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Varicose Veins

Varicose veins are veins that have become enlarged and tortuous. The term commonly refers to the veins on the leg, although varicose veins can occur elsewhere. Veins have bivalve leaflet valves to prevent blood from flowing backwards (retrograde). Leg muscles pump the veins to return blood to the heart, against the effects of gravity. When veins become varicose, the leaflets of the valves no longer meet properly, and the valves do not work. This allows blood to flow backwards and the veins enlarge further. Varicose veins are most common in the superficial veins of the legs, which are subject to high pressure when standing although you can have failure of the valves within the deep veins of the leg as well. Besides cosmetic problems, varicose veins are often painful, especially when standing or walking. Serious complications are rare.

Non-surgical treatments include sclerotherapy, elastic stockings, elevating the legs, and exercise. The traditional surgical treatment has been vein stripping to remove the affected veins. Newer, less invasive treatments, such as ultrasound-guided foam sclerotherapy, radiofrequency ablation and endovenous laser treatment, are slowly replacing traditional surgical treatments. Because most of the blood in the legs is returned by the deep veins, the superficial veins, which return only about 10 per cent of the total blood of the legs, can usually be removed or ablated without serious harm. Varicose veins are distinguished from reticular veins (blue veins) and telangiectasias (spider veins), which also involve valvular insufficiency, by the size and location of the veins. Many patients who suffer with varicose veins seek out the assistance of physicians who specialize in vein care.

As functional venous valves are required to provide for efficient blood return from the lower extremities, chronic venous insufficiency (CVI) often occurs in the veins of the legs. Itching is sometimes a symptom, along with hyperpigmentation of the legs. Symptoms of CVI include phlebetic lymphedema and chronic swelling of the legs and ankles. The skin may react with varicose eczema, local inflammation, discoloration, thickening, and an increased risk of ulcers and cellulitis. The condition has been known since ancient times and Hippocrates used bandaging to treat it.
Venous valve incompetence is treated conservatively with manual compression  massage therapy, skin lubrication, sequential compression pump, ankle pump, compression stockings, blood pressure medicine, frequent periods of rest elevating the legs above the heart level and using a 7-inch bed wedge during sleep. Surgical treatments include the old Linton procedures and the newer subfascial endoscopic perforator vein surgery. Some experimental valve repair or valve transposition procedures as well as some hemodynamic surgeries are being pursued. This whole field of medicine while ancient is still filled with complications. Sometimes an artery can strangulate a vein or sometimes an arteriovenous fistula (an abnormal connection or passageway between an artery and a vein) may be causing the apparent poor venous return.  Patients are often encouraged to walk while wearing the prescribed medical stockings and to sleep in a 6 degree Trendelenburg position (foot of bed elevated). Obese or pregnant patients might be advised by their physicians to forgo the tilted bed.