How to Prevent Varicose Veins

1. 
   Exercise regularly. Walking and jogging improve circulation in the legs, and proper circulation helps ward off varicose veins. Exercise also reduces overall high blood pressure and strengthens the entire circulatory system.
   
   
2. 
   Avoid prolonged standing. Standing in one place for a long time increases venous pressure in the legs and feet, and over time this pressure weakens the blood vessel walls. Since prolonged standing is almost unavoidable in some jobs, mitigate the harm by shifting your position as frequently as possible, and try to walk around at least every 30 minutes. If your job can be performed while sitting, see if you can arrange that.
3. 
   Maintain a healthy weight. If you’re overweight, you put excess pressure on your legs. Exercise regularly and develop healthy eating habits, and you’ll reap a whole host of health benefits, including reduction of your varicose vein risk.
4. 
   Quit smoking. Everybody knows that smoking contributes to myriad health problems, but if you need one more reason, keep in mind that the high blood pressure associated with smoking also helps cause varicose veins.
5. 
   Put your feet up for a while. Especially if you have to stand up for long periods, take time to relax your legs and improve circulation by elevating your legs and feet for several minutes throughout the day or when you finish your shift. With your doctor’s blessing, you might also try using an inversion table or elevating the foot of your bed so that your feet are slightly higher than your head when you sleep. Taking pressure off the legs and letting gravity act on your body a little differently from time to time will help prevent blood from pooling in the veins.
6. 
   Redesign your wardrobe. Improve circulation to your lower body by avoiding tight-fitting clothes on your legs and around your waist. Wear comfortable, low-heeled shoes instead of high heels, and make sure your shoes are properly fitted.
7. 
   Sit properly. Sit up straight and don’t cross your legs. Good posture improves circulation, while crossed legs restrict blood flow to and from the legs.
8. 
   Avoid high-estrogen birth control pills. Long-term use of high-estrogen birth control pills have been shown to increase the risk of varicose veins by altering circulatory valve functioning. If you require birth control for an extended period of time, ask your health care provider about other options.
9. 
   Wear compression hose. If you’re developing varicose veins, try regularly using compression hose (support hose). These can be purchased at medical supply stores or pharmacies and come in a variety of different compressions. Check with your doctor or pharmacist to make sure you get the proper fit and compression level.
10. 
    Consider medical options. While the steps above can help prevent the appearance of varicose veins, stop new ones from forming, and reduce the size and painfulness of existing ones, medical treatment may be advisable if you are in severe pain or if these less severe methods don’t work. Treatments include sclerotherapy, laser surgery, and vein stripping. Consult your physician to determine the best option for you.
    From **here

Oral Bacteria are a Possible Risk Factor for Valvular Incompetence in Primary Varicose Veins

Objectives

To investigate a possible link between valvular incompetence in primary varicose veins and chronic infection of periodontal disease by assessing the presence of oral bacteria in the great saphenous vein from patients with varicose veins and control subjects.

Material and methods

Forty-four primary varicose vein patients were enrolled in the study. 12 control saphenous veins were obtained from patients undergoing peripheral arterial bypass without clinical evidence of venous reflux. In total, 56 saphenous vein specimen (44 varicose veins and 12 control veins) were examined for 7 periodontal bacteria using a polymerase chain reaction (PCR) method.

Results

Of the 44 primary varicose vein patients, 31 patients were women and mean age was 59 years (range, 39–79 years). PCR examination of the diseased vein specimens showed that 48% were positive for at least one of 7 periodontal bacterial DNA. No bacteria were detected in the control specimens.

Conclusion

Bacterial colonisation or infection of varicose veins is a frequent event although we were not able to establish whether this is a cause or consequence of the development of varices but this could be considered a risk factor for the development of varices.

Keywords: Primary varicose veins; Valvular incompetence; Periodontopathic bacteria; Polymerase chain reaction

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Review Journal Varicose Veins

Abstract

This contribution discusses the epidemiology, aetiology, diagnosis and management of varicose veins. Reticular and thread veins are discussed briefly.

Keywords

compression hosiery; endovenous laser ablation; foam sclerotherapy; primary varicose veins; radiofrequency ablation; recurrent varicose veins; reticular; thread; vascular surgery

Author
Rebecca J Winterborn
Frank CT Smith


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Can laser be used to treat varicose and spider veins?

