Varicose veins are quite common and one Finnish study reported an incidence rate of 13.5 per 1,000 person years (8.5 for men and 19.2 for women). They also tend to occur more in women who have had more than two pregnancies, the overweight (again, especially in women) and in people over 50.
The term varicose derives from the Latin 'varix', which means twisted. Varicose veins are caused by stretching that occurs in veins of the legs that are close to the skin surface, allowing blood to pool in the legs.
They may bulge and may cause pain or discomfort, but severe varicose veins may also cause poor circulation which carries medical risks.
In addition to embarrassment and discomfort, varicose veins may result in a number of medical conditions. Most of these conditions concern changes in the skin but can also cause serious blood clots to develop.
Medical conditions associated with varicose veins may include:
Varicose eczema: Dry, itchy skin may develop due to lack of blood flow. It is more prevalent in those who have eczema in other areas of the body and is sometimes treatable with a steroid cream.
Skin ulcers: Lack of adequate blood supply may starve the skin tissue of oxygen, causing it to degrade. This may result in venous ulcers, generally around the ankles and in severe cases may cause necrosis or tissue death. If the ulcers become infected, antibiotic treatment may be needed.
Lipodermatoscleosis: The skin around the ankles may become hardened and discoloured due to long term damage and pressure injury and the development of scar tissue on the skin. A condition termed “champagne ankles” may also develop as the scar tissue contracts and skin above the ankles bulges.
Panniculitis: Panniculitis is similar to lipodermatosclerosis but rather than being hardened and yellow, the skin is inflamed and sore around the ankles.
Lymphoedema: After years of unrelieved pressure, the lymph system may not work well. This may cause lymph fluid to accumulate and result in extreme swelling. Lymphoedema is not easily treatable.
Superficial Thrombophlebitis: Because the blood is allowed to accumulate, the sluggish flow may cause it to clot. In some cases, the clot may remain localized, resulting in reddened skin. In other cases, the clot may continue to grow in size, which will increase the risk of pulmonary embolism, particularly if the clot develops close to a vein junction or is in deeper tissue.
Pain in the legs, particularly if newly developed, warrants medical attention. The pain may be insignificant and simply due to excessive pressure, but may indicate other issues such as deep vein thrombosis (DVT).
Treatment options for varicose veins
In most cases varicose veins are readily treatable. Patients with severe or large varicose veins may require traditional surgical vein removal or “vein stripping” but patients with less severe issues may be treated with newer procedures.
Newer options include Endovenous Laser Therapy (EVLT) in which a small catheter containing a laser fibre is inserted through a small skin incision into the vein. In short pulses, the laser heats the vein tissue causing it to collapse and seal.
Other patients may be treated with the Clarevein procedure in which a microcatheter is introduced into the vein, allowing injection of a sclerosing solution, causing the vein to close over a period of time. The endovenous laser thermal ablation procedure has only a short recovery time and the Clarivein procedure generally allows the patient to immediately return to normal activities.
Watch: How veins are treated using the Clarivein procedure