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Varicose veins

What are varicose veins?

They are twisted and swollen veins caused by faulty valves in the system of veins in the leg. The failure of the valves to close properly causes blood returning to the heart to pool in the veins.

How do they form?

Blood is collected from the leg in a network of superficial veins (just under the skin, on the surface of muscles). These veins are connected with deep veins in the muscles by perforating veins. When the muscles of the leg contract they pump the blood up these veins, which have one-way valves to prevent blood flowing back into the superficial veins.

When the valves do not close properly the blood tends to flow into the superficial veins, causing them to swell with the 'pooled' blood.

There are two main types of faulty systems:

1. faulty valves in the groin, which cause the typical long knobbly veins along the leg
2. faulty valves in the perforating veins, which cause problems mainly around and above the ankle.

The latter problems are the most troublesome.

What are the symptoms?

The usual first sign is the appearance of prominent bluish swollen veins in your leg when you stand up. The usual site is either at the back of the calf or the inside of the leg from the ankle to the groin. At first they are not painful, but as the veins get larger they may become tender to touch and the skin above them or at the ankle may begin to itch.

With severe varicose veins the whole leg may ache and the skin, especially at the ankle, may become brownish. This discoloured skin is called varicose eczema.

What are the risks?

Varicose veins are usually annoying and unsightly rather than disabling. Serious complications include the development of an ulcer in the skin (usually after an accident), inflammation of the vein or a clot in the vein.

Sometimes a knock or cut over a vein can cause severe bleeding. If this happens, put your leg up above your body and wrap a firm bandage around the bleeding vein.

What is the treatment?

Self-help

• Keep off your feet as much as possible.
• Whenever possible, sit with your legs up on a footstool.
• Buy or get a prescription for support tights or stockings and put them on before you get out of bed every day.
• Do not scratch itchy skin over your varicose eczema.
• See your doctor if you develop eczema or an ulcer.

Surgery

The most satisfactory answer the problem of varicose veins is through surgery. The operation generally has good results, as the veins with the faulty valves are tied off or stripped away. It is possible to operate without leaving large scars.

After surgery varicose veins tend to come back, usually in a different place, in about 10 per cent of treated patients.

Copyright 1995: John Murtagh, Professor of General Practice
Monash University, Melbourne, Australia