Cause varicose veins. Spider veins and small varicose veins can be treated with laser treatment applied from the surface of the skin. The laser applies an intense energy that essentially destroys the small blood vessels in the surface of the skin. Results are variable, and multiple treatments may be necessary to have some benefit. This is generally less invasive than sclerotherapy and vein stripping (no insertion of needles or catheters are required). Possible problems may involve a temporary discoloration of the skin. Larger varicose veins may be treated with endovenous (inside the vein) catheter ablation or laser surgery. This basically involves inserting a probe (or catheter) into the large vein in the lower leg (saphenous vein) and closing the vein by applying heat generated through laser. This technique has proven to be less painful, and it also has a faster recovery time compared to the vein stripping surgery.

What type of doctors provide treatments for varicose and spider veins?

Doctors providing surgical treatments (stripping and laser ablation) include general and vascular surgeons. Sclerotherapy and laser treatments are often performed by dermatologists. Some general, vascular, and plastic surgeons also perform sclerotherapy treatments. You may want to consult more than one doctor before deciding on a method of treatment. Be sure to ask the doctors about their experience in performing the procedure you want.

What are the side effects of these treatments?

A patient should carefully question the doctor about the safety and side effects for each type of treatment. Thoroughly review any "informed consent" forms your doctor gives you explaining the risks of a procedure. For surgical removal of veins, the side effects are those for any surgery performed under anesthesia, including nausea, vomiting, and the risk of wound infection. Surgery also results in scarring where small incisions are made and may occasionally cause blood clots.

For sclerotherapy, the side effects can depend on the substance used for the injection. People with allergies may want to be cautious. For example, Sotradecol may cause allergic reactions, which can occasionally be severe. Hypertonic saline solution is unlikely to cause allergic reactions. Either substance may burn the skin (if the needle is not properly inserted) or permanently mark or "stain" the skin. (These brownish marks are caused by the scattering of blood cells throughout the tissue after the vein has been injected and may fade over time). Occasionally, sclerotherapy can lead to blood clots. Laser treatments can cause scarring and changes in the color of the skin.

How long do cause varicose veins or spider vein treatment results last?

Many factors will affect the rate at which treated varicose veins recur. These include the underlying diagnosis, the method used and its suitability for treating a particular condition, and the skill of the physician. Sometimes the body forms a new vein in place of the one removed by a surgeon. An injected vein that was not completely destroyed by sclerotherapy may reopen, or a new vein may appear in the same location as previous one. Many studies have found that varicose veins are more likely to recur following sclerotherapy than following surgery. However, no treatment method has been scientifically established as being free from recurrences. For all types of procedures, recurrence rates increase with time. Also, because venous (vein) disease is typically progressive, no treatment can prevent the appearance of new varicose or spider veins in the future.

What Causes Varicose Veins?

What are varicose veins and what causes them? Maybe you or someone you know has this problem. Read on to find out more about this disorder.

What are varicose veins and who gets them? Well, you may have them yourself, but why? What causes varicose veins in the first place? Varicose veins are defined as swollen, distended veins, usually occurring in the legs. They are quite unsightly as I am sure you already know, but more than that, they can be painful. First we must know the normal functioning of the circulatory system. Arteries bring oxygen rich blood from the heart to the entire body. Then veins bring unoxyegenated blood back up to the heart. Under normal conditions, the actions of your leg muscles causing movement help circulate the blood through the veins and back toward the heart. But with varicose veins, the walls of the veins in the legs are weakened. Usually, these veins are superficial, or near the skin's surface where they protrude and are more easily visible. You also have tiny valves inside the veins, just as you have valves inside your heart. With varicose veins, the valves inside the veins are damaged and do not function properly. Gravity can then cause the blood to "pool" in the vein, which means the blood stays in the veins, becoming stagnant there and making them bulge out. Varicose veins can also occur in deeper veins under the skin. 

Varicose veins like these can lead to venous thrombosis, which is the medical term for a blood clot. When this occurs, circulation becomes poor. They may lead to swollen ankles, feet and legs, scaly, itchy skin, darkening of the skin, changes in temperature in the legs and feet and may even cause sores and ulcers on the skin to develop. These are called venous stasis ulcers. Blood clots in the legs can be dangerous. Symptoms of venous thrombosis, or blood clots in the legs include, but are not limited to swelling, redness and tenderness along a vein.

