Introduction :
Distended superficial veins in the legs.

Anatomy :
The heart pumps blood out around the body through arteries. These become smaller and smaller until they are only one cell in diameter, when they are known as capillaries. In the capillaries, the oxygen and nutrition are removed from the blood, which then travels back to the heart through the veins. Two systems of veins are used in the legs to move the blood from the feet back to the heart. One system is deep inside the muscles of the calf and thigh, the other system is outside the muscles and just under the skin. It is this superficial system that causes varicose veins. The contraction of the muscles in the leg supplies the force to move the blood out of the legs. The muscle movement squashes the veins, and with the aid of one way valves scattered through the superficial venous network, the blood is steadily pushed back towards the heart.

Cause :
Pregnancy (because of the growing baby putting pressure on the veins in the pelvis) and prolonged standing (in jobs like hairdressing and shop assistant) make it difficult for the blood to move up from the legs into the body. The veins then become swollen with blood, and the one way valves can become damaged. The damaged valves then allow more blood to remain in the veins, dilating them further and eventually causing the grossly dilated varicose veins.

Incidence :
Very common in certain occupations where prolonged standing is required. More common in women than men due to pregnancy. Worsen steadily with age.

Prevention :
Reducing the amount of standing, wearing elastic support stockings and regularly exercising the muscles in the legs while standing may prevent varicose veins.

Investigations :
Ultrasound examinations and rarely x-rays after injection of dye, may be performed before surgery to determine the appropriate areas for correction.

Course :
Large, ugly, blue, knotted ropes straggling across the surface of once shapely legs like a blue-water seaman�s nightmare! Tired, aching, swollen legs, that make their owner wish that medical science had developed a way of transplanting firm and supple limbs onto an otherwise well-tuned body. Varicose veins never kill their owner, but they certainly cause a great deal of discomfort, and a significant drop in ego and self-esteem, when their owner finds others staring at the patterns they describe across the blotchy, red and sometimes ulcerated skin.

Treatment :
Unfortunately, there are no magic cures for this very common problem, but doctors do have ways of reducing the symptoms and removing the veins. Once present, there are tablets (eg: Paroven - see Medication Table) that can reduce the aching that may be present in the dilated veins, but only surgical procedures can permanently remove the veins. Injections may be used to destroy small, fine, spider-like networks of veins. This is rather like injecting a special type of glue into the veins, to stick the walls together. Larger isolated veins can be removed one at a time by a nick and pick procedure, with a small cut being made over each vein to allow its removal. The most major procedure is stripping, where most of the superficial veins on one side of the leg from the groin to the ankle, are removed. This procedure may be combined with a nick and pick . After all these procedures, the leg must remain firmly bandaged for several weeks. It is sensible to discuss the matter with your general practitioner sooner rather than later if varicose veins worry you, so that referral to a surgeon can be arranged before too many of the tortuous veins develop.

Diet :
A loss of weight in the obese may reduce the discomfort of varicose veins, improve the chances of surgical success, and reduce the risk of recurrence.

Complications :
Varicose veins may rupture to cause severe bruising, or be cut and bleed profusely. In these situations, the bruised or cut area must be bandaged firmly, the patient should lie down, the leg must be elevated for an hour or so, and ice applied.

Outcome :
The operations are successful in most people, but they do not prevent the development of veins elsewhere in the legs, and the skin staining caused by the varicosities is usually permanent.