VARICOSE VEINS

Our upright stance, with all its many advantages, has not come without a price. For many, this price may include varicose veins-those twisted knots of vein that snake embarrassingly across the lower legs.

Veins are said to be varicose when they become torturous, thin-walled and widened and easily visible below the skin. The veins in the superficial tissues of the legs are most commonly affected.

There is no known cause of varicose veins of the legs, but there are many factors which may lead to a worsening of varicose veins do run in families, but there is no clear-cut reason for this. They are also much more common in women than they are in men.

THE VEINS

Normally, the blood which supplies the tissues of the lower limb flows down the arteries to the feet and then back up the veins, and so to the heart. In the lower limb, there are two systems of veins: the deep system, and the superficial system. It is the superficial system that is affected as it consists of veins in the tissues between the muscle and the skin, veins which can easily be seen and are called varicose when they become enlarged.

Both the superficial and deep veins contain valves every few centimeters. These valves consist of tiny folds of the lining of the vein, and they allow blood to flow up the limb, but not the other way.

In patients with varicose veins, these valves are found to be defective. It is not clear whether the defective valves cause the varicose veins, or whether it is the other way round. However, the final effect of having defective valves is that the blood in the vein can flow down the vein, leading to stretching of its wall. The superficial veins of the lower limb are divided into two main veins, the long saphenous and the short saphenous veins. The long saphenous vein carries blood from the front of the foot, up the inner side of the leg and goes deeply into the thigh just below the groin. The short saphenous vein carries blood from the outer side of the foot up to the back of the knee, where it also goes deeply to join the deep system of veins. The long saphenous vein and its many branches are the commonest site of varicose veins.

AGGRAVATING FACTORS

Although there are no obvious causes of varicose veins there are a number of factors that increase their possibility.

PREGNANCY

Many women notice varicose veins after pregnancy. It is probable that the veins were abnormal before pregnancy, but that pregnancy made them worse. There are two theoretical reasons why this should happen. First, the presence of an enlarged uterus leads to pressure on the veins in the pelvis, causing increased pressure in the veins of the leg. This pressure may cause the veins to become swollen. Second, hormones which are produced during pregnancy lead to a general softening-up of supporting tissues to allow the baby's head to pass through the birth canal, and the supporting tissues of the veins may also be similarly affected.

OBESITY

Varicose veins can be brought on through obesity because of increased pressure inside the abdomen, together with general weakening of fibrous tissue in the wall of the vein.

PROLONGED STANDING

Jobs which require prolonged standing may put an undue strain on the veins of the legs, especially if they have to be kept still.

INJURY

Sometimes, a large varicose vein develops at the site of an injury, such as where a cricket ball hits the leg. This may be the only varicose vein in an otherwise normal leg.

DEEP VEIN THROMBOSIS

Occasionally, patients who have had a deep vein thrombosis may develop varicose veins in the lower leg, but these are usually of a different pattern compared with the more common varicose veins which start in the superficial veins.

EFFECTS OF VARICOSE VEINS

Varicose veins do not look pleasant, and by far the commonest reason for people to seek medical help for their varicose veins is because the veins are unsightly. But varicose veins can cause complications and these may necessitate surgical or other treatment.

Because they are thin-walled and near the surface, they are more susceptible to injury. This, coupled with the fact that the blood flow is much more sluggish in varicose veins, can lead to a thrombosis in the vein. The resulting inflammation around the thrombosis - known as phlebitis - causes pain and redness in the affected area.

For unknown reasons, some patients with varicose veins develop quite bad eczema on the lower leg. This eczema can be treated with skin preparations, but if the varicose veins are treated, then the eczema usually disappears.

TREATMENT

Various forms of treatment have been tried, but nowadays the treatment is divided into surgery, injections and other forms, such as the wearing of bandages and support stockings.

SURGERY

The aim of surgery in varicose veins is twofold. First, an attempt is made to remove the unsightly veins. Second, an operation is done to prevent the veins coming back again.

The first part of the treatment involves making several tiny little cuts in the skin over the veins, and removing them a segment at a time. The distance between the cuts will vary, but may be 5 cm (2 in).

The second part of the operation treating the root cause of these particular varicose veins - may be more difficult, and it is here that careful examination of the pattern of the individual patient's veins is of vital importance. By examining the patient first lying down and then standing up, the surgeon determines whether the long or the short saphenous vein is at fault, and at which point along the vein the trouble arises.

It is usually found that the valves in the upper part of the long saphenous vein (in the groin) are causing the problem, a lowing blood to leak back down the vein. If the long saphenous vein is therefore tied off in the groin, then the pressure is taken off this vein at points lower down. The blood which would a. normally flow through the long saphenous vein finds its way back to the heart via a different vein, of which there are dozens in the leg.

This sort of surgery, although it may seem quite elaborate, is relatively minor for the patient. Usually he or she is in hospital for one or two days and can get up and walk the day after the operation.

INJECTIONS

In this form of treatment a special substance is injected into different parts of the vein, causing the lining of the vein to become inflamed. The leg is then tightly bandaged - and remains so for about a month - so that the vein is compressed. The object of the treatment is to get the opposite walls of the vein to stick together permanently, thus effectively closing it.

The main disadvantage of this form of treatment is that it is only effective on small varicose veins, and only if they are situated below the knee (it is virtually impossible to get a bandage to stay on the thigh for more than a few hours).

BANDAGES

There are no. other forms of treatment which are capable of actually removing varicose veins once they are present, but the wearing of support stockings or tights can help to prevent varicose veins from getting any worse. These stockings are specially designed to give firm, even pressure all the way up the leg, and are usually quite comfortable.

TAKING CARE

If you have varicose veins, the chances are that you will always have a few prominent veins for the rest of your life, even if you have the existing ones treated. There is no guarantee that they will not appear elsewhere after treatment. However, there are some things you can do to try and prevent them reappearing!

Try not to do too much standing, if at all possible. Walking is fine, but do not stand still for long periods.

When you sit down, always try to put your feet up on a stool or chair, so that the blood in the legs can flow more easily back up the body to the heart.