10 Questions about Varices
By Dr. Valter Castelli Jr.
WHAT ARE VARICES?
Varices are permanently dilated, tortuous, functionless veins.
Their incidence is about 15% in the adult population.
They occur 3 times as many in women than in men due to hormonal factors.
They are rare before 14 years old and usually, when they do occur in children, they are part of congenic vascular deformities.
Starting in puberty, there is a progressive increase in varix incidence, and, above 70 years old, some 70% of people present venous dilations in the lower limbs.
Varices constitute a hereditary disease A person with genetic propensity is born with a weaker resistance on vein walls and such a predisposition, associated to triggering factors such as pregnancy, obesity and sedentariness, professions that require a standing position for a long time (barbers, shop attendants, porters) or that require great effort (stevedores, weight lifters) favor the emergence of varices.
HOW IS ITS DIAGNOSIS MADE?
Through simple clinical exam, in most cases the doctor is able to identify varicose veins and determine their origin, that is, if they are primary or secondary.
Complementary exams are limited to suspected cases. In most cases, the tests used today are non invasive.
In most cases, the tests used today are non invasive.
The venous Doppler test is an ultrasound exam carried out in the doctor's office to assess the presence of a blockade in the deep venous system.
The Duplex-Scan (Echo-Doppler) is also a especially designed ultrasound exam for the examination of blood vessels, allowing, without a contrast injection or X-ray irradiation, to visualize vein or artery clots.
When previous exams are insufficient to explain a case, the venous system is used to detect vein clots and evaluate the function of the valves.
WHAT ARE THE MOST FREQUENT SYMPTOMS?
Varix symptoms usually are: pain or discomfort in the legs when in standing position.
Such symptoms occur in women in the pre-menstrual phase and during pregnancy.
Complaints about pain are also frequent in hot weather. Such a sensation usually improves when the patient walks and raises his/her legs.
In more advanced cases, an edema (swelling) may appear on the legs, which intensifies by the end of the afternoon, causing discomfort.
WHAT ARE VARIX TYPES?
Varices may be classified into two types: primary (essential) and secondary.
The primary type constitutes the majority of varices seen in medical practice. They are the result of hereditary factors, genetic and associated with triggering factors.
(
PREGNANCY, PROFESSIONS requiring long standing periods).
The association of varices with other defects held as hereditary, such as flatfoot, hemorrhoids, hernias and others is relatively frequent;
Secondary varices usually are the result of the obstruction of deep (main) veins, caused by a thrombo-phlebitis process.
VARICES AND PREGNANT WOMEN:
Pregnancy is the most important triggering factor, causing the incidence of varices to prevail in women. In this condition, besides the hormonal alterations that occur during pregnancy, in the second half of the pregnancy there is an increase in leg veins due to the compression by the uterus.
If this pressure increase is not sufficient to cause permanent dilation, the veins return to their previous caliber after parturition. This usually occurs after the first pregnancy; however, with successive pregnancies, veins tend to dilate, becoming varicose and remaining that way after parturitions.
VARIX TREATMENT:
Lower limb varices may be treated by clinical or surgical methods.
There is no drug-based treatment for varices.
The so-called phlebotropic medicines only assuage the feeling of weightness and tiredness of the legs, but they do not have any preventive or curative effect on varicose veins.
The clinical treatment consists of four items:
• use of elastic compression;
• guided physical exercises;
• avoidance of long standing periods;
• weight loss, if necessary.
Elastic compression with stockings or bandages is aimed at compressing insufficient veins, removing excess blood from their interior and avoiding leg edemas.
For more information, consult an angiologist or a vascular surgeon.
WHAT ARE VARICES' MAIN COMPLICATIONS?
The main complications caused by varices in the lower limbs are five:
• superficial thrombo-phlebitis
• bleeding by varicose veins (varicorragia);
• hyperpigmentation (dark skin spots);
• eczema;
• skin ulcer (wound) (varicose ulcer).
Superficial thrombo-phlebitis consists of the inflammation of the vein wall by the formation of clots in its interior. The vein becomes hardened, reddish, hot and very painful, preventing the patient from walking properly. Usually, it is no more serious than that, consisting just in discomfort to the patient. However, when it occurs in saphenous veins, I may be more serious due to the possibility or originating pulmonary embolism.
Varicorragia consists of bleeding due to the rupture of a varicose vein. Usually, it occurs in very superficial venous dilations with very fine walls.
It is caused by traumas; even small traumatisms, those almost never noticed, a mere light touch of the leg against a hard structure may cause the vein the rupture.
Hyperpigmentation (spots) of the skin occurs in chronic cases. They are located in the legs, in their lower third or over varicosed venous ways. They do not cause pain but interfere in the aspect of the leg, particularly in women and, to their chagrin, do not vanish after being operated on.
The varicose eczema is characterized by a reddish, scaling-off of the legs' skin, accompanied by prurigo (itching). Usually, it is made worse with the use of antibiotic- or sulfa-based creams, which intensify allergic reactions and may in some cases disseminate the eczema all over the body.
Varicose ulcers are the most serious varix complication. In the vast majority of cases, they are located in the lower third of the leg, in the internal part, next to the ankle. They may appear after light traumatisms which, in non-varicose persons, would not entail any big consequence.
They become particularly painful when infected and are hard to cicatrize.
ARE THERE INTERNAL VARICES?
No. Varices are always visible and palpable.
Some persons who suffer from pain in the legs (caused by several factors) ascribe it to varices
Since they lack visible varices, they usually say they have internal varices.
DO MEN HAVE VARICES?
Numberless medical studies point to a predominance of varices in women in a 2-to-1 ratio.
However, it is undeniable that there is a large varix incidence in the male population.
DO MEN LOOK FOR SPECIALIZED DOCTORS?
Although they worry more and more with the anti-esthetic aspect of varices, men usually go after a specialized assistance (angiologist or vascular surgeon) because of symptoms such as pain, burning, weight and swelling of the legs that grows worse with the passing of the day.
WHAT TYPE OF MEN ARE MORE SUSCEPTIBLE
Usually, the problem is more intense in sedentary men and those who work for long periods either standing or sitting.
In a more advanced stage of the illness, it is possible the emergence of wounds, bleedings and vein inflammation (phlebitis).
Obese men tend to have more varices.
WHAT IS THE TREATMENT USED FOR MEN?
They must be advised about losing weight, performing aerobic exercises compatible with their age, shunning sedentariness, wearing medicinal elastic stockings every day in order to improve the blood's venous return to the heart and lungs, preventing the varices from getting worse with time and avoiding complications such as laceration and phlebitis (inflammation).
WHAT ARE LITTLE VESSELS?
The little vessels are called Teleangiectasias and never become varices.
The only accepted treatment nowadays, without side effects and with optimum results is sclerotherapy, consisting in the injection of irritating substances into them in order to eliminate them.
The laser method for treating "little vessels" is inappropriate for the moment.
It has already been tested as compared with the conventional method and it showed to be less efficient and more expensive, causing irreversible skin spots.
Currently, it is not accepted by the Brazilian Society of Vascular Surgery.
There is another method to treat the "little vessels" now being used by some specialists.
It is a device called Photoderm that burns the "little vessels" with an appropriate light shaft. The greater difficulty in using this device lies in its regulation, for each skin type requires the emission of a specific light. It is a promising method which, however, requires better evaluation of its results in order to be indicated.