Varicose veins, particularly seen in the legs, refer to the enlargement and visibility of the veins under the skin, indicating a disease. In the human body, there are two systems of veins in the legs: deep and superficial veins. The function of veins is to transport impure blood against gravity from the feet to the heart. Deep veins are not visible and are responsible for 90% of venous circulation. Since they run under the muscles, they transport blood to the heart through muscle movements. Superficial veins, on the other hand, run under the skin and lack any supporting tissues. Therefore, to prevent blood from flowing back when they raise it to a certain level, they have valves that function as check valves. These valves are approximately every 10 cm. The most important valve is located in the groin area where superficial and deep veins merge. If, for various reasons, this valve cannot perform its function, the veins enlarge due to the backflow of blood. This enlargement alone can cause a feeling of tension or discomfort. As the amount of backflow increases, the superficial vein can no longer function and cannot carry more blood to the heart. If the deep veins are normal, they take over the function of the superficial veins and start carrying all the venous blood. Meanwhile, the superficial vein, which normally has a diameter of 3-4mm, continues to enlarge. As the diameter widens, the valve function deteriorates further, and irreversible insufficiency begins. This condition is called chronic venous insufficiency. As the vein widens, over time, the micro pores in the veins also widen, causing fluid leakage out of the veins, resulting in edema.
What are the symptoms of varicose veins?
- Blue or purple swelling in the legs
- Feeling of heaviness
- Night cramps
- Burning sensation while standing
- Swelling in the legs
- Itching in the legs
What causes varicose veins?
There can be various reasons. Genetics is the most important factor. In addition to this, pregnancy, obesity, professions that require standing for long periods (doctors, nurses, teachers, factory workers, bakers, etc.), professions that require sitting for long periods (long-haul drivers, etc.), and the use of birth control pills or hormone medications can be among these reasons.
What are the types and stages of varicose veins?
According to the CEAP classification of varicose veins:
Stage 0: No visible venous disease Stage 1: Reticular veins or telangiectasias with a diameter less than 4mm Stage 2: Varicose veins with a diameter greater than 4mm Stage 3: Swelling or edema in the ankle Stage 4: Brown discoloration of the skin due to chronic venous insufficiency Stage 5: Healed ulcer in addition to discoloration Stage 6: Open ulcer
Does varicose veins cause problems if not treated?
Varicose veins or chronic venous insufficiency is a progressive disease. Initially, it only appears in appearance, but in the later stages, it presents symptoms such as pain, heaviness, night cramps, and burning sensations. Subsequently, edema develops in the legs, and in more advanced stages, clots may form in the veins, leading to painful infections (thrombophlebitis). Clots formed especially in deep veins can cause pulmonary embolism, and depending on the amount of clot and the vessel to which the embolus goes, it can be fatal. In the advanced stages of chronic venous insufficiency, wounds may open above the ankle, cellulitis may occur in these wounds, and these wounds may never heal.
How can the formation of varicose veins be prevented or delayed?
- Avoid standing for long periods
- Avoid sitting for long periods (stand up and walk for 2-3 minutes at least every half hour)
- Achieve an ideal weight
- Exercise regularly (deep vein movements pump more blood, so there is less work for superficial veins)
- Wear loose clothing
- Use comfortable shoes
- Elevate the legs while resting
- Avoid heat (baths, hot springs, sunbathing cause the veins to widen)
- Avoid spicy foods
How is the diagnosis of varicose veins made?
If varicose veins are suspected after a physical examination, the diagnosis can be made with Doppler ultrasound. According to the ultrasound result, the leakage degree is classified into 4 degrees.
Grade 1: Mild leakage Grade 2: Mild to moderate leakage Grade 3: Moderate to severe leakage Grade 4 is considered severe leakage. Stages 3 and 4 are generally irreversible.
How is varicose vein treatment done?
Treatment varies depending on the type of varicose veins. If there is 1st or 2nd-degree leakage according to the Doppler result, various varicose medications, regular use of varicose stockings, and general measures can return the disease to normal within 6 months. Patient compliance with treatment is crucial at this stage.
Intervention is required in cases of 3rd and 4th-degree leakage. In this intervention, the diameter of the vein in the groin area is decisive for treatment. Classical (conventional) stripping, Endovenous Laser or radiofrequency stripping, and vein gluing with medication (variclose) are treatment methods that can be applied.
In addition to these major vein treatments, sclerotherapy (injections with medication) or exolaser treatments can be applied for reticular veins or telangiectasias (spider veins) with a diameter below 4mm. The underlying major vein disease must be resolved first, or else sclerotherapy or exolaser will fail.