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The longer a person stands without moving, the more the blood pools in the veins. As more blood pools in the veins, the walls of the veins stretch. Symptoms of varicose veins are the appearance of bluish, soft, and sometimes tender lumps and bulging veins under the surface of the skin. These can be painful at times, but not always. Very tiny veins of the legs can also dilate. These are called spider veins because of the spider web pattern they form. They are actually not related to real varicose veins at all. 

It is suspected that varicose veins run in families. Simply looking at the legs for deep veins can make a diagnosis, a Venogram can be taken, which is an x-ray of the blood vessels. Doppler ultrasound may also be used to study the blood flow. This is less invasive than the venogram because for the venogram an i.v. must be started to inject dye and with the ultrasound it is simply like any other ultrasound, no needles are necessary. 

Treatment and prevention entail the following common sense, self help approach. Treatment includes raising your legs when sitting. This may help reduce the pain, swelling and may help prevent getting varicose veins at all. When sitting watching TV or reading or even at the computer, try to remember to put you feet up on a chair or footstool, the higher the better. This will help the blood to recirculate back into the body. Another thing that can be done is to get custom fitting support stockings. While they are not very attractive, you could wear them under pants and when at home. Prevention of varicose veins includes the following recommendations:

-take breaks from standing, especially if you have a job where you stand all day, mostly in one place. Raise your feet on a stool, one at a time, switch side and move around when you can. Walking is better than standing still all day. 

-wear your support stockings or pantyhose

-avoid wearing tight knee hose or knee socks, and tight girdles which all impair circulation.

-take short walks during the day, walk on your lunch break. Do calf pumping and make circles with your ankles during the day.

-avoid sitting with your legs crossed

-each day lie on the floor or bed near a wall. Put your feet up on the wall. Lie there for at least fifteen minutes each day. This will allow some or most of the blood that has pooled down in your legs to move out of the legs and back into the body. It is also very relaxing and destressing. Take a catnap or read a book while doing this exercise, if you like.

AP-1 Protein Causes Varicose Veins

Varices, commonly called varicose veins, are a cosmetic problem if they occur as spider veins but in their advanced stage they pose a real health threat. In those patients, the blood is no longer transported to the heart unhindered but instead pools in the veins of the leg because the vessel walls or venous valves no longer function adequately.

According to the German Vascular League, 30 million people suffer from minor vein-related symptoms, women are affected around twice as often as men. According to a health report published by the German government, 15 to 20 percent of the population has varicose veins.
 

Dr. Thomas Korff of University Hospital Heidelberg and colleagues write in The FASEB Journal that the pathological remodeling processes causing varicose veins are mediated by a single protein, the activator protein 1 (AP-1).

As a response to increased stretching of the vessel wall, the AP-1 transcription factor triggers the production of several molecules promoting changes in wall architecture, findings which may offer a possibility for using drugs to decelerate the formation of or even prevent new varicose veins. Previously, no suitable experimental systems existed for studying the way in which these changes in the cells of the blood vessels are controlled. For their studies, Korff and his team took advantage of the fact that blood vessels in the mouse ear are clearly visible and are also easily accessible for minor surgical procedures. In order to artificially set off processes that are similar to the formation of varicose veins, they tied off a vein with a thin thread. The elevated pressure in the vessels caused by the pooled blood led to the recognizable remodeling characteristic of varicose veins.

In addition, in the affected veins, the cell proliferation rate and the production of MMP-2 increased. The MMP-2 enzyme breaks down the non-cellular components of the connective tissue of the blood vessels. On the other hand, there were no signs of an inflammatory response, which can be observed during other vessel remodeling processes. "Nevertheless, the cellular mechanisms that control the formation of varicose veins appear to be similar to mechanisms that orchestrate the remodeling of arteries in patients with high blood pressure," Korff explains. The transcription factor AP-1 which regulates the activity of certain genes and thus the corresponding protein production is regulated by the filling pressure in the blood vessels and in turn controls the formation of varicose veins, Korff adds.

If AP-1 is inhibited, thus prohibiting it from activating genes, the characteristic corkscrew-like varicose veins do not form and cell proliferation and the production of enzymes that break down connective tissue remain at normal levels.

