Chronic venous insufficiency, also known as varicose veins or varicose veins, are swollen veins caused by an abnormal accumulation of blood due to weakness, often inherited, in the walls and valves of superficial veins. This causes the veins to widen and dilate, so blood pools easily when a person stands for a long time.

“When the vein dilates, it does not fulfil its function. These are in charge of carrying out the blood return to the heart, implying that the flow has to go against gravity: from the foot to the heart.

“The veins have valves that prevent the return of that blood flow to the foot and facilitate the ascent. However, if the vein is dilated, the valves do not perform their function, and the flow is reversed, which causes further dilation and problems such as oedema, swelling of the leg or, in more advanced stages, ulcers or phlebitis ( thrombosis of a varicose vein).

Causes

Three of the leading causes of varicose veins’ appearance stand out.

In the first place, and the case of primary varicose veins, there are congenitally defective valves responsible for circulating blood to the heart, so if they don’t work properly, blood accumulates in the vein causing it to swell.

Thrombophlebitis causes the same effect. In this, they are thrombi, or clots, which hinder circulation. This situation can occur, for example, after prolonged periods of bed rest.

The third most likely cause for the appearance is pregnancy. Varicose veins during pregnancy are secondary and tend to disappear between two and three weeks after delivery.

Symptoms

The most common clinical manifestations are:

  • Leg heaviness.
  • The appearance of varicose veins with visible veins.
  • Oedema.
  • Swelling.
  • The appearance of pain.
  • Cramps.
  • Cramping sensation.

Prevention

Currently, no measure helps prevent the appearance of varicose veins.

However, a healthy lifestyle, physical exercise, avoiding overweight, obesity and a sedentary lifestyle contribute to the fact that if a person is at risk of developing varicose veins, they are controlled.

Types

There are different ways to classify this problem. 

The main one, at a medical level, is the Clinical-Etiological-Anatomical-Pathophysiological (CEAP ) classification, which establishes a grading of varicose veins based on the clinical presentation, the aetiology, the anatomy of the vein and its pathophysiology.

At a general level, that two types can be established:

  • Superficial varicose veins. It is the most frequent type. Small, highly visible varicose veins known as telangiectasias or spider veins often cause concern. “This type of varicose vein does not usually have a major pathological significance and is usually a mainly aesthetic problem. It does not usually cause skin problems of darkening or dermatitis, ulcerations or phlebitis,” he adds.
  • Trunk varicose veins. They can present different degrees of dilation and are the varicose veins themselves: dilated veins that can be more or less visible.

Diagnosis

The first recommendation patients should follow to be diagnosed to go to a vascular surgery specialist. The expert is fully trained to, only with the clinic and a physical examination, give a first diagnosis that is usually entirely accurate.

Next, performing a venous echo-Doppler usually provides more specific information on the anatomy of the varicose vein and the therapeutic options that can be established.

Treatments

Pharmacological treatment is focused on relieving symptoms and preventing the disorder from worsening. Some orally administered vagotonic drugs are effective. The most used are Venosmil (hydrosmin), Daflon (diosmin) and Venoruton (operations), among others.

To relieve symptoms, experts also recommend a series of measures:

  • Wear compression stockings. These garments help push blood from the capillaries to the heart, preventing stretching or injury. Despite the discomfort they may cause, their use is especially indicated in the summer months since there is a risk of worsening disorders associated with venous return.
  • Avoid exposure to the sun for a long time, lying down and not moving, especially during the hours of maximum heat, which would lead to an intense and prolonged vasodilator effect.
  • Apply cold water showers on the legs, making the jet impact in ascending circles.
  • Avoid standing for a long time, especially for people with a family history of the same type.
  • Use gels with a cold effect through soft massages in an ascending direction or with vagotonic active ingredients.
  • Lying down and raising the legs above the heart’s height, after long periods of sitting or standing, and when sleeping.
  • Walk along the beach and bathe from time to time, as the freshwater activates circulation and improves the feeling of tired legs. In this case, it is necessary to take a shower after the bath to remove the salt, since it dries the skin, and apply a moisturising cream.
  • Avoid overweight, obesity and sedentary life.
  • Do not wear too tight clothes.
  • Wear comfortable shoes, avoiding high heels and flat shoes as much as possible.
  • Moisturise the skin daily.

It is also possible to resort to surgery. When the surgeon operates on varicose veins, he is acting on the already established disease in the varicose vein that is causing the problem for the patient. Still, the body can continue “generating” new varicose veins.

For this reason, current treatments eliminate the varicose vein from its origin. It can be through two processes:

  • Through surgery. The patient may have surgical treatment or receive the application of heat. That heat can be applied through the use of a catheter with a laser or a catheter with radiofrequency.
  •  With chemicals. Through Microfoam that has a sclerosing substance to eliminate varicose veins. 

Promising results of varicose vein sealing

At the XIII International Symposium on Endovascular Therapeutics, held in 2019, Juan Fontcuberta, head of the Angiology, Vascular and Endovascular Surgery Service of the Sanitas hospitals in Madrid, and Sandra Vicente, belonging to the aforementioned service, presented a new technique to eliminate the varicose veins without the need to go through the operating room. This new approach has been tested on 85 extremities of 70 patients.  

The technique consists of sealing the diseased veins with an adhesive, causing the blood to be diverted towards healthy veins of the deep venous system. “Its main advantage is that it allows us to treat varicose veins outside the operating room and to do so with great success on an outpatient basis, which makes it easier for patients to return to their normal lives in 24 hours.

This specialist adds that “the use of this technique avoids the possibility of thermal injuries to nerves located in the vicinity of the treated vein since the adhesive does not transmit heat to nearby structures, as is the case with endolaser or radiofrequency techniques. In addition, it is not necessary to wear compression stockings after the treatment, which facilitates the possibility of performing this approach throughout the year, including the summer”.

It is the most common vascular disease. They affect between 20 and 30% of the adult population, and their prevalence increases with age. In fact, from the age of 50, almost half of the population has one degree or another of venous insufficiency. 

Forecast

The prognosis of chronic venous insufficiency is usually benign. However, if varicose veins are not adequately treated, they can cause a loss in the patient’s quality of life due to the discomfort of the disease, such as heaviness and pain, which increase in the summer.

Risk factor’s

Three factors increase the risk of developing varicose veins:

  • Have a family history.
  •  Pregnancies that’s why it’s more common in women.
  •  Obesity, overweight and a sedentary life would also increase the presence of varicose veins.
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