VARICOSE VEINS

Varicose Veins :: Travellers Clots DVT
Spider Veins :: Superficial Thromboplebitis

What are the varicose veins?

Normally, blood is pumped out of the legs back towards the heart, and this is mainly by the leg muscles squeezing blood up the veins as the muscles contract and relax with movement. Normal veins have a series of “trapdoor” valves that open as the blood flows up but close when the blood falls back down (as the muscles relax). In varicose veins, these valves have been damaged, so the valve does not close properly. This allows the blood to fall back down through the valve. As a consequence, blood return is sloppy. Being a heavy fluid, a long column of blood such as in a varicose vein, will stretch the vein causing it to become dilated and tortuous. Hence the typical appearance of a varicose vein.

Varicose veins do not occur in the arms. They can occur in the pelvis, but nearly always they are limited to the legs.

Most of the blood returning from the leg does so via the deep system, which is deep within the leg and not visible. The veins under the skin can expand and contract, to allow for temperature changes. That's why ordinary veins stand out on a hot day....they have dilated to allow the body to lose heat. That's also why varicose veins tend to ache more on hot days.

When a muscle contracts, the valve opens. Blood is squeezed up the vein.		When a muscle relaxes, the valve closes, holding the blood in place.		In a damaged vein, the blood can move in both directions.

SYMPTOMS OF VARICOSE VEINS

Often there are no symptoms at all, even when there are complications from the varicosities. However, symptoms are related to the weight of the column of blood, so tend to be prominent after prolonged standing, and relieved by elevating the leg. Thus it is very unusual to have symptoms in bed, except possible nocturnal cramps in the affected leg.

The veins dilate on hot days, so we can lose body heat. Hence the symptoms tend to be worse on hot days.

Women also have more fluid circulating in their blood stream before their period, which explains why they often note more discomfort in their legs during the week before their period. The same situation with extra fluid occurs during pregnancy. This is compounded by the extra hormones actually affecting the blood vessels, as well as the back pressure caused by the baby squashing veins in the pelvis. Some women can develop very uncomfortable varicose veins in their genitalia during pregnancy (vulval varicosities). They usually improve or settle after delivery, and are easily treatable if they persist.

Typical symptoms are:

• Heavy tired legs when standing, particularly by the end of the day
• Aching calf, or area over a visible vein
• Itching skin or eczema, often in the area of a varicose vein
• Patchy brown spots over lower leg
• Leg swelling
• Leg ulcers, usually on the inner aspect of the lower leg
• Tight shiny thin skin about the ankle area
• Leg cramps in bed

TRAVELLERS CLOTS

Also known as “Economy class syndrome”. This is a bad term as they can occur in first class, in buses, or in fact any prolonged travel over 4hrs. Travel is not the only factor, as they can occur with prolonged squatting as with gardening. They also can occur after any surgery, although some operations are more of a concern than others. In fact, there is probably more leg movement in economy class as the seating is so uncomfortable. There are also recognized risk factors (see below).

These clots are in the veins deep inside the leg, and are known as Deep Vein Thrombosus (DVT). They are potentially lethal, as they can break off and travel along with the blood stream and lodge in the lungs. Most patients survive however.

It is not known whether travelers clots differ from post-operative clots. Walking and compression knee length stockings are the only proven beneficial factors. Although unproven, drinking lots of fluids to prevent dehydration might help and makes sense.

We have special sox available that have graded sequential pressures so that they act as pumps to minimize blood stagnating in the legs.

Risk factors for DVT
Previous DVT
Recent surgery
Recent trauma to the leg
Family history of DVT
Oral contraceptives
Known hereditary clotting tendencies

SUPERFICIAL THROMBOPHLEBITIS

This describes a condition where a vein under the skin becomes inflamed and develops a small clot. The inflammation prevents the clot from moving, so they are by themselves not dangerous. A leg vein becomes red, swollen, lumpy, and very tender. If you develop a superficial thrombophlebitis, see your doctor immediately, as he or she can evacuate the clot under local anaesthetic giving instant relief and a speedy recovery. This can only be done within 48hrs of onset of symptoms. Otherwise it will take weeks and weeks to recover.

If you have recurrent superficial thrombophlebitis, you need an urgent duplex ultrasound of both legs as there is an associated risk of a DVT.