In a further experiment, the group showed that the results obtained in the mouse are also valid for humans. Varicose veins that have been surgically removed from patients exhibited the same cellular and molecular changes as the varicose veins created artificially in the mouse ear. Based on these results, Korff plans more studies. "Using our model, we can now more precisely analyze the early stages of the disorder and test possible drugs for their ability to prevent varicose vein formation, which, as a result, may improve the quality of life of afflicted patients.

Cause Varicose Veins video

Varicose and Spider Veins

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Varicose Veins

Varicose Veins

What are varicose and spider veins?

Varicose veins are abnormal, dilated blood vessels caused by a weakening in the vessel wall. They may appear as swollen, twisted clusters of blue or purple veins. Varicose veins are sometimes surrounded by thin, red capillaries known as spider veins (group of tiny blood vessels located close to the surface of the skin, also called telangiectasias).Varicose and spider veins can appear anywhere, but most often appear on the legs and in the pelvic area. Most varicose veins develop near the surface of the skin.

What are the symptoms of varicose veins?

Some people do not have symptoms but may be concerned about the appearance of the veins. If symptoms occur, they may include:

• Tiredness, burning, throbbing, tingling or heaviness in the legs
• Itching around the vein
• Swollen legs
• Muscle cramps, soreness or aching in the legs
• Brown discoloration of the skin, especially around the ankles
• Leg ulcers

Symptoms usually worsen after prolonged standing or sitting. In women, symptoms may be worse during menstruation or pregnancy. Occasionally varicose veins can form a painful blood clot, referred to as superficial thrombophlebitis (inflammation of a vein).

Who gets varicose and spider veins?

Varicose veins are common and are usually not a sign of a serious medical problem. Varicose and spider veins are seen more often in women than in men. They become more prevalent with age and have been reported to affect from 30 to 50 percent of the adult population. The incidence varies depending on the group of people who are studied.

What causes varicose and spider veins?

Varicose veins occur when healthy vein walls become weak and the vein enlarges. Blood can “pool” or collect inside the vein. Varicose veins are related to increased pressure in the leg veins or defective valves in the veins.

The exact cause of varicose veins is unknown, but there are a number of factors that contribute to the development of varicose and spider veins. Risk factors for varicose and spider veins include:

• Heredity or family history of varicose veins
• Advancing age
• Prolonged standing (especially for people who work in occupations such as nurses, beauticians, teachers, factory workers and others)
• Being overweight
• Hormonal influences during pregnancy
• The use of birth control pills
• Post-menopausal hormonal replacement therapy
• Prolonged sitting with legs crossed
• Wearing tight undergarments or clothes
• A history of blood clots
• Injury to the veins
• Conditions that cause increased pressure in the abdomen including liver disease, fluid in the abdomen, previous groin surgery, or heart failure

Other reported factors include topical steroids, trauma or injury to the skin, previous venous surgery and exposure to ultra-violet rays.

How are varicose veins diagnosed?

During a physical exam, the doctor will check your legs while you are standing. Your doctor also may request that you have a Doppler scan, an ultrasound exam to check the blood flow in the veins near the skin’s surface (called superficial) and the deep veins.

When is treatment necessary?

Varicose and spider veins may require medical treatment. If varicose veins make walking or standing painful, you should ask your doctor for advice. You also should call your doctor if a sore develops on or near a varicose vein or if your feet or ankles swell.

In some cases, varicose veins can be harmful to your health when they are associated with these conditions:

• Venous stasis ulcers that result when the enlarged vein does not provide enough drainage of fluid from the skin. As a result, an ulcer (open sore) may form.
• Fungal and bacterial infections may occur as the result of skin problems caused by fluid buildup (edema) in the leg. These infections also increase the risk of tissue infection (cellulitis).
• Thrombophlebitis: Inflammation of the vein due to blood clot formation.
• Venous hemorrhage: Bleeding in the vein.

Complications are more likely when varicose veins are the result of a problem or disease in the deep veins or in the perforating veins which connect the deep and superficial veins, such as deep vein thrombosis (DVT) or chronic venous insufficiency. Ask your doctor if you have an increased risk of developing any of these conditions.

What are the treatment options?

