Varicose veins in the legs: causes, symptoms and treatment

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Varicose veins occur in people of diverse ages and situations. We invited the vascular surgeon Dr. Rodrigo Bono Fukushima to discuss this subject

Varicose veins of the lower limbs are veins that become dilated, tortuous, visible and palpable over time. Varicose veins affect approximately 40% of the population, being more prevalent in women — for each man with varicose veins, it is estimated that there are 4 women with varicose veins.

The main cause for varicose veins of the lower limbs is genetic; that is, the person has the tendency inherited from family members. Some environmental factors and day-to-day habits can accelerate or even initiate the appearance of varicose veins.

The main causes are:

—Genetic predisposition / family history

—Overweight

—Routine use of inappropriate footwear

—Sedentary lifestyle

—Long periods of sitting or standing without moving

—Use of hormones (contraceptives and hormone replacement at menopause)

—Pregnancy

Main symptoms

The disease evolves over years, worsening if no treatment is performed. Initially, the patient presents with discrete varices, often almost imperceptible and without symptoms. Over time, these veins dilate, become larger and more apparent and other symptoms may arise. The most common symptoms:

—Weight and tiredness in the legs

—Pain in the legs

—Itching (pruritus) in the legs

—Cramps

—Constant feeling of leg fatigue

—Tingling in the legs and feet

—Swelling (edema) mostly at the end of the day

—Loss of hair on lower limbs

—Darkening of lower limbs

—Appearance of lower limb wounds

Complications caused by leg varicose veins

In more advanced stages of varicose veins, the skin begins to look thinner and brighter. Dark spots, known as ocher dermatitis, begin to appear. Over time, these spots enlarge, affecting the entire ankle and foot.

This thinner skin is extremely fragile, and minor trauma or just scratching the leg vigorously can cause sores. As the venous pressure is increased with the varicosities, the healing process is greatly impaired and these small wounds can progress to extensive, deep, and painful ulcers.

When left untreated for a long period, varicose veins can cause constant leg swelling, dark spots on the ankle (“ocher dermatitis”) and wounds that are difficult to heal, called varicose ulcers.

Eventually, the varicose veins may bleed—either spontaneously or due to small local trauma—since, over time, the skin over these enlarged vessels becomes thin and fragile. Other complications include superficial thrombophlebitis and deep venous thrombosis, or clot formation within the vessel itself.

Treatment

There are several treatments for varicose veins of the lower limbs. The ideal treatment depends on the degree of the varicose veins and the symptoms.

Treatment is carried out with the use of compression therapy (elastic stockings) and the regular practice of physical activity, with leg strengthening exercises. Healthy eating habits and weight management are also recommended.

For patients who present with varicose veins and telangiectasias (fine, superficial vessels), treatment can be performed with sclerotherapy. The goal is to cause injury to the vein, leading to its reabsorption into the body. With this process, a small fibrosis forms and the disappearance of the vein occurs along with aesthetic improvement. This treatment is performed in the office, without the need for surgery or hospitalization. Over the years, different techniques and medications were developed with this objective.

Sclerotherapy techniques

Sclerotherapy with hypertonic glucose

It is among the best known and most frequently performed techniques in Brazil. It consists of the injection of glucose into the treated vessels; causing injury to the vessel wall and local inflammation. As a result, the vein is reabsorbed by the body and is no longer visible. The technique is suitable for the treatment of telangiectasias, but it does not give satisfactory results for reticular veins (“feeder veins”) or for small varicose veins.

Laser sclerotherapy (CLaCS – Cryo-Laser and Cryo-Sclerotherapy)

This technique consists of the application of transdermal laser and 75% glucose, in one procedure, guided by augmented reality. Throughout the procedure, the skin is cooled to -32° C (-25° F). The procedure is performed using an augmented reality apparatus, which improves the visualization of the vessels and allows more precision in the treatment. The combination of these two techniques potentiates the efficacy, allowing the treatment of larger caliber veins, with faster and longer-lasting results.

Sclerotherapy with foam

Consists of injecting a medicated foam (polidocanol) into the vessels to be treated.

Surgical treatment

For patients with large varicose veins and advanced disease, surgical treatment is needed. The surgical treatment of varicose veins has evolved over the years. Currently the procedure is performed with minimally invasive techniques, making it safer, with faster recovery.

About the author

Dr. Rodrigo Bono Fukushima

 

Dr. Rodrigo Bono Fukushima practices in the Higienópolis district of São Paulo (SP). He graduated from the Faculty of Medicine of the University of São Paulo,  and is certified by the Brazilian Medical Association and the specialty societies in Vascular and Endovascular Surgery, Angio-radiology and Vascular Ultrasound.

Esta postagem também está disponível em: Portuguese (Brazil)

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