St. Joseph Hospital of Orange
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Varicose Veins

About 15% of all American adults eventually develop varicose veins. Varicose veins are abnormally and irregularly dilated veins (the blood vessels that return blood to the heart from the lower extremities and other regions of the body). The condition occurs four times more often in women than in men. The St. Joseph Hospital Vascular Institute provides a variety of services to help diagnose, prevent and treat this common condition.

The lower extremity veins have to work against gravity to return blood to the heart and lungs, and there are thin-walled, one-way valves to stop blood from flowing backward. Due to a variety of reasons, veins can lose elasticity over time. When this happens, they stretch, the valves become incompetent and blood that should move toward the heart may flow backward toward the feet. This abnormality is called venous reflux. As a result of this reflux, blood pools inside the veins causing them to enlarge and become visible. The signs and symptoms of venous reflux disease are frequently referred to as chronic venous insufficiency.

Dilated veins cause pain, and venous reflux in general causes leg/foot swelling and the sensation of achiness, heaviness and fatigue. The veins appear blue because they contain the deoxygenated blood. Pregnancy can also contribute to the emergence varicose veins. The hormones produced during pregnancy cause vein walls to relax and to dilate. This phenomenon in addition to increased blood volume leads to incompetent venous valves, venous reflux and varicose veins.

Besides pregnancy and age, obesity and standing for long periods of time can cause valvular dysfunction and venous reflux leading to varicose veins. In some cases, simple lifestyle modifications can help to relieve symptoms. Daily exercise, weight loss, compression stockings and avoidance of long periods of standing or sitting can improve symptoms related to varicose veins. However, if self-help measures don’t improve symptoms, there are several new options available to treat painful varicose veins as well as lower extremity fatigue, swelling and aching caused by reflux in the greater or lesser saphenous vein. These main superficial veins are deeper than the obvious varicose veins; however, they are the primary culprit that contributes to those unsightly varicose veins.

Risk Factors

Most people with varicose veins are between the ages of 30 and 60. Varicose veins develop slowly, but once they start, they usually continue to progress due to chronic untreated venous reflux.

Risk factors for varicose veins include:

  • Weakened vein walls- vein walls lose their elasticity with age. Venous reflux combined with this loss of elasticity leads to dilated, unsightly varicose veins.
  • Valvular incompetence– when veins become stretched the one-way valves can no longer keep blood flowing upward against gravity. This leads to reflux (backward flow of venous blood). Valvular incompetence may also be due to injury, blood clot or chronic inflammation.
  • Pregnancy - varicose veins can develop or worsen during pregnancy. This is due to increased pressure from the uterus on the pelvic veins, which hinders the flow of venous blood toward the heart, increased blood volume and changing hormones.

Signs & Symptoms

Signs and symptoms of venous reflux disease, or chronic venous insufficiency, include:

  • Aching and fatigue of the legs, especially when you sit or stand for extended periods
  • Leg and foot swelling that is essentially back to normal after sleeping
  • Veins that may bulge or appear twisted for a portion or entire length of your leg
  • The skin between the knee and ankle may become swollen, dry, irritated or discolored
  • Itching or eczema of the skin between the knee and ankle
  • A varicose vein can become engorged with blood and swollen, firm, red and tender. This process is call superficial thrombophlebitis
  • Although uncommon, varicose veins may bleed after being injured by a nick or cut
  • Non-healing open sores near the ankle associated with leg swelling

Screening and Diagnosis

The vascular specialist at the St. Joseph Hospital Vascular Institute will take a detailed venous history and examine your legs as a first step. Lower extremity ultrasound may also be performed to look for evidence of venous reflux caused by valvular dysfunction and to determine the primary cause of symptoms. The diagnosis, as listed below, will result from a thorough patient history, physical examination and expertly performed ultrasonography:

  • Spider veins and telangiectasias
  • Superficial thrombophlebitis
  • Varicose veins
  • Non-healing venous ulcers and severe skin changes
  • Leg swelling due to chronic venous insufficiency or lymphedema

Treatment

The St. Joseph Hospital Vascular Institute offers a variety of treatment options to improve symptoms and to correct the appearance of varicose veins. These are all designed to fit individual patient needs. Conservative treatment begins with the use of compression stockings and elevation of the affected leg as needed. More corrective options as listed below include the use of minimally invasive surgical techniques such as vein injections (sclerotherapy), vein closure using radiofrequency energy and varicose vein excision.

  • Sclerotherapy - during this office-based procedure medication is injected into varicose veins, which causes inflammation inside of the vein. This essentially causes the vein to close down so that it will not fill with blood and cause symptoms.
  • Radiofrequency Ablation(The Closure Procedure) – in this procedure, a catheter is inserted into either the greater or lesser saphenous vein. Transmitted electrical impulses are converted into heat at selected areas of the vein. This causes the vein to contract to such a point that reflux is eliminated and varicose veins that were attached to the main greater/lesser saphenous vein stop filling up with blood. The overwhelming majority of patients do not require additional varicose vein excision as the closure procedure is so effective. This technique is an outpatient procedure with rapid recovery, quick return to activities and little to no time off work.
  • Vein Excision in this procedure very small incisions are made over the varicose veins and the veins are gently pulled out using a micro-hook. This technique is an outpatient procedure with rapid recovery, quick return to activities and little to no time off work.