The goals of treatment are to reduce symptoms and reduce the risk of complications. Since not all varicose and spider veins require medical treatment, the goal of treatment may be simply to improve the appearance of the affected areas.

Compression therapy and lifestyle change

Wearing properly fitting support hose (also called compression stockings) is the most conservative approach for treating varicose veins, especially when the veins are symptomatic. Compression stockings can be purchased at some pharmacies and medical supply stores and come in various styles including below-the-knee, above- the-knee and pantyhose styles. They also come in different compressions varying from 8 to 10 mmHg, up to as high as 40 to 50 mmHg. Your doctor can recommend the compression that is right for you.

Other conservative treatment methods include:

• Practicing good skin hygiene
• Losing weight if you are overweight
• Exercising regularly (especially walking)
• Avoiding prolonged periods of sitting or standing
• Elevating your legs while sitting and sleeping

When you need to stand for long periods, take frequent breaks - sit down and elevate your feet.

If you do not achieve satisfactory relief of symptoms with conservative treatment, or if the appearance of the veins is bothersome, other treatments may be offered, depending on your overall medical condition and the size and location of the veins. Other treatment options include sclerotherapy, laser and light therapy, minimally invasive procedures and surgery. These techniques are described below.

Sclerotherapy

Sclerotherapy involves the injection of a solution directly into the varicose veins that cause them to collapse and disappear. Several sclerotherapy treatments usually are required to achieve the desired results. Foam sclerotherapy is a variation of the procedure performed under ultrasound guidance that involves the injection of a foaming agent mixed with a sclerosing agent. The foaming agent moves blood out of the vein so the sclerosing agent will have better contact with the vein wall. Sclerotherapy is a simple procedure that can be performed in the doctor’s office. Sclerotherapy can eliminate the pain and discomfort of varicose veins and helps prevent complications such as venous hemorrhage and ulceration. It is also frequently performed for cosmetic reasons.

Laser and Light Therapy

Laser and pulse-light therapy are used to heat the blood vessel to shrink it. Laser therapy is most effective for the treatment of small varicose veins and spider veins. Laser therapy may be used as an additional treatment after sclerotherapy, endovenous procedures, or surgery of larger veins. Lasers are also being used for endovenous ablation of larger varicose veins. Laser treatments may require several sessions, spaced at six-week intervals, to properly treat the vein.

High-intensity, pulsed light (photoderm or light therapy) is another treatment option. It is different than laser and pulse-light therapy because a spectrum of light is emitted during treatment, rather than a single wave-length. It can be used to selectively shrink abnormal veins including small spider veins, certain varicose veins and vascular birthmarks.

This treatment may be recommended when sclerotherapy or laser therapy does not effectively treat the vein or for patients who do not like needles.

Minimally Invasive Procedures

Endovenous thermal ablation therapy is a procedure that uses laser or high-frequency radio waves are to create intense local heat in the varicose vein. A tiny cut is made in your skin near the varicose vein (generally below the knee). Your doctor inserts a small catheter (tube) into the vein. A device at the tip of the catheter heats up the inside of the vein and closes it off. The technology is different with each type of energy source, but both forms of local heat close up the targeted vessel. This treatment closes off the problem veins but leaves them in place so there is minimal bleeding and bruising. You are awake during this procedure, but your doctor numbs the area around the vein. Compared with ligation and stripping, endovenous thermal ablation results in less pain and a faster return to normal activities, with similar symptomatic improvement and cosmetic results.

Micropuncture or micro-incision or stab phlebectomy is performed in an outpatient surgery center. The physician makes a tiny incision and uses a surgical instrument or a large needle to hook the problem vein through the opening. The vein is then removed a tiny piece at a time.

Transilluminated power phlebectomy is an enhanced version of stab phlebectomy and was developed to reduce the number of incisions, pain, bleeding and scarring. The procedure involves inserting a fiberoptic light under the skin while simultaneously injecting a mixture of saline and local anesthetic. This creates a silhouette of the veins to guide the surgeon in placing a powered tissue resector. This instrument cuts the vein into smaller pieces and suctions the pieces from the space.

Surgery

Surgery may be the best treatment when varicose veins are severe and associated with problems such as bleeding, or symptoms including pain or swelling. Several surgical treatments are available, including endoscopic options. Before choosing any treatment option, it is important to discuss the potential benefits, risks, and side effects with your health care provider. Surgical treatments are performed in the hospital or outpatient setting by a vascular specialist.

