Varicose Veins: what they are, causes, symptoms and treatments

• Varicose veins are formed due to circulatory problems in the veins that cause the accumulation of blood in some areas of the body, especially the legs.
• The appearance of varicose veins is more common in women than in men, mainly due to pregnancy and hormonal changes, although there are many factors that have an influence.
• In the most severe cases of varicose veins, the only definitive solution to alleviate the symptoms and discomfort is varicose vein surgery.

Varicose veins occur due to circulation problems in the legs, usually called chronic venous insufficiency, which causes poor circulation and blood to accumulate in the veins in some areas of the body, the most common place being the legs, where the veins dilate and become visible through the skin. 

In severe cases where the symptoms are very bothersome and interfere with the patient's daily life, varicose vein surgery by saphenectomy is usually considered.

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The function of the veins is to return blood from the muscles and organs of the body back to the heart. To do this, they are equipped with valves that prevent the blood from flowing back downwards, as they rise against gravity, which requires a lot of work. 

Muscles also play a part in this process, as their contraction helps this circulation, as do the footpads, which exert pressure on the circulatory system when walking, which is why avoiding a sedentary lifestyle is key to preventing varicose veins.

If the veins have dilated, the force with which the blood rises decreases and blood accumulates, which can cause the oedemas and swelling that we perceive as varicose veins.

Although varicose veins are typically associated with the legs, they can also occur in other parts of the body although different terminology is used in these cases. 

For example, haemorrhoids consist of varicose inflammation of the veins of the haemorrhoidal plexus and varicocele consists of inflammation of the venous plexus that supplies blood to the testicle.

The appearance of varicose veins is gradual over time and is more common in women than in men, although it is not exclusive, being more common in women over 45-50 years of age. 

There are some recommendations to prevent the appearance of varicose veins, although they cannot always be avoided as they are often due to genetic inheritance in many cases. Likewise, in addition to the visual fact of having varicose veins, these are a complex pathology that can lead to more serious complications. In the following sections we explain these complications and the other aspects related to varicose veins.

Varicose veins are a very common pathology, being much more common in women than in men. This may be due in a large number of cases to pregnancy, as this is one of the factors that may favour the appearance of varicose veins.

Despite this, the main cause of varicose veins is the same as in many pathologies, genetic predisposition and a sedentary lifestyle. 

Below is a list of the different factors that predispose to the appearance of varicose veins:

• Obesity: Excess weight causes an increase in pressure in the veins of the lower limbs, favouring their dilation. This process follows the same guidelines as pregnancy.
• Prolonged standing: Static standing can increase the pressure in the veins and make it more difficult for the blood to return to the heart. This is why many people who work standing up end up suffering from varicose veins.
• Genetic inheritance: A person is more likely to suffer from varicose veins if there are people in their family who have suffered from them.
• Age: Varicose veins are more common in people over 45-50 years of age than in younger people.
• Gender: As we have already mentioned, the incidence of varicose veins is higher in women than in men.
• Pregnancy: The appearance of varicose veins is common during pregnancy, related to hormonal changes, the pressure the uterus exerts on the veins and, of course, weight gain.
• Sedentary lifestyle: Lack of exercise means that the muscles do not do their bit to circulate the blood and therefore encourages the appearance of varicose veins.
• Type of work: In jobs where the patient has to stand for long periods of time, as we mentioned, the chances of suffering from varicose veins increase.

It is important to note that none of the factors mentioned above imply that varicose veins will necessarily appear, although they are risk factors that favour their appearance.

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The main symptom of varicose veins is of an aesthetic nature and is the visual perception of the veins on the surface of the skin. In addition to this symptom, which is usually the most common, there are others that sometimes appear, which are more or less serious depending on the discomfort they cause the patient. 

Here we list them for you:

• Visibility of the veins from the outside: The first symptom of varicose veins is the possibility of seeing them on the back of the knees and inner thighs. In these cases, no other symptoms appear yet.
• Tiredness and heaviness in the legs: This occurs mainly when you do not move for a long time. In these cases, blood starts to accumulate in the veins of the legs and to improve these symptoms it is best to walk, exercise and keep your legs up.
• Pain: It occurs in the area where the dilated vein can be seen and along its course, mainly in the ankle and calf area. These pains are caused by a slight friction or blow.
• Cramps during the night: These are quite common.
• Tingling when remaining in the same position: Especially in cases where one travels sitting down or remains in this position for a long time.
• Heat, itching or stinging: This usually occurs in the lower areas of the extremities, in the ankles or feet, and scratching should be avoided as these affected areas are more prone to wounds and tend to become infected more easily.
• Swelling in the feet and ankles: As the pathology progresses, it is possible for the swelling to move up the length of the leg. In the early stages it decreases with rest, elevating the legs and especially in the morning when getting up, becoming more persistent over time, becoming permanent in many cases.
• Skin discolouration: Due to the outflow of blood around the affected veins, blood accumulates under the surface and can cause deterioration of skin and fat, leading to hardening, pain and eczema, as well as inflammatory reactions.
• Dilated and twisted veins: As veins dilate and elongate, they must bend to fit the available space.

