Varicose veins are a common condition that affects 1 out of every 3 people during their lifetime. They result from a malfunction in the direction of blood flow within the veins that carry blood from the legs towards the heart. As a result, the veins expand and bulge. Varicose veins can cause pain, and in some cases, they can lead to complications such as ulcers and venous thrombosis (varicose veins occur in veins, not arteries). Lower limb varicose veins can be categorized as:

1. Superficial varicose veins (visible on the skin and require treatment for cosmetic and medical reasons).
2. Deep varicose veins (located far beneath the skin’s surface and not visible, but they can cause swelling and pain).

This page will provide detailed information with images and videos exclusively about lower limb varicose veins for readers. For more information about other types of varicose veins, you can click on the following links to case pages: Facial Varicose Veins, Testicular Varicose Veins, Pelvic Varicose Veins.

Images Before and After the Treatment of Lower Limb Varicose Veins

What are Varicose Veins, and How Do They Form?

Varicose veins are swollen veins resulting from a malfunction in the direction of blood flow within them and may appear on the skin. Here’s an explanation:

Veins are tubes that carry blood from the extremities towards the heart only. One-way valves inside the veins, called unidirectional valves, allow blood to move in the direction of the heart only. These valves are distributed along the length of the veins. Varicose veins indicate a malfunction in these valves, causing blood to flow backward, increasing pressure on the vein walls, raising venous blood pressure (venous hypertension), and causing the affected vein to swell, resulting in varicose veins.

What are Varicose Veins? How do Varicose Veins Occur? What is the Relationship Between Valves and Varicose Vein Formation?

Vein Networks in the Legs:

1. Deep Veins (Location: deep within the muscles, away from the skin; Importance: carries 90% of the blood).
2. Superficial Venous System (Location: between muscles and the skin; Importance: carries 10% of the blood).
3. Communicating Veins (Location: between deep and superficial veins; transport blood between them).
4. Venous networks in the human body and in the legs, including the great and small saphenous veins.

Stages of Varicose Veins (Stages of Appearance):

1. Stage 1: Appearance of Spider Veins

   • The leg veins appear as thin threads on the skin.

2. Stage 2: Appearance of Varicose Vein Networks

   • The leg veins become swollen, and their color darkens. Mild pain may occur in some cases during this initial stage.

3. Stage 3: Varicose Vein Clusters

   • Varicose veins expand further, leading to swelling and inflammation in the legs and ankles. Inflammation occurs due to the obstruction of blood flow, which results in vein dilation.

4. Stage 4: Chronic Varicose Veins with Ulceration

   • The skin around the varicose veins starts to change color, becoming dark brown and resembling skin tissue.

5. Stage 5: Varicose Ulcers – Varicose Eczema

   • Ulcers and open sores represent the most severe stage of varicose veins. Ulcers form due to chronic venous insufficiency in the leg veins. With each stage, the condition continues to worsen.

Symptoms of Lower Limb Varicose Veins

There are several symptoms that distinguish lower limb varicose veins, including the following:

1. Pain: Pain often increases after prolonged periods of sitting or standing, with nighttime discomfort being common.
2. Swelling: Swelling and puffiness in the ankles and legs are typical.
3. Visible and Twisted Veins: Prominent and twisted veins can appear in the legs and thighs.
4. Muscle Cramps and Leg Twitches: Muscles may cramp, and legs may experience sudden twitches, especially when standing up suddenly.
5. Heaviness in the Legs: A sensation of heaviness in the legs and restlessness while walking, particularly in the evening, is common, especially among women.
6. Persistent Itching: Constant itching around a specific vein can occur.
7. Increased Skin Temperature: Skin temperature may rise, accompanied by occasional sensations resembling pricking.
8. Skin Discoloration: The skin around the affected area may change to brown or blue.
9. Skin Ulcers: Some skin ulcers may develop near the ankles.
10. Enlargement of Capillaries: Capillaries in the affected leg may expand, leading to the appearance of spider veins.
11. Prolonged Bleeding: The affected area may bleed for a longer duration than usual when injured or damaged.
12. Stasis Dermatitis: This condition involves redness, dryness, and itching in the affected area.
13. Restless Legs Syndrome: Restless legs syndrome can occur.
14. Atrophy Blanche: White patches resembling scars may appear on the ankles.

Causes of Lower Limb Varicose Veins

The formation of lower limb varicose veins can be attributed to various factors, including the following:

1. Genetic or Congenital Factors: A family history of varicose veins increases the risk of developing them, as it may indicate a genetic predisposition or congenital valve abnormalities.
2. Lack of Physical Activity: Insufficient physical activity and inadequate exercise can weaken the calf muscles, impairing their ability to contract and pump blood effectively. This can result from conditions such as paralysis, prolonged sitting, and a sedentary lifestyle, leading to increased venous blood pressure.
3. Prolonged Standing: Extended periods of standing or walking can strain the legs and, consequently, the veins.
4. Aging: As individuals age, veins lose their elasticity, making them more prone to dilation. Weakened venous valves may allow blood to flow backward, leading to the development of varicose veins.
5. Pregnancy: Some women develop varicose veins during pregnancy. Pregnancy increases the volume of blood in the body while decreasing blood flow from the legs to the pelvis. Although varicose veins that appear during pregnancy often improve within three months after childbirth without medical intervention, it’s essential to consult a healthcare provider for guidance.
6. Hormonal Changes: Female hormones can relax vein walls, potentially leading to varicose veins. The use of hormone replacement therapy or birth control pills may increase the risk of varicose veins.
7. Obesity: Excess body weight places additional pressure on the legs and knees, potentially causing veins to appear dark blue or purple. Additionally, these veins may become more prone to rupture.
8. Pelvic Tumor: The presence of a pelvic tumor can exert increased pressure on the venous system, leading to fluid accumulation in soft tissues, lymphatic system disturbances, microcirculation disorders, fibrin deposits, skin cell damage, and ulcer development.

