The Vain Truth: Varicose Veins

Varicose veins are enlarged, swollen veins, usually found in the legs, but can occur anywhere in the body. Some of them are obvious to spot as they lie just below or on the surface of the skin. There are also deeper lying varicose veins which you cannot see, but cause problems nonetheless.

Around 20% of women and 10% of men have varicose veins. These clients are going to ask you for assistance, not only because varicose veins are unsightly, but they are also painful and even dangerous.

What causes varicose veins?

In a normally functioning vein, blood is forced to move back towards the heart. Tiny valves found every few centimeters along the inside of each vein prevent blood flowing backwards.  Varicose veins develop when these valves are damaged, causing blood to pool in the affected areas. The veins then swell, causing further damage and worsening enlarged veins.

Know your varicose veins

Not all varicose veins are the same. You will need to know some of the different types to recommend the right treatment:

Thread or “spider” veins. These are tiny reddish-blue thread-like veins which your client will complain about for cosmetic reasons.  They don’t always indicate a serious underlying problem.

Blue, Green Reticular Veins: These are slightly enlarged blue veins which more often than not progress to become larger over time. Clients with this type of varicose vein will often complain of pain.
Bulging Varicose Veins: These are very large veins always associated with deeper lying varicose veins. They often are not associated with severe symptoms, despite their size.

Common Complaints

Your clients could complain that their varicose veins are causing:

• Pain, aching and cramping, even during the night.
• Ankle swelling, especially after standing for long periods.
• Skin discolouration: Red, blue veins and later scarring patches may appear
• Itchiness: Sometimes clients will scratch their skin so much that it causes bleeding, ulcers and scarring.

“Why me?” your client may cry

• Genetics: As with most conditions, if your client has parents with the condition, they’re at higher risk. However, many people develop them without any family history.
• Local injury: Damage to a leg (for example being hit on the leg by a hockey ball) can damage the veins.
• Pregnancy: The hormones, additional circulating blood volume and extra weight carried by women during pregnancy, often leads to the development of varicose veins.
• Previous blood clot (deep vein thrombosis): A blood clot in the veins can lead to damage to the internal valve system, leading to varicose veins.
• Overweight/obesity: Increased abdominal girth puts more pressure on the vessels returning blood to the heart, leading to widening and damage of the vessels in the legs.

Why are they a problem?

Varicose veins can cause some unpleasant and dangerous complications:

• Blood clots: Also know as deep vein thromboses (DVT) are more likely to form in legs in which the venous drainage is not working adequately. DVTs dislodge from the leg and shoot up into the heart, leading to a clot in the lungs (pulmonary embolism). People often die if this complication occurs.
• Restless legs syndrome: While there are other causes of restless legs syndrome, varicose veins and poor circulation is a known risk factor. Clients will complain about pain in their legs in the evening or night which is relieved by movement.
• Disability: Varicose veins can make it difficult for those affected to work, especially in positions which require long hours of standing such as teaching, training, nursing etc.
• Skin ulcers: Poor circulation over the site of the varicose veins can lead to serious skin ulcers which can take many months to heal.
• Severe bleeding: The fragile and enlarged veins are prone to bleeding when the leg is bumped or scratched.

Over-the-counter advice

You can advise your clients with varicose veins to:

• Use compression stockings. These are specialized tight fitting stockings which, by squeezing the legs, help to stop pooling of blood in the legs. They help to alleviate symptoms of varicose veins, prevent deep vein thrombosis and slow down worsening of the condition. Compression stockings come in different strengths, a grade II normally being used for varicose veins. Make sure your client sees their doctor to ensure that it is safe for them to use compression stockings. In clients with arterial disease, these stockings can cut off their blood supply. Clients who already use compression stockings should replace them every 6 to 8 months.
• Relax and put your legs up: Get your clients to prop their legs up above the level of their head while seated or lying down (usually putting a pile of cushions under their feet does the trick). This helps drain blood from the legs and alleviates symptoms.
• Exercise: The movement of muscles in the legs during exercise can help to boost circulation and improve their symptoms. Some simple walking would be a good place to start.
• Supplements: There is some evidence that herbal supplements with horse chestnut (Aesculus hippocastanum ) can help tighten the veins and improve blood circulation. Horse chestnut works as a diuretic and so really helps to treat leg swelling (oedema) rather than the varicose veins themselves. Make sure your client does not have any kidney or liver problems, pregnant or breastfeeding while taking this supplement.

At the doctor’s office

Treatment for varicose veins includes numerous options nowadays. You can advise your clients that most procedures are done in the doctor’s rooms under local anaesthetic and include:

• Sclerotherapy: Using very small needles, the doctor injects a combination of local anaesthetic along with saline into the varicose veins. The treatment is done in the doctor’s rooms and takes 60 to 90 minutes. The injected solution makes the vein walls stick together, blocking any further blood flow. Sometimes up to six sessions of sclerotherapy are needed to effectively remove varicose veins. Recurrence is unlikely after a few cycles of treatment.
• Laser therapy:  Laser energy is directed over the affected veins. For smaller veins, laser therapy destroys the varicose veins without causing scarring. For larger varicose veins, a probe is inserted into the vein and the laser energy is directed at the vein from the inside. Both of these procedures are usually done in the doctor’s rooms.
• Radiofrequency ablation: Similar to laser therapy, but radiofrequency energy is used instead to destroy the varicose veins. This is also done in the doctor’s rooms under local anaesthetic.

Surgical treatments:

For some people with larger or recurring varicose veins an operation will be required to treat them. Depending on your client’s overall health, the procedure can be done in-hospital or as an outpatient.

Vein stripping: Under sedation and anaesthetic, a small cut is made in the skin and the varicose vein is followed to where it joins up with the larger, deeper vein in the groin area. At this point it is tied off and then the varicose vein is removed.

Caring for your customer

While the treatments to manage varicose veins are becoming more sophisticated, the condition remains as common as ever before. Varicose veins are not just about vanity as they can lead to serious complications. Clients will ask whether there is any pill, lotion or potion which can make their veins vanish. Unfortunately your advice is probably the best over-the-counter treatment available. Do advise your clients to make appropriate lifestyle changes and have their veins checked by a doctor.