Varicose veins are bulging ropy veins typically found in the legs and thighs. They often cause symptoms of pain, leg fatigue, itching and swelling of the legs and ankles. Very often these symptoms are bearable and many patients do not seek treatment. However, there are well known risks of prolonged untreated varicose veins.
Varicose veins lead to increased pressure in the veins of the legs. Most of these patients have 'leaky' valves in the veins known as venous reflux. Normal valves are one-way valves directing blood from the legs towards the heart. When there is reflux, some blood leaks backwards in the legs causing more pooling of blood in the veins. This causes increased pressure in the veins.
Hyperpigmentation (Dark skin discoloration): As a result of the increased pressure in the veins, red blood cells leak out into the tissues. As these red blood cells break down, they release the iron pigments in the hemoglobin found in red blood cells. The iron pigments stain the skin. This leads to dark discoloration of the skin of the legs in patients with prolonged varicose vein disease.
Lipodermosclerosis (Thickening of the skin): The red blood cells that leak into the tissues cause chronic inflammation of the skin and fat under the skin. Eventually, the skin becomes woody firm. This condition is called lipodermosclerosis.
Leg ulcer (wound): Venous insufficiency is the term used to describe the process of high venous pressure and pooling of blood in the veins that results from the abnormal leaky valves (venous reflux). The leakage of fluid and red blood cells into the tissues can eventually lead to break down of the skin. This skin break down forms an ulcer (wound). These ulcers typically occur over bony prominences and are most common just above the ankle (gaiter area). They are difficult to heal without treatment of the underlying venous reflux.
Spontaneous bleeding: Varicose veins are superficial and located close to the skin surface. The skin over some of the varicose veins are very thin from chronic damage. This can lead to bleeding from these veins either spontaneously or with very minor contact such as friction from clothing or scratching.
Superficial Thrombophlebitis: Inflammation of a vein under the skin is called superficial thrombophlebitis. This is caused by decreased blood flow and clotting of the blood in the vein. The skin over the vein becomes red, warm, tender and firm. The patient often experiences leg pain.
Deep Vein Thrombosis (DVT): Blood clots in the deep veins of the lower extremity is a very serious condition. Without treatment, the blood clot can dislodge and travel to the lungs with potentially life threatening consequence. The superficial blood clots that can occur with varicose veins do not usually travel to the lungs. However, there is a small chance of developing DVT with severe varicose vein disease.
People with varicose veins should seek medical treatment from a board-certified surgeon. The surgeon will evaluate the legs and will perform a venous ultrasound to check for leaky valves or blood clots. Appropriate treatment of the varicose veins depends on the severity. The treatment options include endovenous laser ablation, radiofrequency ablation, microphlebectomy, sclerotherapy and closure of incompetent perforator vein. All of these treatments can be performed in an office setting.