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SVS: When do varicose veins need medical attention?

ROSEMONT, Ill: Most of the millions of people with varicose veins don't consider them a medical issue, unless they happen to be painful, achy or inflamed.

But varicose veins are a kind of chronic venous insufficiency (CVI) and at the upper end of the spectrum, according to the Society for Vascular Surgery, this is a painful, chronic disease that needs regular medical attention.

What is CVI? Leg veins have one job to do - carry oxygen-depleted blood from the feet back up to the heart to get more oxygen. To keep blood going up, healthy veins have one-way valves that prevent blood from flowing back down. In people with CVI, those valves fail to work well, and blood pools in the ankles and feet.

Risk factors for CVI include

having previously had a deep vein blood clot
a job that required lots of standing or sitting
obesity
several pregnancies
a current or previous smoking habit
family history of CVI
advanced age

Healthy younger people can have those risk factors and not have CVI. But for those whose vein valves are insufficient, decades of sluggish blood movement start adding up as they age.

One of the most noticeable differences between varicose veins that cause no symptoms and those that do, is that feet and ankles may swell and ankle skin may change color or texture. In about 3 percent of people with CVI, the condition will begin to cause open sores.

In the body, explained vascular surgeon Dr. Ulka Sachdev of the University of Pittsburgh, who researches CVI, blood is supposed to efficiently leave the legs after oxygen is delivered, but when it stays, protein comes out of blood vessels and settles in the skin, which is then no longer normal.

Those who notice these changes should discuss them with a doctor, and consider being evaluated by a board-certified vascular surgeon who treats venous diseases. That does not mean surgery is required, but likely will assure that the condition is treated conservatively. Seeing the right doctor at the right time may improve the condition.

In its advanced stages, Dr. Sachdev, says, CVI can be a heartbreaking illness. You never want to get a venous ulcer, because of the longstanding and recurring nature. The ulcers can be very large and wet. They smell bad, are painful and can take a year to heal.

For many of her clinic's CVI patients, she said, their lives revolve around their discomfort. Many must travel twice a week to the clinic for specialized compression bandages and evaluation for possible interventions.

Constant pain can cause sleepless nights and fatigue. Excess movement might dislodge bandages or cause them to leak, so patients avoid social events. Some can't wear regular shoes and are embarrassed by their appearance.

There is a huge psychological component for them, Dr. Sachdev said. They become isolated and depressed.

Recent research, however, may offer a ray of hope to CVI patients, she said. Endovenous ablation of refluxing superficial veins has now been shown to help speed up time to venous ulcer healing so there is a role for more invasive treatment beyond just compression.

Make a doctor's appointment if you have these symptoms

Varicose veins around the ankles
Swelling in legs or ankles
Skin changes around the ankles, especially tight and/or fibrous skin, or darkening skin
Leg cramps or spasms
Painful, open sores on ankles or legs

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SVS: When do varicose veins need medical attention?


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