Humans are designed as intricate and beautiful creatures. Every detail and constituent about them is delicately fashioned which makes all structures strong but relatively fragile. That is a dilemma that is faced by the human vasculature as well.
Our vascular systems comprise three primary vascular systems: The arteries, the veins and the capillaries and every one of these has their own set of properties and characteristics. What we intend on discussing today through the medium of this article are varicosities, and that makes it a discussion based on the veins and their characteristics.
Have you ever looked at somebody’s feet and wondered why they appeared bulgy and swollen? Do you ever find yourself in awe about the eerie worm-like structures on the feet of someone you know? If you have ever been confused about the said curiosities or more like ‘varicosities’, then you will most certainly benefit from this article. Keep reading to find out more!
WHAT ARE VARICOSE VEINS?
Varicose veins are venous channels which become swollen, enlarged and twisted and give the cosmetic appearance of irregularity on the surface of the skin. Varicose veins are most commonly observed developing on the lower legs, but practically any part of the body can be affected by them depending on the nature of the pathology.
WHAT’S THE MECHANISM OF DEVELOPMENT?
The venous system is responsible for delivering blood from the entire body to the heart for purification and detoxification. It’s true for the veins in the legs too. Legs veins collect blood from the legs and lower body and direct it to the heart. This is achieved by a system of intricately located valves which prevent the blood from running backwards under the effect of gravity. The competency of the venous system as a whole rests on the competency of the valves, and if the valves become impaired, then the purpose of delivering the blood to the heart cannot be fulfilled.
Thus the valve incompetence leads to blood pooling in the veins and causing swelling and enlargement of veins. This is the primary mechanism which causes the development of varicose veins. The superficial veins of the legs are especially susceptible to the development of varicose veins.
CAUSES OF VEINY FEET
The development of varicose veins can be attributed to a variety of conditions and factors. Varicose veins have a particular propensity of development in middle-aged women but can affect men as well.
When establishing causality, heredity stands out as an important cause of varicose veins. Up to 80% of varicose veins cases are attributed to genetic makeup. There has been significant research going on to still pinpoint the exact genetic error behind it as people who are practising healthy lifestyles also seem to be developing this condition.
Pregnancy predisposes women to a myriad of pathology. Unfortunately, varicose veins are included in that list too. Pregnant women experience an overall increase in their blood volume, however, the speed at which it returns to the heart from the leg veins decreases. It subjects the veins to immense pressure and causes them to swell up and get inflated.
Another possible causation could be the nasty pregnancy hormones like progestin which lead to dilation of the veins causing blood pooling and vein enlargement.
Obesity predisposes to varicosities on the legs due to elevated pressure on the superficial veins. Also, most obese people have a sedentary lifestyle and get minimal exercise which hinders blood circulation and supports blood pooling in the veins ultimately leading to venous swelling.
The human body and its functions begin to deteriorate with passing the time. With increasing age, the venous constituent proteins start to lose their elasticity and turn into more firm and rigid structures. This impairs their ability to function appropriately causing valvular incompetence and leading to accumulation of blood over time and causing venous swellings to appear on the legs.
Standing for prolonged periods of time is a classic contributor to the development of varicose veins. Facilitation of gravitational forces acting on the venous vasculature is done when somebody stands for long hours, and that contributes to blood pooling. That is why varicose veins are most commonly seen on the legs of people working as lecturers, security personnel, sales executives, and assembly line workers.
UNCOMMON CAUSES OF VARICOSE VEINS
Other rather uncommon causes of varicose veins are ovarian venous reflux, incompetent perforator veins and inherited conditions like hyperhomocysteinemia. Ovarian venous reflux or pelvic venous reflux happens when the blood moving from the lower body to the heart via the pelvic veins shoots back and prevents the entirety of the blood to reach the heart. This causes blood pooling in the veins. Hyperhomocysteinemia has a degrading effect on vascular proteins like Collagen and Elastin, making them weak and friable. Alcohol consumption has also been regarded as a contributor due to its effects like vessel dilation and increased blood viscosity.
