Varicose veins are dilated, tortuous veins engorged with blood that results from improper venous valve function. They can be primary, originating in the superficial veins, or secondary, occurring in the deep veins.

About 10% to 20% of Americans have primary varicose veins, which account for approximately 90% of varicose veins. They're twice as common in women as in men. Primary varicose veins also tend to be familial & affect both legs. Usually, secondary varicose veins occur in one leg. Both types are more common in middle adulthood.

Without treatment, varicose veins continue to enlarge. And, although there's no cure, certain measures, such as walking & using compression stockings, can reduce symptoms. Surgery may remove varicose veins; however, the condition can occur in other veins.

reason of Varicose veins

Veins are thin-walled, distensible vessels with valves that keep blood flowing in one direction. Any condition that weakens, destroys, or distends these valves allows blood back flow to the previous valve. If a valve can't hold the pooling blood, it may become incompetent, allowing even more blood to flow backward. As the volume of venous blood builds, pressure in the vein increases & the vein becomes distended. As the vein is stretched, its wall weakens & it loses its elasticity. As the vein enlarges, it becomes lumpy & tortuous. As hydrostatic pressure increases, plasma is forced out of the vein & into the surrounding tissue, resulting in edema.

Primary varicose veins can result from:

congenital weakness of the valves or venous wall
conditions that produce prolonged venous stasis or increased intra abdominal pressure, such as pregnancy, obesity, constipation, wearing tight clothes, or standing for prolonged periods
occupations that necessitate standing for an extended period
family history of varicose veins.

Secondary varicose veins can result from:

deep vein thrombosis
venous malformation
arteriovenous fistulas
trauma to the venous system
occlusion

Signs & symptoms of Varicose veins

Signs & symptoms of varicose veins may include:

dilated, tortuous, purplish, ropelike veins, particularly in the calves, due to venous pooling
edema of the calves & ankles due to deep vein incompetence
leg heaviness that worsens in the evening & in warm weather (caused by venous pooling)
dull aching in the legs after prolonged standing or walking, which may be due to tissue breakdown
aching during menses as a result of increased fluid retention.

Possible complications of varicose veins include blood clots second3IY to venous stasis, venous stasis ulcers, & chronic venous insufficiency.

Diagnosis of Varicose veins

Tests used to help diagnose varicose veins include:

manual compression test to detect a palpable impulse when the vein is firmly occluded at least 8" (20 cm) above the point of palpation, indicating incompetent valves in the vein
Trendelenburg's test (retrograde filling test) to detect incompetent valves in deep & superficial veins
photoplethysmography to characterize venous blood flow by noting changes in the skin's circulation
Doppler ultrasonography to detect the presence or absence of venous back flow in deep or superficial veins
venous outflow & reflux plethysmography to detect deep venous occlusion (invasive; not routinely used)
ascending & descending venography to demonstrate venous occlusion & patterns of collateral flow.

Varicose veins treatment

treatment of the underlying cause, such as abdominal tumor & obesity, if possible
antiembolism stockings or elastic bandages to counteract swelling by supporting the veins & improving circulation
regular exercise program that promotes muscular contraction to force blood through the veins & reduce venous pooling
injection of a sclerosing agent into small to medium-sized varicosities
surgical stripping & ligation of severe varicose veins
phlebectomy (removing varicose vein through small incisions in the skin), which may be performed in an outpatient setting.

Additional treatment measures include:

discouraging the patient from wearing constrictive clothing that interferes with venous return
encouraging the obese patient to lose weight to reduce increased intra abdominal pressure
telling the patient to elevate her legs above her heart whenever possible to promote venous return
instructing the patient to avoid prolonged standing or sitting because these actions enhance venous pooling.

Varicose veins removal by laser treatment

Laser ablation is a new non-surgical way to cure varicose veins which has been developed over the past five years at centres in USA, Spain & Germany. It is performed as an outpatient "walk in, walk out" procedure with no requirement for general anaesthetic or overnight stays in hospital.

The laser treatment involves the insertion of a laser fibre into the varicose vein of the thigh from the knee to the groin using ultrasound imaging to guide the way. The laser fibre is then withdrawn along the vein, heating it from within to close it, using local anaesthetic to minimize discomfort. The treatment session lasts in the region of one hour. A pressure stocking is applied & must be worn for a week. The majority of patients can return to normal activities including work the next day.

Complications

Phlebitis (chronic inflammation of the vein)
Formation of leg ulcers
Rupture of a varicose vein

Special considerations & Prevention

After stripping & ligation or after injection of a sclerosing agent, administer analgesics, as ordered, to relieve pain.

Frequently check circulation in toes (color & temperature), & observe elastic bandages for bleeding. When ordered, rewrap bandages at least once per shift, wrapping from toe to thigh with the leg elevated.
Watch for signs & symptoms of complications, such as sensory loss in the leg (which could indicate saphenous nerve damage), calf pain (which could indicate thrombophlebitis), & fever (a sign of infection).
Encourage the patient to ambulate after surgery & elevate her legs whenever possible to reduce swelling.
Avoid prolonged standing if personal or family history indicates you are at risk of developing varicose veins.

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