Symptoms and diagnosis of varicose veins

 

It's okay in the morning, but after standing all day at work, my legs feel heavy in the evening, and in severe cases, my legs swell so much that I can't even put on shoes. I think my leg veins look a bit prominent; could it be varicose veins? This is a common question asked by patients visiting the outpatient clinic. To answer first, it is unlikely to be varicose veins now, but there is a high possibility that it could develop into varicose veins later.

Varicose veins refer to the condition where superficial veins in the legs become enlarged to 3 mm or more. Generally, dysfunction of the valves in the major superficial veins, such as the great saphenous vein draining into the deep veins in the groin area, the small saphenous vein in the popliteal region, or the perforating veins in the calves, occurs. This dysfunction causes blood to flow backward, leading to dilation of the blood vessels in the calf area. In other words, valvular insufficiency of the leg veins is the main cause.

 

Varicose veins caused by valve insufficiency tend to occur frequently and worsen especially in elderly women, those who have given birth, are obese, or have jobs that require standing for long periods. If left untreated, they can worsen and lead to pigmentation, swelling, and leg ulcers, so treatment is essential. Prevention is particularly important for individuals with risk factors.

 

Based on the symptoms and diagnosis

 

Most patients visit the hospital due to enlarged blood vessels in the calf area, but when valve insufficiency is present, various symptoms may occur. Symptoms of venous valve insufficiency include leg pain, cramping, fatigue, dull pain, burning sensation, heaviness, and more. Additionally, issues related to the musculoskeletal system, nervous system, or arterial system can also cause similar symptoms, so consultation with a specialist is necessary. When venous varicose veins are suspected, confirming valve insufficiency is the most important step.

Generally, reflux in the great saphenous vein, small saphenous vein, or perforating veins is confirmed through Doppler ultrasound, and if there is dilation of branch veins, a diagnosis is made and the treatment plan is determined. Even if symptoms are present only in one leg, ultrasound examinations are performed on the opposite side without lesions. At this time, even if there is valvular insufficiency, treatment is not necessary if there are no symptoms. However, it is important to keep in mind the potential for progression to varicose veins.

 

Treatment

 

When varicose veins of the lower limbs caused by valvular insufficiency are diagnosed, the treatment goal is to alleviate symptoms, prevent disease progression, and remove the enlarged veins. Generally, treatment can be divided into conservative and active approaches, and the choice depends on the patient's condition and circumstances.

For conservative treatment, it is recommended to correct lifestyle habits and wear compression stockings during the day. This is to prevent continuous pressure on the superficial veins caused by reflux in the great saphenous vein, small saphenous vein, or perforating veins. Avoid sitting or standing for long periods, and elevate your legs to a height close to the heart during rest. Elevating the legs during sleep can also be helpful, but it may cause back pain and discomfort, so it is recommended to simply lie down in a comfortable position. Compression stockings come in various sizes, so they should be tight enough to be elastic on the legs and should not be easily pulled away by hand when worn.

 

If conservative treatment is ineffective or interferes with daily life, active treatment is necessary. This involves removing or bypassing the refluxing great saphenous vein, small saphenous vein, and perforating veins caused by valve insufficiency to alleviate symptoms.

 

Generally, the causative vein is removed through surgery, but recently, methods that induce sclerosis of the affected blood vessels using radiofrequency or laser without skin incision have become preferred to block reflux. Radiofrequency or laser treatments have the advantage of producing effects similar to surgery while causing less pain and fewer complications, but they also have the disadvantage of being more expensive compared to surgery. In addition, there are various treatments using sclerotherapy or adhesives, but these can only be used in limited cases.

Prevention and Management Methods

Varicose veins frequently occur in people with jobs that involve standing or sitting for long periods, so prevention and management are important. The most effective method is to wear compression stockings that fit the size of your legs. If possible, it is recommended to wear them from the moment you wake up in the morning until just before bed, and if it is difficult, be sure to wear them when sitting or standing in one place for a long time.

 

In particular, if compression stockings are folded or wrinkled, excessive pressure may be applied to certain areas, causing adverse effects. Therefore, they must always be worn smoothly and correctly without wrinkles. Additionally, when standing or sitting, it is advisable to move your legs as much as possible to encourage blood flow upward through the leg muscles.

 

Additionally, foot baths or half-body baths should be avoided as they induce venous dilation and can worsen reflux. Above all, when there are abnormal symptoms in the legs, it is important to consult and manage with a vascular surgeon.

 

I also studied about varicose veins, which I was worried about.

They say it's not good to walk too much or not to move enough.

I think it's good to exercise moderately and promote good blood flow.