SIGNS AND SYMPTOMS OF VARICOSE VEINS
Varicose veins cause the development of a variety of signs and symptoms which can be quite debilitating and can impede the normal functioning of the sufferer. We have compiled these below for you to enhance your knowledge.
- Leg heaviness
- Aching sensation in the legs
- The appearance of spider-like veins on the legs
- Ankle swelling- especially towards the end of the day
- Brownish yellow discolouration of the affected leg
- Skin thickening (Lipodermatosclerosis)
- Redness, itching, and dryness of the skin (Stasis eczema)
- Painful cramping sensation
- Impaired wound healing due to blood pooling
- Irregular whitened scar-like patches mainly on the ankles (Atrophie Blanche).
TREATMENT OF VARICOSE VEINS
The physically impairing symptoms of varicose veins can lead to dangerous complications like venous ulcers which massively increase the chances of developing infections. Also, long-standing ulcers can commonly transform into malignant cancers and further worsen the condition. Other complication like blood clotting (superficial thrombophlebitis) and fat necrosis are also associated with varicose veins.
After being diagnosed clinically of via ultrasonography testing, there are a variety of treatments both conservative and surgical which can be employed to manage and efficiently treat this cosmetically unpleasant disease.
CONSERVATIVE TREATMENT METHODS
- Leg elevation for temporary relief
- Graduated compression stockings which are available with varying pressure gradients which have been known to reduce swelling and improve microcirculation in the legs providing comfort to the achy and painful legs.
- Intermittent pneumatic compression devices with pumps and inflatable structures which will enhance circulation help reduce swelling.
- Anti-inflammatory agents like naturally occurring flavonoids or more synthetically developed medications like ibuprofen and aspirin.
SURGICAL TREATMENT MODALITIES
Sclerotherapy involves injecting the affected veins with a sclerosing agent which essentially shrinks the vein and relives the swelling and stasis of blood. It has been one of the oldest methods of treating varicose veins with a success rate of around 60% to 80%. There are rarely any complications of this procedure, and there have been extremely scant reports of people experiencing post-procedure clots and ulcerations.
This surgical treatment entails the removal of the culprit’s vein –the saphenous’ great trunk. By removing the vein itself, the hazards of varicosities are eliminated. According to a study conducted in the year 1999, stripping was found to be 71% effective in treating varicose veins however there is a possibility of re-growth of the saphenous vein. The well-known complications associated with stripping are deep venous thrombosis and pulmonary embolism as well as the inability of the saphenous vein to be used as a vascular graft in the future.
ENDOVENOUS THERMAL ABLATION
Endovenous thermal ablation technique makes use of an efficient source like a laser to generate a tremendous amount of heat via radiofrequency waves guided through a catheter into the affected vein to obstruct or obliterate the vessel. This can be deemed as the best treatment as it has a 97-100% success rate. The success rate is not the only attractive feature about this treatment modality, and it is popular among patients as it is a procedure that does not require the administration of anaesthetics and sedatives and has a markedly speedy recovery.
This involves passing a guided cryoprobe into the saphenous vein after the saphenofemoral junction is ligated and then injecting a cooling agent preferably up to a temperature of -85 such as nitrous oxide or carbon dioxide subsequently freezing the vein, making it accessible to stripping. This can be regarded as a less invasive form of stripping as the hassle of a distal incision to remove the stripper is eliminated.
Ambulatory phlebectomy removes the varicose veins by making 2-3 mm incisions on the affected area of the leg. Post-procedure patients are made to wear graded compression stockings for a rapid and complication free recovery.
Known as a minimally invasive surgical technique, CHIVA stands for Conservative Hemodynamic Correction of Venous Insufficiency Method. It cures and treats the varicose vein without removing it and being an outpatient procedure requires a minimum stay at the hospital.