Varicose veins are a condition of dysfunctional veins that are estimated to affect up to 80 million Americans in the next few years. These veins serve no function in the body.  Varicosities primarly occur because of valvular dysfunction.  As the valves in the veins become incompetent, or broken, they permit backflow of blood in the vein and the vein becomes a reservoir. This can promote swelling of the surrounding tissues and eventually lead to skin discoloration, breakdown, and eventually skin ulcerations. Some varicose vein symptoms show externally with veins appearing as elongated, swollen, twisted and blue in color.  However, some symptoms of vein disease are only recognized internally as painful, achy, heavy and/or tired legs.

A vein's primary function is to return de-oxygenated blood to the heart to be pumped through the lung and become re-oxygenated. During walking, for instance, the calf muscles act as a pump forcing blood back to the heart. To prevent blood from flowing in the wrong direction or stagnating, veins utilize valves. If the valves fail (the primary cause of venous reflux) then backflow down the leg is permitted. Over time, this backflow results in veins becoming enlarged and varicose. Vein treatment thus must stop this refluxing to be successful. To accomplish this, treatment must stop the valve failure at its highest level. In the legs, veins near the surface drain into larger veins, called the saphenous veins, that then connect into the deep vein system behind the knee and at the groin. Damaged valves in these larger veins often contribute to backflow, allowing blood to enter surface veins, thus causing swelling, pain, twisting, aching and bulging veins. In addition to valvular dysfunction, other causes for varicose veins are genetics, pregnancy, occupation, in some instances trauma, previous clots and advancing age.

Deep leg veins return blood to the heart and are in the center of the leg, near the bone, surrounded by muscle and fascial tissue under higher pressure. Superficial veins are nearer to the skin. They have less support from surrounding tissue than the deep system and thus may develop areas of weakness in the vein wall. When ballooning or engorgement of the vein occurs, it becomes varicose. Perforator veins serve as connectors between the deep system and the superficial system of leg. As they become enlarged and incompetent, these particular veins force blood from the higher pressure deep system to a lower pressure superficial system creating varicose veins. These veins are becoming more recognized as a primary source of venous reflux.

In the simplest terms, arteries pump oxygen rich blood from the heart to tissue, veins return oxygen depleted blood to the heart. Arteries are thicker wall structures than veins and the larger ones can be palpated resulting in a “pulse”.

Gravity is the culprit. The distance from the feet to the heart is the furthest blood has to travel in the body. Consequently, those vessels experience a great deal of pressure. If vein valves can’t handle the pressure, the back flow of blood can cause the surface or superficial veins to become swollen and distorted.

Conditions contributing to varicose vein disease include genetics, obesity, pregnancy, work or hobbies requiring excessive standing and previous vein disease such as thrombophlebitis (inflammation of a vein from prior clots). Women suffer more than men and advancing age shows an increase in incidence.

Varicose veins may cause aching, soreness, leg fatigue, swelling and hard painful areas or “phlebitis”. As the disease progresses, you'll see skin thickening, discoloration, eczema changes and even ulcers.

Vein ulcers are areas of the lower leg where the skin has died and exposed the flesh below. Ulcers can range in size from a penny to completely encircling a leg. They are sometimes painful, odorous open wounds which leak fluid and can last for months or even years. Most ulcers occur when vein disease is left untreated. They are more common as age advanced but also can occur in teenagers.

The gold standard of any venous treatment is compression. This means compression or support garments. Medical grade compression hose with at least 20-30 mm mercury compression is necessary. These garments provide support for weak, incompetent and dysfunctional veins. In addition, leg elevation, routine exercise (which helps build muscle to aid in the “pump” action to help return blood) and weight control all will assist with vein disease.

Closure is used, like vein stripping, to eliminate reverse blood flow in the saphenous vein, but without physically removing the vein. It can be performed without general anesthesia. Like other venous procedures, the Closure procedure involves risks and potential complications. Each patient should consult their doctor to determine whether or not they are a candidate for this procedure and if their condition presents any special risks. Potential complications reported in medical literature include: numbness or tingling (paresthesia), skin burns, blood clots and temporary tenderness of the treated limb.

A chemical injection, such as a saline or detergent solution, is inserted into a vein causing it to "spasm" or close up. Other veins in the area then take over its work. This procedure is most effective on smaller surface veins, less than 1-2 mm in diameter.  Sclerotherapy may bring only temporary success and these varicose veins frequently recur. 

ESES (pronounced SS) is an easy way to remember the conservative approach. It stands for Exercise Stockings Elevation and Still. Exercising, wearing compression hose, elevating and resting the legs will not make the veins go away or necessarily prevent them from worsening because the underlying disease (vein reflux) has not been addressed. However, it may provide some symptomatic relief. Weight reduction is also helpful. If there are inflamed areas or an infection, topical antibiotics may be prescribed. If ulcers develop, medication and dressings should be changed regularly. There are also potentially longer-term treatment alternatives for visible varicose veins, such as sclerotherapy and Closure techniques.