In addition to these symptoms of varicose veins, which are common and common, there are some complications of varicose veins that should be highlighted, as in many cases varicose vein surgery is chosen to solve or avoid them.

Complications of varicose veins

In addition to the unsightly appearance of varicose veins in the legs that we are all familiar with, there are a number of complications that can cause further discomfort and problems for the patient. These complications are discussed below:

Varicotrombosis

These are clots that form in the veins of the legs causing difficulties in the correct flow of blood. They usually appear in large varicose veins in which the blood flows slowly and ends up accumulating in the area.

This problem has a number of characteristic symptoms:

• Redness of the area where the varicose veins are located.
• Pain along the area where the varicose vein is located and visible to the naked eye.
• Swelling in the affected area.

Varicotrombosis should not be confused with deep vein thrombosis, as the clots that form due to varicotrombosis are very small and remain in the superficial area of the varicose veins, which does not make them life-threatening unlike deep vein thrombosis that requires urgent treatment.

Treatment of this complication of varicose veins can be done with the use of compression stockings and painkillers for discomfort and pain, and varicose vein surgery can be scheduled to solve the problem, especially if the clots are of considerable size or there is any sign of infection.

Phlebitis

Phlebitis is the inflammation of the dilated vein that forms the varicose vein. It can be considered a complication of varicotrombosis and can be superficial, if it occurs in a vein on the surface, or deep if it is a vein in the tissues beneath the skin:

• Deep vein thrombophlebitis: This is a serious complication that must be treated immediately. It consists of the formation of a clot in the deep veins and must be treated quickly.
• Superficial thrombosis: This occurs in the superficial veins and the prognosis is favourable. In any case, varicose vein problems must be diagnosed by specialists and a complementary test called Eco-Doppler is usually necessary.

On the other hand, phlebitis may or may not cause symptoms. If they do occur, these symptoms may be:

• Pain in the area.
• Reddening of the area.
• Perception of bulging of the affected vein.
• Excess sensitivity.

Varicose vein bleeding (varicorragia)

Varicorragia consists of bleeding from varicose veins close to the skin, i.e. those that are perceived as lumps in the superficial area of the leg. 

This haemorrhage is caused by a bump or graze in the area that breaks the skin and causes significant bleeding, although not excessively serious, which can be quite frightening for the patient and those close to them.

Venous ulcers

This is the most unpopular complication of varicose veins. Venous ulcers appear around the ankles and present a rather uncomfortable symptom picture, mainly because of the pain, as well as the fact that they become infected on a regular basis.

Although it is an important and very visual complication, it is rare that both the patient's life and leg are in danger. In the event that a light-coloured fluid is felt to be coming out of the skin in the area, it is important to see a doctor for early treatment to avoid complications.

What types of varicose veins are there?

Depending on the severity of varicose veins, we can differentiate between 4 types, mainly based on their symptoms. Below we explain the different degrees of varicose veins:

• Grade 1 varicose veins: In the early stages of the pathology, what we call varicose veins or spider veins appear, which are mainly an aesthetic problem although they can sometimes cause heaviness and tiredness in the legs. They do not require surgical treatment, but it would be interesting to start a treatment to change habits to prevent them from worsening.
• Grade 2 varicose veins: This type of varicose veins are more serious than grade 1 and, although surgical treatment is not recommended, it is important to start treatment to prevent them from worsening. In this case, the symptoms are very common and their visibility is greater, as is the risk of the aforementioned complications.
• Grade 3 varicose veins: This is the next step and occurs when grade 1 and 2 varicose veins have remained untreated for a long time. In this case the veins are much more dilated and problems such as swelling, changes in skin colour and oedema gradually appear. In these cases, varicose vein surgery may be the only solution.
• Grade 4 varicose veins: This is the most serious stage of varicose veins and a surgical solution is practically obligatory. It is in these cases that the most serious complications appear, such as ulcers, which are difficult to treat and easily become infected. It is important to prevent the pathology from reaching these extremes, as treatment must be more aggressive.

