Varicose veins: Venous insufficiency

What are they?

Varicose veins are dilations and lengthening of the veins. They can appear in any area of ​​the body but are especially common on the legs.

It is one of the main signs of what is called tired leg syndrome or chronic venous insufficiency. It is a frequent problem in the population and they appear more in women than in men.

How are they produced?

The circulatory system is made up of veins and arteries. The veins are responsible for returning the blood to the heart. To facilitate this work they have to prevent the blood from going backwards and continuing upwards, towards the heart.

The cause of varicose veins is usually multiple, and their origin is often involved, on the one hand, a weakness of the venous wall and an incompetence of the veins and, on the other, causes that lead to an increase in venous pressure.

When for different reasons the valves become incompetent, the venous return is difficult and the blood remains stagnant in the veins. If this situation persists over time, the veins increase in size and dilate, appearing the well-known varicose veins.

Its appearance is especially favored by certain factors such as obesity, sedentary lifestyle, pregnancy, age (it increases in older people), professions that require standing for a long time such as shop assistants, waiters or hairdressers. Spending more than 5 hours standing or more than two sitting are factors that aggravate the problem.

Symptoms

In many cases, varicose veins do not give symptoms and are only an aesthetic problem, because they appear as cords that protrude on the leg. Other times symptoms may appear before they are clearly visible.

Patients with varicose veins may have fluid build-up and swelling of the ankles and legs, pain, heaviness, and cramps. The discomfort usually worsens after a long period of time sitting or standing, without doing physical activity, with a burning sensation and constant tingling in the legs.

In more advanced cases, ulcers appear on the skin with itching, changes in color and texture, and clots may appear due to the stagnation of the blood inside what is known as superficial venous thrombosis.

Diagnosis

Varicose veins are easy to identify by the doctor with a proper physical examination. During this exploration, certain maneuvers can be performed to see the venous return.

To complete the diagnosis, an ultrasound is performed to assess the functioning of the venous valves.

Treatment

In mild cases, treatment is aimed at alleviating the discomfort and preventing the problem from getting worse.

Conservative measures:

• Measures to facilitate venous return such as compression stockings sold in pharmacies (normal or medium compression: 22-30 mmHg).
• Avoid standing or sitting for a long time, changing posture or getting up frequently.
• Avoid tobacco and being overweight.
• Avoid wearing clothing items that are too tight that hinder venous return.
• Eat a healthy diet.
• Get regular exercise (especially walking, cycling).
• Keeping your legs up (raising them above your heart) at the end of the day, especially during times that may be worse, such as during pregnancy.

Medical-surgical treatment It is especially indicated when there is a risk of complications such as bleeding or thrombosis, ulcers and infections, or due to the persistence of symptoms despite adequate conservative treatment. Alternatives that exist include:

• Venotonic drugs. They are indicated for relief of symptoms and decrease of swelling of the legs.
• Sclerosis: an irritating substance is injected, that is, that causes a scarring and closure of the vein, into the affected venous vessels. It is performed on an outpatient basis and is indicated above all in small and medium caliber varicose veins.
• Surgery. There are two techniques, the classic or phleboextraction in which the vein is totally removed (saphenous vein) or by means of the CHIVA technique (Hemodynamic Cure of Ambulatory Venous Insufficiency) in which only the pieces of vein that hinder venous return are removed by performing microincisions. This technique is done on an outpatient basis. Both are performed on large varicose veins.
• Endovascular laser: it is a newer treatment in which, using the energy of the laser inside the vessel, the varicose veins are destroyed. The laser can also be used for the cosmetic treatment of small varicles or telangiectasias (small capillaries).

Prevention

Although the appearance of varicose veins cannot be prevented, its appearance and worsening can be reduced with general measures such as avoiding tobacco and being overweight, exercising, avoiding tight clothing and wearing comfortable shoes without excessive heels.