Varicose Veins Backgrounder
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1 What Are Varicose Veins? Varicose veins are a clinical presentation of superficial venous insufficiency a condition in which veins are inefficient in returning blood to the heart due to venous hypertension. 1,2 One-way valves that normally direct blood towards the heart are damaged or missing, and instead, some blood refluxes (moves in the opposite direction) and often pools in the vein. 1,2 Varicose veins are 3 mm or greater in width 3, appear twisted and cord-like, and tend to be blue to dark purple in color. 4, 5 What Is the Prevalence of Varicose Veins? In the United States, more than 30 million adults over 40 years old have varicose veins. Women are twice as likely as men to develop varicosities. 3 What Are the Causes of Varicose Veins? Varicose veins can be the result of a partially blocked vein (e.g., due to deep vein thrombosis [DVT]), failure of venous valves, calf-muscle pump dysfunction or a combination of these factors. 6 Failure of venous valves is the most common form of venous disease. 6 There are a number of risk factors that can contribute to the development of varicose veins, including 1 : Increasing age Obesity Female gender Pregnancy Being tall Lack of movement 4, (i.e., sitting or standing for a long time Family history of vein problems 5 History of DVT in the legs What Are Common Symptoms of Varicose Veins? Varicose veins may not cause any problems, or they may cause symptoms and complications that may lead to absenteeism, disability and decreased quality of life 3. Symptoms of varicose veins include 3 : Leg pain or aching Itchiness Heaviness Tingling Restless legs Edema or swelling Cramps Skin changes Throbbing Ulcers Fatigue Last Update: April 2014 pg. 1
2 What Are the Consequences of Untreated Varicose Veins? Untreated varicose veins tend to worsen over time and can lead to hemorrhage (in rare cases, fatal hemorrhage), thrombophlebitis, deep vein thrombosis and venous ulcers Approximately 500,000 patients in the United States have venous ulcers, 13 and physical impairment seen with venous ulcers is comparable with that of congestive heart disease and chronic lung disease. 14 In the United States, chronic venous ulcers cost approximately $2 billion per year due to lost wages. 15 Why Do Varicose Veins Go Untreated? Although the prevalence of varicose veins, or venous disease, is more than twice that of peripheral arterial disease (PAD), 16, 17 most vascular surgical practices are better equipped to care for PAD, with less attention placed on venous disease. 18 The lack of treatment for venous disease may be due to the perception that varicose veins are primarily a cosmetic issue. 3, 19, 20 However, varicose veins are a real medical concern that often requires treatment. How Are Varicose Veins Treated? Superficial venous insufficiency (SVI) and varicose veins can be managed and treated in a variety of ways. Conservative measures to manage the symptoms of varicose veins include compression stockings and avoidance of long periods without movement. More invasive treatment options include surgery or ablation. If you think you may be experiencing symptoms caused by SVI and varicose veins, it is important to talk to your doctor, who can diagnose your condition and determine which treatment plan is appropriate for you. How Are Varicose Veins Treated? Superficial venous insufficiency (SVI) and varicose veins can be managed and treated in a variety of ways. Conservative measures to manage the symptoms of varicose veins include compression stockings. Last Update: April 2014 pg. 2
3 References: 1. National Institutes of Health. Venous insufficiency. MedlinePlus website. Accessed April (Page 1 of PDF, paras 1 & 3.) 2. Whiddon LL. Advances in the treatment of superficial venous insufficiency of the lower extremities. Proc (Bayl Univ Med Cent). 2007;20: Gloviczki P, Comerota AJ, Dalsing MC, et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011;53(5 suppl):2s-48s. 4. U.S. Department of Health and Human Services, Office on Women s Health website. Varicose veins and spider veins fact sheet. fact-sheet/varicose-spider-veins.pdf. Accessed April Mayo Clinic website. Varicose veins. Accessed April Fronek H. Fundamentals of Phlebology: Venous Disease for Clinicians. 2nd ed. London, England: RSM Press; Sarin S, Shields DA, Farrah J, Scurr JH, Coleridge-Smith PD. Does venous function deteriorate in patients waiting for varicose vein surgery? J R Soc Med. 1993;86: Byard RW, Gilbert JD. The incidence and characteristic features of fatal hemorrhage due to ruptured varicose veins: a 10-year autopsy study. Am J Forensic Med Pathol. 2007;28: Pulliam CW, Barr SL, Ewing AB. Venous duplex scanning in the diagnosis and treatment of progressive superficial thrombophlebitis. Ann Vasc Surg. 1991;5: Chengelis DL, Bendick PJ, Glover JL, Brown OW, Ranval TJ. Progression of superficial venous thrombosis to deep vein thrombosis. J Vasc Surg. 1996;24: London NJ, Nash R. ABC of arterial and venous disease. Varicose veins. BMJ. 2000;320: Nicholls SC. Sequelae of untreated venous insufficiency. Semin Intervent Radiol. 2005;22: Rhodes JM, Gloviczki P, Canton LG, Rooke T, Lewis BD, Lindsey JR. Factors affecting clinical outcome following endoscopic perforator vein ablation. Am J Surg. 1998;176: Carradice D, Mazari FA, Samuel N, Allgar V, Hatfield J, Chetter IC. Modelling the effect of venous disease on quality of life. Br J Surg. 2011;98: Sen CK, Gordillo GM, Roy S, et al. Human skin wounds: a major and snowballing threat to public health and the economy. Wound Repair Regen. 2009;17: Brand FN, Dannenberg AL, Abbott RD, Kannel WB. The epidemiology of varicose veins: the Framingham Study. Am J Prev Med. 1988;4: Al Mahameed A. Peripheral arterial disease. Cleveland Clinic Center for Continuing Education website. Accessed April Passman MA, Dattilo JB, Guzman RJ, Naslund TC. Impact on physician workload and revenue following the creation of a specialty vein clinic within an academic vascular practice. Phlebology.2007;22: Last Update: April 2014 pg. 3
4 19. Dean M. London Perspective: End of a comprehensive NHS? [News & Comments]. Lancet. 1991;337: Mason H, Baker R, Donaldson C. Understanding public preferences for prioritizing health care interventions in England: does the type of health gain matter? J Health Serv Res Policy. 2011;16: Biocompatibles, Inc., a BTG International group company All rights reserved. US-VAR /14 BTG and the BTG roundel logo are registered trademarks of BTG International Ltd. Last Update: April 2014 pg. 4
5 Last Update: April 2014 pg. 5
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