Column: The cause of varicose veins


Compiled by Mark Ambrogi

Dr. Jeff Schoonover, chief medical officer of Indiana Vein Specialists, shares some information about causes and treatment of varicose veins and chronic venous insufficiency.

What are varicose veins and chronic venous insufficiency? 

“This condition typically affects the legs in which large ‘ropey’-type veins develop because of a sequential failure of valves inside the veins and subsequent vein wall dilation. Under normal conditions, these valves work with the calf muscle to pump venous blood back to the lungs and heart against gravity. Over time, these dilated veins can cause a variety of symptoms, including leg heaviness, aching/pain, swelling, leg throbbing or cramping, skin itching and advanced skin issues including dermatitis and open sores (ulcerations). Varicose veins that present with these issues is termed chronic venous insufficiency. There is also a growing body (of) evidence that this condition may be correlated with restless leg syndrome.”

Is there are certain age where most patients typically start to develop these veins?

“Venous insufficiency is driven largely by genetics and environmental factors such as pregnancy and the type of occupation a patient has. Some patients that have a strong family history, both parents affected, may present in their late teens to early 20s. In our practice, we have a significant amount of male and female patients that present in their late 30s/early 40s and beyond.”

Are there some exercises that help? 

“We encourage all of our patients to have a regular walking/exercise regimen that focuses on maintaining the calf muscles. For people that spend a lot of time working on computers, we also recommend regular walking breaks. Heel lifts and standing on tiptoes is a great calf muscle exercise as well as doing regular dorsiflexion/plantar flexion range of motion exercises at the ankle. This involves pointing the toes out and then bringing them back when you are in a seated or lying position.”

Any additional conservative measures? 

“Our practice also has a team of lymphatic physical therapists that can help with additional exercises for the patient that is presenting with a significant amount of lower extremity swelling that cannot be explained by other causes, i.e., medications, thyroid issues, etc. Due to more screen time with the pandemic, we are seeing a significant amount of patients that have issues with a variant of venous insufficiency that includes a specific type of swelling pattern that can extend from the ankles all the way to the upper thigh. Paying attention to weight, salt and caffeine intake as well as fitted, gradient compression stockings can also help.”

What is important to do it in winter when people might be less active? 

“We encourage our patients to use compression stockings following any venous treatment, and (we) find it is easier for our patients to be more compliant with post-procedure stocking requirements at this time.”

What are some of the treatment options? 

“Treatment of larger-caliber varicose veins can be accomplished by thermal or nonthermal-based catheter techniques that can be done in the office with local anesthesia. This is known as endovenous ablation and closes off the abnormal superficial vein segment at the source of reflux, usually the great saphenous vein. This helps the body to reroute to normal veins and reduce the discomfort associated with venous insufficiency. Another option is the use of sclerotherapy, which is a specialized medication that is injected into the abnormal vein and triggers a low-grade inflammatory reaction and causes it to close. With our procedures only needing local anesthesia to perform, our patients have no down time and are encouraged to be active and take a walk that same day. Prior to considering any of these procedures, a specialized diagnostic ultrasound, known as a venous mapping, is used to evaluate and measure these abnormal vein segments of the legs.”