Charlotte, NC
Minraj Bhurtel,MD
Bibhusan Basnet, MD
Varicose veins are swollen and enlarged veins visible just below the skin’s surface. They are dark blue to purple and may appear lumpy or bulging out from the skin, making patients physically conscious of them.
Healthy leg veins carry blood from the legs to the heart. Leg veins have a small one-way valve that helps move the blood in the right direction (towards the heart). However, if these valves become faulty or if the vein walls weaken or become twisted, the leg veins become swollen as blood pools in them. This is how varicose veins are formed and are quite painful. Essentially, varicose veins are caused when the veins in our legs do not work correctly.
When more blood pools in the legs due to faulty or weak veins, there is an increase in venous pressure. Venous pressure causes blood proteins and fluid to leak outside of the vein. This eventually causes inflammation and tissue breakdown, including the blood vessels in your skin which then cause venous ulcers.
Venous leg ulcers are unhealed sores or wounds on the leg’s skin, especially around the ankle. It usually starts with a slight sore that gradually increases in size.
You may develop stasis dermatitis or stasis eczema in the lower legs because of tissue fluid pooling within the legs. The skin in the lower legs may become swollen, itchy, and discolored.
In the beginning, you may have swollen, heavy, tired, and aching legs. Over time, however, you may develop blue to purple bulky and twisted veins in your legs which can be painful. You may have wounds on your mid-calf area to the ankles which are hard to heal. People who develop stasis dermatitis experience dry and itchy skin with a scaly and dry rash.
If you have blue or prominent veins in your legs or minor wounds in your leg, start by making an appointment with your primary care physician. Your doctor will then conduct a thorough physical exam of the skin and veins of the legs. You will need to talk about your symptoms, family history, activity levels, and lifestyle to determine your risk factors for developing varicose veins.
An ultrasound machine can be used to take pictures of your veins to determine whether your veins are functioning properly or not. Sometimes your doctor may order another test like a Computed Tomography Scan (CT) of the legs to further assess detailed pictures of your veins. If you have a non-healing wound, your doctor can take a small skin sample from your wound (called a skin biopsy) if they suspect an infection.
Depending on your veins’ condition, your primary care physician may also refer you to a vascular surgeon, a dermatologist, or a radiologist.
Treating varicose veins and venous ulcers involves identifying the cause of the venous disease and taking active steps to reduce high pressure in these leg veins. Here are some steps that help reduce swelling and discomfort in your legs as much as possible;
Many patients prefer surgical procedures for varicose treatment for cosmetic reasons. If you develop venous ulcers that do not heal well, your provider may recommend specific surgical procedures to improve blood flow through your veins. The surgical procedures might involve;
Venous Ulcers | Dermatology | JAMA Dermatology | JAMA Network
Venous Leg Ulcers – Annals In the Clinic Patient Information (acpjournals.org)
Stasis Dermatitis | Dermatology | JAMA Dermatology | JAMA Network
Varicose Veins – Varicose Veins | NHLBI, NIH
