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Varicose Veins

Varicose veins the most common vein disorder affect approximately 40 million Americans. They are large twisted veins usually in the legs and feet that are not transporting blood effectively. They appear as bulging bluish cords beneath the surface of your skin. If ignored varicose veins can cause not only discomfort and cosmetic concerns but also serious complications such as phlebitis (inflammation of the veins) skin ulcers and blood clots.

Signs and Symptoms

Varicose veins are accompanied by the following signs and symptoms.

bulletProminent dark-blue blood vessels especially in the legs and feet (not spidery -looking veins)
bulletAching tender heavy or sore legs
bulletSwelling in the ankles or feet especially after standing
bulletBreaks in the skin
bulletSuperficial blood clots
bulletBleeding after a minor injury (rare)

What Causes It?

Varicose veins develop when your veins stretch and their valves which prevent back flow of blood fail. Primary varicose veins result from weakness in the walls of the veins. Secondary varicose veins are most often caused by problems with veins lying deep among the muscles which carry about 90 percent of the returning blood. These problems include blood clots and the resulting diversion of blood flow into other superficial vessels.

Who's Most At Risk?

People with the following conditions or characteristics are at risk for developing varicose veins.

bulletFamily history (accounts for 50% of cases)
bulletFemale (three times more common)
bulletHormonal changes related to pregnancy premenstrual period and menopause
bulletStanding for long periods
bulletObesity
bulletTumors
bulletCertain diseases
bulletArteriovenous fistulas (abnormal blood flow between arteries and veins)

What to Expect at Your Provider's Office

If you are experiencing symptoms associated with varicose veins you should see your health care provider. He or she will conduct a physical exam and also may perform tests to determine how well your veins are functioning and to distinguish between primary and secondary varicose veins. Imaging procedures may also be used.

Treatment Options

Prevention

Regular exercise improves vein functioning and weight loss and exercise decrease the likelihood of blood clots.

Treatment Plan

Conservative treatment may be all that is needed. This may involve avoiding prolonged sitting standing or walking; getting regular exercise; elevating your legs on a periodic basis; and wearing compression stockings.

Surgical and Other Procedures

bulletSclerotherapy—injection of a solution into a varicose vein followed by application of a compression dressing in order to obliterate the vein
bulletRadiofrequency ablation—a new technique in which a catheter is threaded into the varicose vein to heat the vein wall in order to obliterate the vein and improve the function of its valve
bulletSurgery—removal of the varicose vein

Complementary and Alternative Therapies

A comprehensive treatment plan for varicose veins may include a range of complementary and alternative therapies.

Nutrition

Eat foods rich in dietary fiber in the form of complex carbohydrates (whole grains) and bioflavonoids (dark berries dark leafy greens garlic and onions).

Potentially beneficial nutrient supplements include vitamin C (500 to 1 000 mg three times per day) vitamin E (200 to 600 IU per day) and zinc (15 to 30 mg per day).

Herbs

Herbal remedies may offer relief from symptoms. Herbs are generally available as dried extracts (pills capsules or tablets) teas or tinctures (alcohol extraction unless otherwise noted). Dose for teas is 1 heaping tsp. per cup of water steeped for 10 minutes (roots need 20 minutes).

bulletHorse chestnut (Aesculus hippocastanum) 500 mg three times per day or standardized Aescin 10 mg three times per day
bulletButcher's broom (Ruscus aculeatus) standardized extract (9% to 11% ruscogenin) 100 mg three times per day
bulletGotu kola (Centella asiatica) 1 000 mg two to four times per day or standardized extract (asiaticoside 40% Asiatic acid 30% madecassoside 1% to 2%) 60 mg one to two times per day
bulletBilberry (Vaccinium myrtillus) standardized extract (25% anthocyanoside) 80 to 160 mg three times per day

Combine the following in equal parts: yarrow (Achillea millefolium) hawthorn (Crataegus monogyna) ginkgo (Ginkgo biloba) marigold (Calendula officinalis) horse chestnut (Aesculus hippocastanum) and ginger (Zingiber officinalis). Take 30 to 60 drops tincture two to three times per day or drink three to four cups of tea daily.

Homeopathy

Some of the most common remedies include Aesculus Fluoricum acidum Hamamelis and Secale. Acute dose is three to five pellets of 12X to 30 C every one to four hours until symptoms are relieved.

Physical Medicine

Cold compresses of witch hazel (Hamamelis virginiana) and yarrow (Achillea millefolium) tea may provide temporary relief.

Acupuncture and Massage

Acupuncture and massage may help improve the overall circulatory system.

Prognosis/Possible Complications

Varicose vein disease is a chronic condition and new varicose veins often develop after treatment.

Following Up

Walking after sclerotherapy is important to help promote healing.

If you've had surgical treatment contact your health care provider if you develop severe pain tenderness swelling scabs or blisters.

Supporting Research

Bergan JJ Yao JST. Venous Disorders. Philadelphia PA: Saunders; 1991: 201–215.

Blumenthal M ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston Mass: Integrative Medicine Communications; 1998:99 149 432.

Branch WT Jr. Office Practice of Medicine. 3rd ed. Philadelphia PA: Saunders; 1994: 144–146.

Fauci AS. Harrison's Principles of Internal Medicine. 14th ed. New York NY: McGraw-Hill; 1998: 1405.

Goldman MP Weiss RA Bergan JJ. Varicose Veins and Telangectasias: Diagnosis and Treatment. 2nd ed. St. Louis MO: Quality Medical; 1999: 3–41 110–124 164–174 175–264 414–424 470–497.

Gruenwald J Brendler T et al eds. PDR for Herbal Medicines. Montvale NJ: Medical Economics Company; 1998:729-730.

Hoffman D. The New Holistic Herbal. New York NY: Barnes & Noble Books;1995: 31.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany Calif: Hahnemann Clinic Publishing; 1993.

Murray MT Pizzorno JE. Encyclopedia of Natural Medicine. Rocklin Calif: Prima Publishing; 1998: 540.

Rosen P et al. Emergency Medicine: Concepts and Clinical Practice. 4th ed. Vol 2. St. Louis MO: Mosby; 1998: 1862–1863.