The diagnosis of varicose veins and their level of severity must be made by a specialist doctor. However, we will discuss the diagnosis of varicose veins below, as additional tests are sometimes necessary.

How are varicose veins diagnosed?

The first diagnosis is usually made by the patient, as varicose veins are visible at first sight. However, if you have symptoms such as tiredness or heaviness, or if you notice varicose veins of considerable size and decide to go for a consultation with a specialist, the doctor will make the diagnosis as follows:

• Physical examination: In addition to being seen at first glance, the diagnosis of varicose veins should be made with the patient standing up, as this makes the varicose veins more visible. This will allow the doctor to see the extent of the problem and to determine whether or not there are any signs of complications associated with varicose veins such as changes in colour, lesions or oedema. In addition to this, the doctor may need some additional tests to determine the extent of the problem.
• Echo-Doppler: This is the main test used to diagnose varicose veins. This technique combines ultrasound with the Doppler effect, which allows the doctor to observe the veins and arteries along their course and thus check for any alterations that may exist.
• Phlebography: This is only used in very specific cases and consists of injecting a contrast agent into the vein and then carrying out an X-ray.

Once the doctor has diagnosed the varicose veins and determined their severity, he or she will provide the patient with the most appropriate recommendation for their case. 

Treatments can be conservative in grades 1 and 2, with changes in habits and other recommendations that we will explain below, or surgical in more serious cases.

The treatment of varicose veins will depend directly on the severity of each case. As we have mentioned throughout the text, in milder cases and where there are few or no symptoms, non-surgical treatment can be chosen, while in severe cases, saphenectomy surgery (complete phleboextraction) is usually chosen so that the patient can recover their quality of life.

Conservative treatment of varicose veins

Conservative treatment of varicose veins consists of palliating the symptoms and delaying the progress of the disease, although in many cases it can be solved definitively, especially if it is treated in the early stages.

The decision to follow one treatment or another should be made together with a specialist who will help you decide the best option for your specific case. With regard to the conservative treatment of varicose veins we find:

Physical and hygienic measures

These measures improve symptoms and prevent the development of complications. They mainly consist of avoiding risk factors:

• Avoid being overweight and sedentary: This is vital to reduce the chances of any pathology.
• Moisturise the skin on a daily basis.
• Strengthen your leg muscles: Exercise promotes blood circulation back to the heart.
• Wear elastic compression stockings: This type of stocking helps the blood to circulate upwards. They should only be used when prescribed by a doctor.
• Avoid overexposure to the sun without moving: Especially during the hottest hours of the day, as high temperatures can cause the veins to dilate.
• Cold showers: Cold water favours the contraction of the veins, reducing the dilatation process that leads to the formation of varicose veins.

Drugs for varicose veins

There is the possibility that, in less severe cases (grades 1 and 2), some type of medication can be used to improve the tone of the veins and the strength and firmness of the vein walls. Flavonoids, escin, centella asiatica extract, horse chestnut extract, troxerutin and ginkgo biloba extract are among the drugs available for this purpose. All of these reduce the likelihood of oedema.

On the other hand, there are also topical anticoagulants and other drugs whose function is to treat complications and their associated symptoms, reducing the possibility of thrombus formation and improving circulation:

• Analgesics: These are used to relieve pain associated with varicose veins.
• Antibiotics: These are used when an infection occurs, especially with ulcer formation.
• Anticoagulants: They are used topically, but in severe cases they can be administered by other routes.
• Anti-inflammatory: As the name suggests, these are used to reduce inflammation caused by oedema and other complications.
• Cicatrizants: In this case, they are used to treat ulcers, which are the main cause of the wound.
• Corticosteroids: This is required if there are skin disorders or eczema.
• Diuretic drugs: These are used to reduce swelling and eliminate fluids.

Despite all the above, in severe cases of varicose veins, the most recommended option is usually varicose vein surgery, the conventional operation being saphenectomy. 

Below you will find a step-by-step guide to the varicose vein operation:

Surgical treatment of varicose veins

The most common surgery for the treatment of the most severe varicose veins is saphenectomy or complete phleboextraction. This operation consists of the removal of the internal or external saphenous veins, as these are the veins in which varicose veins usually form. In the case of smaller varicose veins, other techniques can be used.

Before varicose vein surgery is performed, it is necessary to carry out a complete preoperative examination to determine the feasibility of the surgery and the type of anaesthesia to be used. If the surgery is indicated and there is no problem with the preoperative, the intervention is performed.

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