How They Develop

The heart and arteries pump oxygen-rich blood around the body to be used by various tissues and organs. Veins carry the oxygendepleted blood back to the heart. The veins of the legs are divided into two systems - deep veins and superficial veins. The superficial veins are the ones that you can see through the skin.

In a number of places within the leg, the superficial and deep veins are linked by perforator veins. These veins penetrate (perforate) the leathery layer of tissue surrounding the leg muscles. The leg muscles help to pump blood back to the heart. However, since blood in the veins must fight gravity as it returns to the heart, the veins contain one-way valves to prevent backflow. In the main superficial veins of the leg, these valves occur every five to ten centimetres. If one or more valves become weakened, blood can leak backwards and pool up in the superficial veins. The pooled blood puts increased pressure on the walls of the vein, causing it to weaken and bulge. The damaged, bulging vein is said to be varicose.

What Causes Vein Damage?

Close to 50 percent of Canadian women and 40 percent of Canadian men experience problems with leg veins. Several factors increase a person's chance of developing varicose veins. These include:

• Having a family history of varicose veins. Weak vein walls and valves appear to be inherited characteristics.
• Hormonal changes. Pregnancy and menopause are common times for leg veins to make an appearance. Birth control pills and hormone replacement therapy also increase the risk.
• Pregnancy. During pregnancy, the volume of blood in the body increases significantly. This puts pressure on the veins. The expanding uterus also contributes to this pressure.
• Increasing age
• Being obese
• Standing for prolonged periods

What are the Dangers?

The pooling of blood that occurs with severe varicose veins slows the return of blood to the heart. This can cause blood clots and severe infections. Blood clots can be dangerous as they may travel from the veins in the leg to the lungs. Once a clot has reached the lungs, it can be life-threatening as it may prevent the heart and lungs from functioning properly.

Sores or skin ulcers can occur on skin tissue around varicose veins and are more common among the elderly. Ulcers are caused by impaired circulation.

It is important to talk to your doctor if you experience any discomfort, itching or skin condition associated with varicose veins.

Recognizing the Symptoms

Frequently, the first sign of a varicose vein is a dull, tired, achy sensation in one or both legs. This can be particularly noticeable at the end of the day or after prolonged periods of standing.

Many people first realize that they may have varicosities when their ankles and/or feet begin to swell. This swelling is caused by the seepage of fluids from stagnant blood leaking through the walls of the veins into surrounding tissues.

Varicose veins may also cause persistent itching of the skin that covers the affected area/s and a brownish-grey skin discolouration.

What Can Be Done?

Varicose veins are treated in a number of ways, depending on the sufferer’s concerns and whether or not the veins pose a medical problem. Treatments include:

• Surgery (phlebotomy) which may be done in the doctor’s office or in hospital.
• Injection therapy (sclerotherapy)
• Laser therapy
• Compression stockings

Compression stockings are elasticized stockings that improve circulation by putting pressure on the muscles that squeeze the veins. This improves the flow of blood back to the heart, reducing swelling, tiredness, and aching. Compression stockings (or compression socks for men) must be worn all the time when standing and put on/taken off when lying down. They will not cure varicose veins and may not be acceptable to people who are concerned about the appearance of their legs. You can find compression stockings on the upper shelves of the foot care section at London Drugs.

Injection therapy or sclerotherapy involves injecting the vein/s with an irritating substance (sclerosing agent) which causes the vein walls to develop scar tissue. This blocks blood flow and closes off the vein. Injection therapy is not suitable for large varicose veins. It is particularly effective for varicose veins below the knees. Sclerotherapy injections are usually done in a doctor’s office and are not painful.

Surgery is often required to effectively treat larger varicose veins. There are two kinds of surgery for varicosities: stripping of the vein/s and a technique known as ambulatory phlebotomy.

Stripping is normally performed only on the saphenous vein - the primary deep vein in the leg. The procedure is usually carried out in hospital, under general anaesthetic. It involves making two small incisions, one in the groin and the other close to the ankle. The surgeon then ties off the saphenous vein and its branches at the groin incision, and extracts it with a thin wire.

Ambulatory phlebotomy is usually performed in a vein specialist’s office and does not involve a hospital stay. In this procedure, the surgeon makes a series of tiny incisions in the skin above the vein, then takes out small segments of the vein with a fine, hooklike instrument. A local anaesthetic is given before the procedure, and mild sedation provided if required. The tiny incisions require no stitches. Most people are able to walk immediately following surgery, and carry on with their day.

Laser therapy is now being used in Canada to treat varicose veins. The procedure, known as EVLT ™ (Endovenous Laser Treatment), was approved for use in Canada in 2002. EVLT ™ uses laser energy delivered through a laser fibre that is inserted into the saphenous vein. This seals the vein and cuts off blood flow. No cut in the groin is required and the operation is performed under local anaesthetic.

Preventing Vein Problems

While the tendency to develop problems with leg veins is often hereditary, you can reduce your risk factors by observing the following: 

• Exercise regularly to improve the muscles in your legs, your circulation, and strength of your veins.
• Control your weight to reduce strain on your legs.
• Include high-fibre foods in your diet and drink plenty of water to prevent constipation.
• If desired, wear elastic support hose. Avoid clothing that is too tight or constricts your waist, groin, or legs.
• Consider taking health supplements that have been shown to benefit the veins. These include vitamin C, grapeseed extract and herbal blends that incorporate diosmin.

Supplements for Veins

New at London Drugs is Holista ® VariVein™, a wholly-natural supplement that supports healthy functioning of the veins.

VariVein™ contains diosmin - an anti-inflammatory substance derived from the bioflavonoid hesperidin, found in citrus rinds. Diosmin has been used for over 30 years to treat vein problems including varicose veins and hemorrhoids. This powerful antioxidant improves vein tone, inhibits inflammation, and reduces the permeability of the capillaries.

A number of studies and clinical trials attest to the efficacy of diosmin¹. In one multicentre international trial, 5,052 people with chronic venous insufficiency were treated with 450 mg diosmin and 50 mg hesperidin daily for six months. Continuous clinical improvement was reported throughout the study, as well as improvements in quality-of-life scores for the trial participants.

VariVein™ also contains horse chestnut, the active ingredient in which - aescin - has been shown in studies to improve the flow of blood back to the heart and relieve swelling in the legs. The addition of butcher’s broom extract and hesperidin provide further support for the veins.

Grape seed extract and vitamin C are also helpful for vein problems. Both strengthen the tissues that support the veins, and the veins themselves.

i. Jantet G. Chronic venous insufficiency: Worldwide results of the RELIEF study. Reflux assessment and quality of life improvement with micronized flavonoids. Angiology 2002;53:245-256.

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