The Hidden Risks of Untreated Varicose Veins

Ever wonder why you have those visible veins on your legs?

We all know about varicose veins and spider veins but will they affect your life more than being an upsetting sight to see when you wear skirts?

Varicose veins are usually a cosmetic issue for most people, especially women. They are bluish to purplish just right under the surface of the skin but can also cause other problems like skin discoloration, itching, swelling, leg cramps, and leg fatigue.

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Most varicose veins are seen in the calves or the inner leg, they develop because of poor valves in the veins or a weak vein wall. Risk factors for varicose veins include pregnancy, old age, standing for long periods of time, vascular diseases like deep veins thrombosis (DVT), family history of varicose veins, and obesity.

Women are more likely to get varicose veins than men but an estimated 20% of adults can get varicose veins at some point in their lives. Women are more likely affected because of their hormones and since pregnancy is one risk factor for the disease.

The diagnosis of varicose veins is through physical examination of the lower legs and by getting a doppler ultrasound. This doppler ultrasound will help the doctor know more about the specific vein affected and the blood flow.

There are a lot of treatments available for varicose veins like compression stockings, vein stripping, phlebectomy, radiofrequency ablation, and sclerotherapy.

If you have varicose veins, it is important that you have yourself checked because of the risks involved.

Studies have reported that up to 28.6% of patients with visible varicose veins without swelling of the leg or any other complications may progress to a serious venous disease after 6.6 years. (1)

The severity of varicose veins progresses over time and can lead to the following complications:

Skin Changes

Skin changes in varicose veins can be as simple as hyperpigmentation, where the skin has darker areas, to more pressing problems like venous dermatitis or varicose eczema and lipodermatosclerosis.

Venous dermatitis causes inflammatory changes in the skin which makes it dry, scaly, or even weeping (wet) in appearance. The risk of having venous dermatitis is because of loss of the topmost layer of the skin and constant inflammation in the area, it may lead to a wound and progress into an ulcer.

Lipodermatosclerosis is the progressive thickening or scarring of the skin and can involve the underlying subcutaneous (fat) tissue because of a long-standing increase in venous pressure. It is also called fat necrosis because it involves the fat tissue which will appear as a raised, red or brown area in the skin of the lower leg. It is very painful and there is a sensation of heat in the area. When you have lipodermatosclerosis, it is important that you get a consultation with your doctor immediately.

Superficial Thrombophlebitis

Superficial thrombophlebitis is an inflammatory process that happens commonly in varicose veins. It is a complication that causes a blood clot to form in one or more veins near the surface of the skin. It can cause problems because it makes the legs more susceptible to minor traumas.

Bleeding

Bleeding or hemorrhage of the varicose veins are frequently seen in those with big varicose veins bulging in the lower extremities that are easily nicked with minor traumas like hitting the leg on a table leg or edge of a wall. Patients with varicose veins often have thin-walled veins which makes them susceptible to bleeding.

Bleeding can be minor if only small and controllable but they can also be profuse and it may be a cause for a visit to the emergency room to get proper treatment.

Venous Ulceration

Venous ulceration occurs in varicose veins because of the progressive nature of the skin changes in the disease. If the changes are not treated on time, it may lead to an ulcer. This is because in varicosities of the legs, there is poor circulation in areas of ulceration which leads to a decrease in nutrition and oxygenation thus slow healing or even progression of these ulcers occur. (2)

When the ulcers start, the layers will gradually begin to have partial skin loss, and because healing is affected (and very slow in some patients especially those with comorbidities like diabetes), ulceration will progress rapidly and there could be a full-thickness skin loss over time. When this happens, the necrosis often extends from the subcutaneous (fatty tissue), superficial and deep fascia, up to the muscles, and even the tendons and bones.

The problem with ulcerations is that secondary infection that might set in the exposed areas and lead to more serious problems like sepsis.

Luckily, ulcers in varicose veins are not that common. If treated early they are not life-threatening but they can be a cause of pain and discomfort.

Other Complications

Other complications such as ankle joint stiffness, fixed plantar flexor and periostitis can also occur.

Progression of the scarring in the subcutaneous tissue near the ankle may extend up to the ankle joint thus causing stiffness and limited mobility while chronic pain from ulceration or lipodermatosclerosis may also be another cause of joint stiffness and fixed plantar flexor. Periostitis occurs because of inflammation of the tissues near the periosteum (the tissue that covers the bone).

So, what does this mean?

Varicose veins are easily treatable with the numerous procedures that are currently available. Minimally invasive procedures such as sclerotherapy and radiofrequency ablation are accessible for patients who do not want to undergo surgery. Patients with advanced or complicated varicose veins have options like vein stripping and ligation.

If surgeries or procedures are something you do not want to undergo, compression stockings are still the go-to treatment for varicose veins. You can visit your health care provider and they can assess what treatment best suits you.

Remember that any disease will always start simple--- by being vigilant enough with what’s going on in our body, we can prevent diseases from becoming complicated. Early treatment will always save you a lot of money and time while early detection can save your life!

If you have varicose veins symptoms that you think needs to be seen by a professional, do not hesitate to visit your doctor!

References:

National Clinical Guideline Centre (UK). Varicose Veins in the Legs: The Diagnosis and Management of Varicose Veins. London: National Institute for Health and Care Excellence (UK); 2013 Jul. (NICE Clinical Guidelines, No. 168.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK264166/
Nicholls S. C. (2005). Sequelae of untreated venous insufficiency. Seminars in interventional radiology, 22(3), 162–168. https://doi.org/10.1055/s-2005-921960

The Hidden Risks of Untreated Varicose Veins