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Varicose veins are veins that have become large and twisted, most commonly occurring in the veins of the surface of the leg. In this article, we provide an overview of how varicose veins develop, the symptoms of varicose veins, and the current state of varicose vein treatment.
Figure 1: Three different presentations of varicose veins on the leg. Image Credit: Dallas Vein Institute
What Causes Varicose Veins?
Blood circulates throughout the body in two separate systems: arteries and veins. Arteries carry blood away from the heart, while veins carry blood back to the heart. The pumping action of the heart creates a high-pressure system that propels blood through the arteries, whereas veins are low-pressure vessels that rely on the contraction of surrounding muscles to propel blood through the vessels. To keep blood moving in the right direction, healthy veins also have a series of one-way valves that prevent blood from flowing backwards.
Varicose veins occur when blood flow through the veins is insufficient, which is why vein conditions in the legs are more broadly referred to as “venous insufficiency.” At the heart of this issue is a phenomenon called “venous reflux.” Venous reflux refers to the condition in which blood in a vein or a group of veins flows backwards, causing blood to accumulate in the veins, causing the veins to distort and swell into visible varicose veins.
Figure 2: Diagram of healthy veins and varicose veins in the leg. Image Credit: Dallas Vein Institute
In a given individual, the exact origins of varicose veins are difficult to pinpoint, but any phenomenon that adds pressure to the veins, stifles blood flow, weakens the vein walls, or damages the vein valves can contribute to the genesis of varicose veins. Risk factors include: being female, having a family history of varicose veins, aging, sitting or standing for extended periods of time, smoking, obesity, and pregnancy.
Symptoms of Varicose Veins
It’s tempting to dismiss varicose veins as a cosmetic issue, but venous reflux causes a number of symptoms that can impose a serious hindrance on daily life. Such symptoms include:
– Leg pain
– Itching or burning
– Throbbing or aching
– Restless legs
– Tingling or numbness
– Leg fatigue or heaviness
– Leg cramps
Varicose Vein Treatment
There are three unique approaches to varicose vein treatment that are typically carried out by different medical specialists: (1) conservative management, (2) surgery, and (3) minimally invasive treatment.
Conservative Management
Conservative management aims to improve the immediate symptoms of varicose veins and prevent progression into more serious stages of venous insufficiency. As a first line of management, a primary care physician may prescribe compression stockings to improve circulation in the leg and recommend lifestyle changes like diet and exercise to reduce the load on the veins. These approaches can help, but they do not address the underlying problem of venous reflux.
Surgery
Surgery is the most invasive treatment option for varicose veins. Vein removal surgery is appropriately called “vein stripping.” The surgery involves making incisions at the two ends of the vein and threading a special wire (the “vein stripper”) through the vein from one incision to the other. The wire is attached to the vein and ripped from the body. This technique is still practiced by some surgeons and was the ‘gold standard’ in symptomatic varicose vein treatment prior to the advent of minimally invasive procedures.
Minimally Invasive Vein Treatment
Minimally invasive therapies have been a reliable means of treating varicose veins for the past two decades. Rather than removing varicose veins, minimally invasive treatments employ a variety of catheter-delivered technologies to ‘close down’ varicose veins from the inside. These treatments are just as effective as surgery, but with significantly faster recovery time and lower complication rates. These procedures are best performed by a vein specialist that is well-versed in vein anatomy.
Thermal Ablation
Thermal ablation was the first minimally invasive treatment for varicose veins that saw widespread use and is still the most common vein treatment used today. With thermal ablation, a special catheter is equipped with a heating element or a laser that delivers thermal energy to the vein wall, causing the vein wall to denature and collapse. Because the vein is subject to high temperatures, tumescent anesthesia is injected around the vein to numb the area and function as a heat sink. Thermal ablation has an excellent track record of providing safe, effective, and comfortable varicose vein treatment.
Figure 3: Diagram of thermal ablation treatment for varicose veins showing catheter insertion and vein closure. Image Credit: OnChart Medical
Glue Vein Closure
An adhesive n-butyl-2-cyanoacrylate (NBCA) formulation is delivered to the inside of the vein. Upon contact with blood inside the vein, the NBCA polymerizes, sealing the varicose vein shut. This is a non-thermal, non-destructive approach that does not require tumescent anesthesia. Success rates with glue are similar to those observed with thermal ablation, and some evidence suggests that glue provides faster recovery and fewer side effects than thermal ablation.
Chemical Ablation
Chemical ablation, also called “sclerotherapy,” is yet another minimally invasive varicose vein treatment. With sclerotherapy, an irritant such as polidocanol is delivered to the inside of the vein, causing fibrosis and scarring in the vein. Sclerotherapy should be thought as working like thermal ablation. In both cases, damage to the inner lining of the vein causes it to collapse, effectively closing down the vein.
Source: Dallas Vein Institute