How varicose veins Impact on health and quality of life

What are varicose veins?

Veins are the blood vessels that return blood to the heart from the body. The leg veins
must overcome gravity to perform their job, and are aided by the muscles of the calf,
which squeeze the veins, pushing blood toward the heart. A series of valves, or one-
way flaps of tissue, prevent blood from flowing backward. In some people, stretching
of the veins near the surface of the skin (superficial veins) and failure of the valves to
close properly allows blood to flow in both directions. This backward flow of blood is
called venous reflux. Reflux can lead to twisted, bulging veins, which are known as
varicose veins, or varicosities (Figure 1). The two main superficial leg veins are the
great saphenous vein, which runs from the inner ankle to the inner thigh, and the
small saphenous vein, which runs along the outer ankle to the back of the calf. These
veins may form varicose veins, or they may feed branch veins that form varicose
veins.1

Figure 1. Varicose veins. A patient with bulging, tortuous (twisted) varicose veins on
the backs of both legs.

What are the risks of having varicose veins?

Because varicose veins are bulging and twisted, blood flow through them is often
sluggish. This can occasionally lead to blood clots, a condition known as superficial
thrombophlebitis, phlebitis, or superficial venous thrombosis. Unlike blood clots in
the deep veins of the legs, these clots do not usually travel to the lungs, but they may
cause significant symptoms including leg swelling, redness, pain, and tenderness at
the site of the affected vein. The swelling may feel like a firm cord or knot in the leg.
In some patients, prolonged swelling due to varicose veins may lead to skin changes
and sores that may occur spontaneously or after minor trauma. Not all patients have
swelling with their varicose veins.1
Impact on health and quality of life

There appears to be a high acceptance of symptoms of venous disorders of the leg

among affected people.2 In around two-thirds of patients who have varicose veins the
condition is medically insignificant, i.e. it is seen by the patient as insufficiently
important to mention spontaneously in health questionnaires, despite being
diagnosable on clinical examination. This acceptance could be put down to the fact
that varicose veins are such a widespread disease and in most patients are only a
slowly progressing condition.3 For the remaining patients, varicose veins do present a
significant problem,4 one of which may be concerns about the future impact of the
disease.

Symptoms reported by patients presenting with varicose veins include aching pain,
tiredness/feelings of heaviness, throbbing, itching and swelling in the lower limbs.
The relationship between the visible severity of varicose veins and symptoms is,
however, weak. Cosmetic dissatisfaction with the appearance of varicose veins is
probably universal, although the extent to which it distresses an individual and affects
his or her lifestyle will be a matter of personal outlook.

Women are more likely to consult their doctor for varicose veins than men. A study in
Edinburgh found that only 10% of men reported a previous doctor’s diagnosis of
varicose veins, compared with 17% of women. This was despite the fact that these
men on examination were subsequently found to have a significantly higher
prevalence of lower limb varices than women.5

Few studies of function or quality of life have been carried out for venous disorders of
the leg. Biland and Widmer reported that 10% of patients with varicose veins were
unable to work and 25% demonstrated reduced well-being. 6 Smith et al., using the
Aberdeen Questionnaire, found that patients with varicose veins have a reduced
quality of life compared with the general population and that this is significantly
improved at 6 weeks by operating on them.7 People with leg ulcers have a poorer
perceived quality of life than age-matched controls, mainly because of pain and
odour.8 Studies of patients with venous ulcers in the UK have shown high levels of
depression, pain and isolation, with very considerable gains from effective
treatment.9 In some severe cases, venous ulcers may lead to long-term entry into care
in nursing or residential homes.10

Source :

1. Natalie S Evans, Section of Vascular Medicine, Department of Cardiovascular

Medicine, Cleveland Clinic, Cleveland, OH 44122, USA. First
Published February 26, 2015
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workers with a standing profession. Part 1. Epidemiology. Dermatology 1997;
194: 111–20.
3. KrijnenR,deBoerE,BruynzeelD.Epidemiologyofvenousdisordersinthegenerala
ndoccupational populations. Epidemiol Rev 1997; 19: 294–309.
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Economics, 1992.
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and chronic venous insufficiency in men and women in the general
population: Edinburgh vein study. J Epidemiol Community Health 1999; 53:
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6. Biland L, Widmer L. Varicose veins and chronic venous insufficiency:
medical and socio-economic aspects. Basle study. Acta Chir Scand 1988; 544
(Suppl.): 9–11.
7. Smith J, Garratt A, Guest M, Greenhalgh R, Davies A. Evaluating and
improving health-related quality of life in patients with varicose veins. J Vasc
Surg 1999; 30: 710–19.
8. Roe B, Cullum N, Hamer C. Patients’ perceptions of chronic leg ulceration.
In: Cullum N, Roe B (eds). Leg Ulcers: nursing management. Harrow: Scutari
Press, 1995, pp. 125–34.
9. Franks P, Moffat C, Connolly M et al. Community leg ulcer clinics.
Phlebology 1994; 9: 83–6.
10. Bosanquet N, Franks P. Venous disease – the new international challenge.
Phlebology 1996; 11: 6–9.