Grape seed extract 100mg bid-tid.
Vitamin C 500-1,000gm tid with Bioflavonoids 3,000-6,000mg per day.
Bromelain (1,200-1,800mcu) 500-750 bid-tid.

Prognosis; Complications; Seek medical attention if

The body does not miss veins that are blocked with sclerotherapy or removed with surgery. The legs have many alternative channels for the blood to take. Problems never return in treated veins, but new varicose veins can develop in another location. Mild problems are easier to treat than severe ones, so be sure to deal with your symptoms early.

Varicose veins very seldom pose any danger.

Medical help should be sought if: