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Varicose Veins

Symptoms | Causes | Risks | Diagnosing | Treatment | Complications

Varicose veins are swollen, dilated and tortuous veins – usually blue or dark purple – that usually occur in the legs.  They may also be lumpy, ropy or twisted in appearance.  They usually develop on the legs, either on the back of your calf or on the inside of your leg.  However, they can also develop in other parts of your body (esophagus, vagina, pelvis, anus and around the uterus).

Seek medical attention when:

  • Your varicose veins are causing you  pain or discomfort
  • The skin over your veins is sore and irritated
  • The aching in your legs is disturbing your sleep
  • You observe color changes to the area of your leg above the ankle
  • You have a painful lump, redness or swelling
  • If you’re concerned by the development of varicose veins or spider veins that are causing aching, discomfort, swelling, heaviness or itching
  • You have a varicose vein that is hard and painful
  • You have a skin condition affecting your leg (such as eczema) that may be caused by problems with the blood flow in the leg
  • Your varicose veins are preventing you from exercising or completing your daily chores
  • You have a healed or unhealed leg ulcer below the knee

SYMPTOMS OF VARICOSE VEINS

  • Aching, heavy and uncomfortable legs, especially when you have been standing for awhile
  • Swollen feet or ankles
  • Muscle cramps in your legs, particularly at night
  • Dry skin and color changes in the lower leg
  • Burning and throbbing in your legs
  • Dry itchy and thin skin over the affected area
  • Some may appear dark blue and can bleed spontaneously when you are in the shower

Symptoms are usually worse at the end of the day and during warm weather, if you have been standing up for long periods of time, or if you lift heavy objects.  The symptoms may improve when you walk around or elevate your legs over a couple of pillows.

CAUSES OF VARICOSE VEINS

Varicose veins are usually caused by weak vein walls and valves.  Inside your veins are tiny one-way valves that open to let the blood through and then close to prevent it flowing backwards.  Sometimes the walls of the veins become stretched and lose their elasticity, causing the valves to weaken.  When the valves don’t function properly, the blood leaks and flows backwards.   (This is called venous reflux).  If this happens, the blood will collect in your veins, which will become swollen and enlarged due to the increase in pressure.  The reason why this happens is poorly understood.

CAUSES

RISK FACTORS FOR VARICOSE VEINS

A number of things can increase your likelihood of developing varicose veins, including:

  • Female gender
  • Family history: if one parent has varicose veins, 47% of the children are at risk, and if two parents have them, the risk is 90%
  • Multiparity (delivering three or more children)
  • Standing occupation (i.e., chefs, factory workers, pharmacists)
  • Heavy lifting
  • Pregnancy
  • Tall stature
  • Advancing age
  • Having a previous blood clot
  • Swelling or a tumor in the pelvis
  • Abnormal blood vessels

DIAGNOSING VARICOSE VEINS

VaricoseVeinsVaricose veins are diagnosed by means of a Duplex Ultrasound Reflux Study.  This test lasts about an hour and is performed in the standing position.  The patient stands on an elevated platform, so that the vascular technician can map the veins in both legs.  During this test, an inflatable cuff will be placed at the level of your calf.  Normal venous blood flow is color-coded blue, while reversed venous blood flow is color-coded red.  This test is entirely painless, and uses sound waves to build a picture of the blood vessels in your legs, then assesses the flow of blood through them.  Once the study is completed and your medical history is taken, the physician will discuss the findings and propose a treatment plan.

TREATMENT OF VARICOSE VEINS

Treatment of varicose veins is usually necessary:

  • To ease symptoms
  • To treat complications (such as a leg ulcer, swelling or skin discoloration)
  • For cosmetic reasons (rarely available through health insurance)

Individual insurance plans vary in their specific requirements, but all require a patient to have tried conservative measures for 6 weeks to 3 months, prior to treatment authorization.   (A patient with an active leg ulcer may be exempt from this requirement.)  Medical grade compression stockings (compression level >20mmHg) are part of the required conservative management trial.

Compression stockings are specially designed to squeeze your legs and compress the superficial veins. This will improve your circulation. They are tighter at the ankle and get gradually looser as they go further up your leg. This encourages your blood to go upwards towards your heart. Compression stockings may help prevent your varicose veins from getting worse. You should wear compression stockings for the entire period of your pregnancy if you are pregnant and have varicose veins… They are available in a variety of sizes and colors, with and without toes. If you have deep venous incompetence (Chronic Venous Insufficiency) you may need to wear them for the rest of your life. Compression stockings usually have to be replaced every 3-6 months as they lose their elasticity. When you start wearing them, you should get two pairs so that you do not interrupt the compression regimen.

If your varicose veins need further treatment, or they are causing complications, the type of treatment will depend on your general health and the size, location and severity of your veins.  All treatments are performed in the office by Dr. Plaza-Ponte personally, using only local anesthetic (when needed).

