Removing varicose veins may reduce risk of venous insufficiency
DEAR DOCTOR K:
I have unsightly varicose veins and would like to get them treated. But could that lead to venous insufficiency?
To answer your question I consulted with my colleague Dr. Celeste Robb-Nicholson, editor-in-chief of the Harvard Women's Health Watch. In a nutshell, varicose veins are both a cause and a result of venous insufficiency, and treating them can improve venous insufficiency.
What is venous insufficiency? Normally, leg veins return blood from the legs back to the heart. Particularly when you're sitting or standing, that's not easy. Your circulation is gently pushing blood in your leg veins up to your heart. When you use your legs, the muscles in your legs also help squeeze the blood upward toward the heart. But at the same time gravity is pulling the blood down, so the circulation needs some help.
That's why your leg veins have a series of one-way valves. These valves open to allow blood to flow upward toward the heart. They close to keep blood from flowing back down into the legs. When the valves are damaged or don't close properly (as with varicose veins), blood can pool in the legs. This increases pressure in the veins, causing them to expand. (I've put an illustration of this on my website, AskDoctorK.com.)
When something is making it hard for blood to return from the legs to the heart, you've got venous insufficiency. It could be caused by varicose veins, or by not using your leg muscles enough, or by blood clots that form in the veins and block blood flow.
Whatever the cause, the result is a range of conditions. On one end are tiny spider veins that may be unsightly but cause no discomfort. In the middle are moderate-sized, swollen, twisted varicose veins that cause achy, tired legs and occasional ankle swelling. Finally, there's severe chronic venous insufficiency. This causes swollen legs, skin color changes, itchy skin, leg cramping, pain and ulcers on the legs and ankles.
Having varicose veins removed doesn't make you more likely to develop venous insufficiency. In fact, by removing the varicose veins with defective valves -- which are a source of increased pressure in the leg veins -- it might even help to reduce the risk of developing chronic venous insufficiency. It will force blood to return to the heart through other veins that do not have defective valves.
Whether or not you get treatment, try the following to help reduce the risk of vein problems progressing or recurring:
-- Avoid sitting or standing in one place for long periods.
-- Wear compression hose.
-- Elevate your legs a few times each day to reduce blood pooling and leg or ankle swelling.
-- Exercise your toes and feet while sitting.
-- Don't cross your legs.
-- Take walks to get your leg muscles moving; they help squeeze veins and pump blood back to the heart.
-- Maintain a healthy weight.
(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)
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