Tips for Women:

• If you have severe varicose veins and wish to become pregnant, consult your healthcare provider first.
• Avoid using birth control pills or any hormonal substances that may increase the risk of varicose veins and venous thrombosis. Consult a gynecologist to choose the appropriate contraception method if needed.
• Avoid wearing high-heeled shoes and opt for comfortable, low-heeled shoes.
• Elevate your legs while sleeping, but avoid elevating them above pillows, as this may lead to vein thrombosis. Elevating the bed itself from the foot end is recommended.
• If surgery is recommended for your condition, do not delay making the decision, as postponing treatment can lead to deterioration. Remember that even after the procedure, you will continue to wear compression stockings and follow the same previous instructions and guidelines.
• Be cautious about advertisements for creams or herbs claiming to eliminate varicose veins. These are commercial advertisements primarily aimed at profit.
• Injection therapy is not necessary in all cases; the specialist physician will assess the condition and determine the best treatment methods.
• Daily walking for 30 minutes is important and necessary.

Excessive Obesity:

Excessive body weight is one of the primary factors leading to varicose vein development because it increases the pressure on the legs and knees, potentially causing the veins to appear dark blue or purple. These veins may also become more prone to rupture.

Diagnosis of Lower Limb Varicose Veins

To diagnose varicose veins, the doctor will inquire about the symptoms in detail. Then, a physical examination is conducted, including observing the legs while standing to check for swelling. Sometimes, the doctor may also ask about the nature of pain in the legs.

How is the diagnosis of varicose veins done?

Duplex Ultrasound Examination in the Clinic

Undergoing a Duplex ultrasound examination using ultrasound waves. This medical examination helps the doctor select the appropriate treatment for varicose veins and reduces the risk of future recurrence. Duplex ultrasound examination also determines the direction of blood flow, thereby identifying the area where blood flows in the opposite direction to normal.

Video Examination

In some special and rare cases, there may be a need for imaging tests. A certain substance is injected into the superficial blood veins, and then the leg is imaged to determine the problem in the blood vein. Based on this, the treatment plan for varicose veins is determined. This examination is very useful in cases of recurrent varicose veins.

Treatment of Lower Limb Varicose Veins

Varicose veins do not heal on their own. There are multiple and different treatment options because varicose vein disease is characterized by various and diverse patterns.

Steps in the Treatment of Varicose Veins:

1. Examination by a specialized doctor and an echo examination in the same clinic to diagnose varicose veins.
2. Choosing the treatment method: Self-treatment or in the clinic.
3. Precisely mapping the varicose veins.
4. Discussing proposed treatment plans with the patient.
5. Implementing the varicose vein treatment.
6. Follow-up and advice after treatment.
7. Self-care.

Often, the doctor recommends following self-care advice for 3 to 6 months, which includes:

• Regular physical exercise.
• Avoiding prolonged standing.
• Elevating the affected leg when lying down and resting.
• Using compression stockings chosen by the doctor based on the condition.

In cases where self-care does not yield results, non-surgical modern treatment options can be considered.

3 Modern Techniques for Treating Varicose Veins without Surgery

Types of Varicose Vein Treatment:

The latest varicose vein treatments are available at Dr. Saher’s clinics, and the choice of the most suitable treatment is made through discussion between the patient and the doctor after examining the varicose veins.

1. Sclerotherapy for Varicose Veins

The doctor, using an extremely thin needle, fills the varicose veins with a substance (liquid or foam depending on the type of varicose veins), causing complete blockage of these veins. Subsequently, they dissolve and disappear within weeks, and blood flow is redirected to healthy veins.

Additional Information:

• Multiple injections may be required for one vein.
• No general or local anesthesia (the varicose vein needle is smaller than the injection needle).
• The procedure is performed in the doctor’s clinic.
• The size of the original vein determines the injection material, whether it’s a liquid or foam.
• Improvement can be observed immediately, but the final result may take several weeks.

2. Laser Surgery for Varicose Veins

The laser beam heats the blood vessels, leading to their shrinkage. Blood vessels reduce in size and disappear within weeks without the need for incisions or sutures. This method is suitable for treating small-sized varicose veins.

Additional Information:

• Local anesthesia is used.
• The procedure usually takes less than an hour.
• The success rate of the procedure worldwide is 95%, while at Dr. Saher’s clinics, it’s 98%.
• This surgical technique is suitable for small, straight veins, as it facilitates the passage of the laser through them.
• It is not suitable for large, tortuous veins as it is difficult for the laser to pass through.

3. Catheter Procedures for Treating Varicose Veins

A thin catheter is inserted into the affected vein, and using an ultrasound device, the catheter’s movement is guided. The vein is then treated from the inside, and it is completely sealed. The sealing can be done with laser or radiofrequency, depending on the varicose veins’ condition.

Additional Information:

• Local or general anesthesia is used.
• Suitable for moderate to large varicose veins.
• Involves a small incision for catheter entry.
• Treatment of varicose veins with catheter and laser or radiofrequency.

Please note that the choice of treatment method depends on the patient’s specific condition and needs.