The treatments available for varicose veins are:

COMPLICATIONS OF UNTREATED VARICOSE VEINS

Varicose veins can cause complications because they stop your blood from flowing normally. Most people do not develop complications, but, if you do, it will usually be several years after your varicose veins first appear. Some possible complications are:

  • Bleeding – varicose veins near the surface of your skin (blue blebs) can sometimes bleed if you bump or cut your leg.  The bleeding may be difficult to stop if you remain standing.  Should this happen, apply finger pressure at the bleeding site, elevate your leg and seek immediate medical advice.
  • Blood Clots – If a clot forms in a superficial vein, it can lead to conditions such as superficial thrombophlebitis (SVT) or deep vein thrombosis (DVT).
    • SVT symptoms – pain, redness, warmth.  This can be treated by compression stockings or by draining the clot through a tiny cut in the skin
    • DVT symptoms – pain, swelling. This may develop in up to 20% of people who develop SVT. It may lead to serious complications, such as pulmonary embolism (PE)
  • Chronic Venous Insufficiency – usually results from scar tissue and the resistance to the return of venous blood to the heart when a DVT occurs. It can be prevented by seeking medical help before the scarring process takes place. Chronic venous insufficiency can lead to:
    • Varicose eczema – a condition that causes your skin to become red, scaly and flaky. You may also develop blisters and crusting of your skin. This condition is often permanent, but does not lead to major problems.
    • Lipodermatosclerosis – causes your skin to become hardened and tight, and you may find it turns a red or brown color.  The condition usually affects the calf area.
    • Venous ulcers – develop when there is increased pressure in the veins which is transmitted to the capillary skin of your leg. The fluid can cause the skin to thicken, swell and eventually break down to form an ulcer, most commonly in the ankle area. You should seek medical attention as soon as you see your skin changes. The condition is easily treated.
  • Edema – the medical term for fluid retention in the body.  The swelling can occur in any particular part of the body.  It is commonly seen in patients with varicose veins, chronic venous insufficiency that can occur after a DVT and certain conditions, such as congestive heart failure or kidney failure.  Besides swelling and puffiness of the skin, edema can also cause:
    • Skin discoloration
    • Areas of the skin that temporarily hold the imprint of your finger when pressed (known as pitting edema)
    • Tender, aching legs
    • Weight fluctuations
    • High blood pressure and increased pulse rate
    • Edema is worsened by immobility, prolonged standing or sitting (these are the most common reasons)
    • Edema is often the result of an underlying health condition or treatment:
      • A blood clot in your leg
      • Severe varicose veins
      • A leg injury or surgery
      • Burns to the skin
      • Pregnancy
      • Kidney disease
      • Heart failure
      • Chronic lung disease
      • Liver disease
      • Malnutrition
      • Medications, such as corticosteroids and high blood pressure pills and the birth control pill
    • Other types of edema include:
      • Cerebral edema – affecting the brain
      • Pulmonary edema – affecting the lungs
      • Macular edema – affecting the eye

Lymphedema

Lymphedema is swelling of the legs caused by blockage in the lymphatic system. The lymphatic system consists of a series of lymph nodes (glands) connected by a network of vessels, similar to blood vessels.  Fluid surrounding body tissues usually drains into nearby lymph vessels so it can be transported back into the blood.  However, if the lymph vessels are blocked, the fluid can’t be reabsorbed and will build up in the tissue.  Unlike edema, Lymphedema is a long-term condition that can cause discomfort, pain and loss of mobility.  Lymphedema can be improved using a number of treatments, including compression stockings, lymphatic massage, and elevation.

Varicose Eczema

Varicose eczema is a long-term skin condition that affects the lower legs and is common in people with varicose veins which have associated increased pressure in the veins.  This increase in pressure can cause fluid to leak into the surrounding tissue.  It is thought that varicose eczema may develop as a result of the immune system reacting against this fluid.

Like all types of eczema, the affected skin becomes:

  • Itchy
  • Red and swollen
  • Dry and flaky
  • Scaly and crusty

There may be periods when these symptoms improve and periods when they become more severe.  Some people also have other symptoms, such as:

  • Brown discoloration of the skin
  • Red, tender and tight skin that can eventually become hardened (lipodermatosclerosis)
  • Small, white scars (atrophie blanche)
  • Pain
  • Eczema affecting other parts of the body. Left untreated, leg ulcers can develop.
  • These are long-lasting wounds that form where the skin has become damaged.

How is varicose eczema treated?

  • Varicose eczema tends to be a long-term problem. However, treatments are available to help keep it under control. For most people, treatment involves a combination of:
  • Self-help measures – including ways to improve your circulation, such as keeping active and frequently raising your legs
  • Emollients – moisturizers applied to the skin to stop it becoming dry
  • Topical corticosteroids – ointments and creams applied to the skin to help treat the eczema and relieve symptoms
  • Compression stockings – specially designed stockings, usually worn every day, that steadily squeeze your legs and help improve your venous circulation.
  • It may be necessary to refer you to a dermatologist in case you have another cause of your symptoms.

Other types of eczema:

  • Atopic eczema (also called atopic dermatitis) – the most common type of eczema
  • Contact dermatitis – a type of eczema that occurs when the body comes in contact with a particular substance
  • Discoid eczema – a type of eczema that  occurs in circular or oval patches on the skin
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