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Varicose Veins: Clues to a deeper problem?

Source: Harvard Medical School, June 2018

Leg veins that bulge just beneath the skin's surface are linked to a higher risk of deep-vein thrombosis.

Varicose veins are gnarled, bluish veins near the surface of the skin, usually on the legs and feet. Most people think of them as mainly a cosmetic problem, although varicose veins can cause a range of unpleasant symptoms, from a heavy, achy feeling in the legs to burning, throbbing, or itching sensations. Now, new research suggests that people with varicose veins may also have a higher risk of developing a clot in the deeper veins of the legs, known as deep-vein thrombosis or DVT.

"It's a good reminder for people with varicose veins to talk to their health care provider about their overall risk for vascular disease," says Dr. Gregory Piazza, assistant professor of medicine at Harvard Medical School. Most people with varicose veins won't experience a DVT. But it's still important to know the warning signs of this potentially dangerous condition (see "What is deep-vein thrombosis?") and to address any factors that might add to your risk, such as smoking, high blood pressure, and elevated cholesterol, he says.

What is deep-vein thrombosis?

Deep-vein thrombosis (DVT) refers to a blood clot that forms in a deep vein, usually in the calf or thigh, but also the pelvis or the arm. Traumatic injury, surgery, and lying in a hospital bed are common triggers. Sitting for long periods, such as during long-distance travel, leads to sluggish blood flow and a greater chance of having a clot. Cancer and some cancer treatments may also increase DVT risk. Finally, a small percentage of people have inherited or acquired genetic factors that make them more prone to clots.

DVT symptoms include swelling, discomfort, redness, and warmth in the affected area. But people sometimes mistake these symptoms for a bone or muscle injury, or even nerve damage from diabetes, says Dr. Gregory Piazza, a cardiologist at Brigham and Women's Hospital. If such symptoms linger for more than a few hours — especially in the absence of a known problem — call your doctor for advice.

A DVT poses a very serious threat if the clot breaks off and travels to the blood vessel to the lung, causing a blockage called a pulmonary embolism. Symptoms of a pulmonary embolism include: difficulty breathing that happens suddenly, without an explanation

a fast or irregular heartbeat; chest pain or discomfort, which usually worsens with a deep breath or coughing;coughing up blood; feeling lightheaded or faint. If you have these symptoms — especially if they worsen quickly over a period of hours — call 911 right away.

Shared underlying risks?

For the study, researchers compared nearly 213,000 people with varicose veins to a similar number of people of the same age and sex who did not have varicose veins. They found that DVT was about five times more likely among people with varicose veins. The observation may reflect shared factors that are common to both conditions, according to the authors, whose study appeared in the Feb. 27, 2018, Journal of the American Medical Association.

About one-quarter of adults have varicose veins, and about half of these people have a family history of the problem. Varicose veins are also more common after age 65 and in women, especially those who have been pregnant several times. Larger people — those who are overweight, obese, or tall — are also more prone to varicose veins, as are people who stand or sit for long periods of time.

Causes and treatments

Normally, one-way valves inside the veins, which prevent blood from flowing backward, help propel blood from the legs back up to the heart. But if those valves become deformed, they don't close properly. Blood flows backward, pools, and enlarges the veins.

Lying down with your legs elevated can help the veins drain, relieving the distention and discomfort, says Dr. Piazza. Compression stockings — snug elastic socks that are tighter at the ankle than at the calf — can also help ease symptoms, he adds. Some of these stockings reach up to the lower thigh. They're available with varying degrees of compression, either from a drugstore or by prescription.

People who still have symptoms despite these measures can undergo a vein ablation, a minimally invasive procedure done under local anesthesia. The doctor threads a catheter into the faulty vein, then applies heat in the form of laser or radiofrequency energy to collapse the vein and seal it shut. A newer method, called VenaSeal, uses surgical glue rather than heat energy to close off the vein.


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