Ligation and stripping often are performed in combination. Vein ligation is a surgical treatment for varicose veins. In this minor procedure, a vascular specialist cuts and ties off the problem veins. Most patients recover in a few days and can resume their normal activities.

Stripping is the surgical removal of larger varicose veins through two small incisions. Stripping is a more extensive procedure and may require up to 10 days for recovery. It usually causes bruising for several weeks after surgery.

Will my insurance cover the cost of treatment?

Many insurance companies cover the cost of treating varicose veins, but generally not spider veins. Please check with your insurance company before considering a particular treatment option.

How can I prevent varicose veins?

• Avoid wearing tight-fitting undergarments and clothing that constricts the waist, groin or legs.
• Avoid crossing your legs while seated.
• Avoid sitting or standing in one position for prolonged periods of time.
• Exercise regularly to increase circulation.
• Lose weight if you are overweight.
• Sit or lay down and elevate your legs at least twice a day for 30 minutes at a time.

When should I call the doctor?

Call your doctor if:

• Varicose veins make walking or standing painful
• A sore or tender lump develops on or near a varicose vein
• You have swelling in the feet or ankles
• Your leg suddenly becomes swollen and painful
• Skin over a varicose vein bleeds on its own or when injured
• You have any other symptoms that cause concern

Who treats varicose and spider veins

Varicose and spider veins are treated by:

• Vascular Medicine Appointments: 216.444.4420
• Vascular Surgery Appointments: 216.444.4508

Cause Varicose Veins

Causes of varicose veins
Many theories exist for why varicosities occur in veins, but the consensus is that defective/damaged valves within the veins are to blame.Valves prevent backward flow of blood within the vein. They keep blood in the vein moving toward the heart. Why the valves stop working is up for debate.

• Some experts think inherited problems cause some people to have too few valves or valves that do not function properly.
• Some people may be born with abnormalities of the vein wall. The resulting weakness may predispose the valves to separate and become leaky.

The result is that when a person with poorly functioning valves stands up, the blood flow actually reverses and flows down the superficial veins, when it should be flowing up, toward the heart.

• When the muscles surrounding the deep veins contract, emptying the deeper veins, a build-up of pressure occurs.
• This causes even more blood to go the wrong way from the deep to the superficial veins through faulty valves in the perforator veins.
• This increases pressure in the superficial veins and causes varicosities.

Many factors can aggravate the situation.

• Pregnancy is associated with an increase in blood volume. Also, added pressure on the veins in the legs by the weight of the growing uterus and the relaxation effects of the hormones estrogen and progesterone on the vein walls contribute to the development of varicose veins during pregnancy.
• Prolonged standing
• Obesity or distended belly
• Straining: Chronic constipation, urinary retention from an enlarged prostate, chronic cough, or any other conditions that cause you to strain for prolonged periods of time causes an increase in the forces transmitted to the leg veins and may result in varicose veins. These mechanisms also contribute to the formation of hemorrhoids, which are varicosities located in the rectal and anal area.
• Prior surgery or trauma to the leg: These conditions interrupt the normal blood flow channels.
• Age: Generally, most elderly individuals show some degree of varicose vein occurrence.

Veins

Veins are blood vessels that return deoxygenated blood from the outer parts of the body back to the heart and lungs. When veins become abnormally thick, full of twists and turns, or enlarged, they are called varicose veins. Generally, the veins in the legs and thighs have a tendency to become varicose, cause of varicose vein

• The thickened, twisting or dilated parts of the vein are called varicosities.
• Varicose veins can form anywhere in the body, but they are most often located in the legs.
• In the United States alone, about 19% of men and 36% of women have varicose veins.
• Varicose veins tend to be inherited and become more prominent as the person ages.

Veins in the leg are either superficial or deep.

• The superficial veins and their branches are close to the skin. These veins typically become varicosed. Also included in this category are the communicator or perforator veins, which connect the superficial veins with the deep veins.
• The deep veins are encased by muscle and connective tissue, which help to pump the blood in the veins and back to the heart. The veins have one-way valves to prevent them from developing varicosities.
• Generally, blood travels from the superficial veins to the deep veins. From there, the blood travels through a network of larger veins back to the heart.