Varicose veins are a venous disease most commonly affecting surface veins of the lower limbs. Varicose veins are enlarged, visible veins of various sizes, and frequently coloured blue to violet-blue. Varices (increasing pressure of blood through the large portal vein) appear due to the weakening of the venous wall as a result of an insufficient support of connective tissue owing to a genetic predisposition.Initial symptoms occur due to risk factor effects such as pregnancy and hormonal treatment, extended standing or sitting, and obesity. If primary symptoms, secondary varices develop with enlarged veins as well as venous valve insufficiency (difficulty of the blood to circulate back to the heart from the legs). This change leads to further deterioration of the venous system which may lead to deep venous thrombosis development (i.e. blood clots within the veins).
The prevalence of varicose veins dramatically increases with age as well as with unhealthy nutrition and a sedentary lifestyle (lack of physical activity).
Varicose veins affect both females and males. However, females are more often affected than males due to a greater susceptibility to venous wall and valve dilatability because of cyclic elevations in progesterone levels (steroid hormone stimulating uterus during pregnancy).
Small varicose veins – spider veins (i.e. telangiectasia) – do not often occur in males. Rather, males are mostly affected by deeper veins which may be painful and develop inflammation. The risk of developing varices increases with a positive family history.
Development of varicose veinsIn many cases, varicose veins have only been viewed as cosmetic problem with unremarkable symptoms including the sensation of heavy legs, fatigue, itching, and swelling. These symptoms usually occur at the end of the day after an extended period of sitting or standing. If these symptoms are not treated with appropriate preventive techniques and approaches based on medical recommendations, they will gradually deteriorate and result in more serious complications.
Varicose veins arise as a result of damage to the mechanism transporting blood from the lower limbs back to the heart, where the blood must be transported against the force of gravity. Specific placement of the veins among the muscles allows the use of lower limb muscle contractions to act as a pump that helps return blood back towards the heart. The delicate venous valves in the veins open to direct the blood towards the heart and close to prevent the blood from flowing backward.
The circulatory system is a closed system composed of two main types of circulation. The small (pulmonary) blood circulation system circulates blood between the heart and the lungs and the large (systemic) circulation system in which blood circulates between the heart and the entire body. Blood is transported throughout the human body by means of the blood vessels, whose correct functioning is crucial for the proper transport of nutrients and oxygen to the cells.
When this mechanism of blood flow is faulty, blood may persistently flow back towards the limbs. As a result, venous pressure increases and blood return is deteriorated. As a result of this disorder, valvular insufficiency commences which leads to further increased blood pressure on the venous wall. The vein dilates and its deformation results in the development of varicose veins. The blood flow through these altered veins is slow and may result in the development of blood clots in the superficial veins (i.e. inflammation of the vein wall).
Treatment Options for Varicose VeinsCurrently, there are several reliable methods used in the treatment and elimination of varicose veins. The first step is to make a correct diagnosis by consulting a doctor who examines the venous system and assesses the extent to which normal vein function is damaged. The best quality examination is carried out using ultrasound which can detect all non-functional venous sections, where backward blood flow (venous reflux) occurs. The ultrasound will help the physician decide which of the available varices treatment methods to choose.
In the early stages, a conservative (non-operative) treatment is chosen. This method does not remove the formed varicose veins, but aids in relieving the symptoms (e.g. the use of compression stockings or socks that reduce pressure in the superficial veins). To remove smaller, visible veins, sclerotization is used. In varicose veins which are already the cause of non-functional venous valves, the only solution is surgery aimed at minimising the possibility of recurring varicose veins.
Other possible methods used are laser surgery, radiofrequency ablation, classic surgery removing whole veins, and the most modern and delicate method of ClariVein™ mechanical-chemical ablation (surgical removal of body tissue). As part of the treatment, natural pharmaceuticals (flavonoids) are also used to protect blood microcirculation and favourably influence the lymphatic system.
Structure of Healthy and Varicose VeinsBy impairment of this mechanism, a permanent return of the blood back into the limbs occurs, and thus venous pressure continuously increases, and blood drainage worsens. As a consequence of this disorder, valvular insufficiency occurs, which further leads to increasing the blood pressure on the venous wall. The vein expands, and deformation thereof results in varicose vein development. The blood flow through the modified veins is slow and can lead to the formation of blood clots in the superficial veins, so-called superficial thrombophlebitis.
PregnancyPregnancy is a major risk factor for developing varicose veins. Of all women with varicose veins, almost 1/3 of pregnant women are among them. With the number of pregnancies, the risk of developing varicose veins increases. Although the exact mechanisms of the development of varicose veins due to pregnancy is not fully elucidated, it is assumed that the effects of mechanical compression and hormones are among them. Other risk factors include genetic predisposition and a higher age of the mother.
Mechanical compression during pregnancy occurs due to compression of the pelvic vein when the uterus has increased in size. As a result, the blood flow out of the lower limbs is worsened, causing increased pressure in the veins and damaging the venous valves. Although the development of varicose veins can already occur in the first trimester, when uterine enlargement is not as pronounced, it is assumed that the effect of the uterus increasing in size only acts in the later stages of pregnancy. Hormonal changes associated with pregnancy can also lead to greater extensibility of the veins and decreased elasticity of the venous wall.
The developed varicose veins may again return to their original condition following normalization of the venous pressure subsequent to delivery. One condition for that, however, is sufficient elasticity of the venous wall. If permanent damage to the valves occurs during pregnancy, the varicose veins remain even after delivery, and their impairment worsens.