I’m a vein specialist – from varicose veins to a silent killer, what to spot in your legs
CRINKLY varicose veins in the leg are common and yes, not always the prettiest. But how much do you really know about your vein health?
According to the British Heart Foundation, by the time we’re an adult, we have 60,000 miles of blood vessels inside our bodies, including arteries, capillaries and veins.
The network of veins that run through us make up the venous system, carrying deoxygenated blood back to the heart so it can be replenished with oxygen.
The veins in our legs are the furthest away from our heart and therefore blood has further to travel.
Plus, this blood is fighting against gravity as it travels upwards.
Valves inside our veins open up to allow blood through, and prevent it from falling back down.
Problems can arise however with valves; they may fail to close properly for example.
Professor Mark Whiteley is a Consultant Venous Surgeon and Consultant Phlebologist at The Whiteley Clinic.
What he doesn’t know about vein health, simply isn’t worth knowing.
He says: “If you think you have a venous problem, get it scanned even if you can’t see anything.
“The quicker it gets picked up the better.”
Here, Professor Whiteley reveals the four main vein issues that can occur in our legs and simple tips to minimise problems…
The 4 main types of vein issues in the legs
1. Spider veins
Also known as thread veins, these tiny veins tend to be red, blue or purple and look a little like a spider’s web.
Professor Whitely says these affect men and women in pretty much equal measure, however they are slightly more likely to occur in women. He adds that spider veins are very common below the waist.
He says: “No one knows for sure what causes them; a huge number are assisted with varicose veins. For some it’s just the skin type and we don’t know why.
“Around 89 per cent of spider veins have hidden varicose veins under them.
“Never have spider veins treated unless you’ve had a duplex scan as they could be linked to a further problem.”
A duplex scan is a particular type of ultrasound that looks at the venous system and checks the blood flow within veins.
Suffering from spider veins around the ankles? Professor Whitely says it’s important these are checked: “Thread veins around the ankle are not more dangerous, however, many people see blue veins around the ankles because of hidden varicose veins or rarely because of post thrombotic syndrome due to previous deep-vein thrombosis.”
Simple thread veins around the ankle though would not be a problem but Professor Whiteley says that when a doctor sees them around the ankle, it makes them suspicious that they have been caused by a deeper rooted issue. So be sure to see a professional.
2. Pelvic veins and Pelvic Congestion Syndrome
According to Professor Whiteley, many women suffer from Pelvic Congestion Syndrome which can lead to bad sex, time off work, back ache, hip pain, an aching and dragging pain in the pelvis and even Irritable Bowel Syndrome. For men, it can also lead to erectile dysfunction.
However, Professor Whiteley says that 30 per cent of women with chronic pelvic pain get misdiagnosed, while one in six women with leg varicose veins actually have them arising from pelvic varicose veins, yet virtually none are investigated.
“This is why so many people have their leg varicose veins come back even after treatment.
“If they’re lucky they’ll get varicose veins around the pelvis and then we can spot it.”
He adds that in some cases though, it can take over nine years to diagnose .
“Pelvic congestion syndrome can occur in both men and women and people often don’t know they’ve got it.”
What ends up happening is pelvic discomfort and other pain. The cure? “Pelvic vein reflux (Pelvic Congestion Syndrome) is usually cured by coil embolisation of the veins under x-ray control via the neck and under local anaesthetic.
“The coils block the incompetent veins in the same way that laser would block the incompetent veins in the legs, but without using heat.
“Heat deep inside the body can damage other structures hence the need for coils.
“Most women, and some men, with pelvic pain or varicose veins around the labia or scrotum, have pelvic congestion and coils usually cure them,” explains Professor Whiteley.
He adds that rarely, pelvic veins need to be kept open and this would require a stent. Fortunately, it is uncommon that a stent is needed.
DVT signs and symptoms
Deep Vein Thrombosis can be life-threatening - know the signs:
Symptoms of DVT in the leg include:
- throbbing or cramping pain in one leg (rarely both legs), usually in the calf or thigh
- swelling in one leg (rarely both legs)
- warm skin around the painful area
- red or darkened skin around the painful area
- swollen veins that are hard or sore when you touch them
These symptoms can also happen in your arm or tummy if that’s where the blood clot is.
You can call 111 or get help from 111 online.
Source: NHS
3. Leg ulcers
The majority of leg ulcers are caused by problems with the blood flow in your leg veins; varicose veins or hidden varicose veins that have not been treated and have ended up causing long-term inflammation.
It is the stagnant pooling of blood – called ‘stasis’ – that causes these ulcers.
If you spot red and/or brown stains between your ankle and calf muscle, you may be suffering from a venous leg ulcer.
“If you lift your leg up and let the varicose vein drain away, and there’s stains there, then that person is on their way to leg ulcers,” explains Professor Whiteley.
“I often find a stain when patients come in with varicose veins and aching legs.”
He says there is a simple test to check for stains.
“Put your wrist skin by your ankle skin; lift your ankle up and if the ankle skin is clearly darker while your calf skin is similar to wrist skin, then you need to see a vein specialist.”
He adds that while compression – such as wearing compression socks or bandages – can temporarily improve the ulcer, it is not a cure.
“The treatment to cure venous leg ulcers is a venous duplex ultrasound scan to find out the underlying cause followed by endovenous laser ablation/radio frequency/High-intensity Focused Ultrasound (HIFU) of any underlying incompetent veins and TRLOP (a local anaesthetic pin-hole technique) closure of perforators followed by foam sclerotherapy to the dilated veins directly under the ulcer,” he explains.
Sclerotherapy involves injecting a solution directly into the vein.
4. Varicose veins
Swollen and enlarged veins, which are usually dark purple or blue in colour, affect up to three in ten adults, according to NHS Inform.
“They can occur in both legs or just one leg,” says Professor Whiteley.
Varicose veins aren’t always necessarily visible and other symptoms such as aching legs, tired legs and also swollen legs, can be signs of varicose veins.
“Varicose veins can be made better by placing the legs up at the end of the day against a wall or support stockings.
“Some days are worse than others; varicose veins will tend to be worse if you’ve exercised or if you’re in hot weather,” reveals Professor Whiteley.
He says that a duplex scan is the best way to check for varicose veins and this should be done by a specialist, not your usual GP. The best treatment can then be decided.
Vein health myths…
“Pregnancy, being overweight, constipation – in the past all of these were blamed for varicose veins, but research has shown that none of these cause varicose veins,” explains Professor Whiteley.
He adds that a study was done which discovered how by the age of nine, one in 20 people had valves that weren’t working, which meant they were heading towards varicose veins.
“The underlying cause will have happened earlier (before pregnancy) however you don’t notice the veins get bigger and bigger.
“The number of women who say they got hit by a hockey ball or men who got hit by a tennis ball, which triggered their varicose veins, but the underlying venous problem is already there.”
As for whether genetics play a part, Professor Whiteley says “if it was purely genetic, you wouldn’t get it in one leg and not the other”.
He also adds that strength training using heavy weights is also not likely to make venous issues worse in the legs.
5 lifestyle factors impacting your vein health
There are ways to lessen your chances of developing vein problems in your legs…
- Keep moving
Professor Whiteley says cardiovascular exercise is really good for vein health and blood flow. This can include walking and running.
“Walking is nature’s best exercise. The faster the blood flows, the more your endothelium (the layer of cells that line your blood vessels) releases nitric oxide to keep blood vessels healthy.”
Essentially, the faster the blood flows, the healthier it is.
- Stop smoking
Professor Whiteley warns that all the advantages of exercise are destroyed by cigarettes.
“Smoking also increases your risk of clots, which are associated with deep vein thrombosis.”
- Enjoy oranges
Professor Whiteley explains that citrus fruits such as oranges, grapefruits, satsumas and lemons contain a group of flavonoids (plant compounds) called micronized purified flavonoid fraction (MPFF).
This MPFF is often combined with another flavonoid called diosmin, which studies have found to be helpful in treating venous insufficiency, leg ulcers and other circulatory issues.
“Citrus fruits are brilliant for venous diseases.You can buy MPFF as a supplement,” he adds.
- Stay topped up with vitamin C
Professor Whiteley also says that any patient with a venous leg ulcer has a high requirement for vitamin C.
He recommends 1,000mg a day, unless there is contraindication to do so.
Foods containing vitamin C include fruits and vegetables, in particular citrus fruits, strawberries, tomatoes and white potatoes.
- Eat protein for leg ulcers
As well as vitamin C for leg ulcers, protein is also important.
Protein helps tissues to heal, makes new cells and it is used in the immune response and inflammation that is healing.
“Therefore the protein is needed for tissue repair, not vein health in itself,” says Professor Whiteley.
Find protein in meat, eggs, fish, tofu, dairy foods and also beans and legumes.