Understanding the Complications of Varicose Veins: A Comprehensive Guide

Dec 07, 2023

Dr Tan Yih Kai

Welcome to our latest health blog post, where we delve into the world of varicose veins, a common condition that affects many individuals. While varicose veins are often seen as a cosmetic concern, it’s crucial to understand that they can lead to a variety of health complications. Here, we explore these complications in detail to help you stay informed and proactive about your health.

One of the more severe complications of varicose veins is the development of venous ulcers. These ulcers typically appear around the ankles and can be quite painful. These arise from increased pressure in the veins (Venous Hypertension). Venous hypertension leads to extravasation of macromolecules and red blood cell degradation products, including iron. These result in chronic inflammatory reactions to the skin and fatty tissue that, over time, can lead to skin breakdown. Healing these ulcers can be a challenging process. The venous ulcers take an average of 6 months to heal, and ulcer recurrence rates at 5 years are >60%.

Venous Leg Ulcer

This condition involves the formation of a blood clot along with inflammation in a vein just beneath the skin. It can cause symptoms like pain, redness, and swelling. While not typically life-threatening on its own, people who have a history of superficial thrombophlebitis, have a lifetime risk of DVT or PE of four to six times the general population. It is important to seek professional advice for further evaluation and management. Anticoagulation may be required in higher-risk cases.

Superficial Thrombophlebitis

Varicose veins can increase the risk of deep vein thrombosis by up to 5 times that of the general population. DVT is a serious condition where a blood clot forms in a deep vein which may dislodge and travel to the lungs, leading to Pulmonary Embolism, a potentially fatal condition. It’s essential to recognise the symptoms of DVT:

1) Swelling in the leg

2) Pain in the calf and/or thigh

3) Redness around the painful area of the leg

Deep Vein Thrombosis (DVT)

The skin over some varicose veins may be quite thin due to the enlarging of the veins. Bleeding may occur spontaneously when the overlying skin is broken down by minor injuries. Bleeding may also occur from a preexisting venous ulcer. This complication can lead to considerable blood loss and requires prompt medical attention. People who are in advanced age, have clotting problems, and are on anticoagulation therapy are particularly at risk.

Venous hypertension from varicose veins can lead to chronic inflammation of the skin and the underlying fat. This inflammatory reaction will eventually lead to lipodermatosclerosis, characterized by hardening (scarring) and tightening of the skin on the lower legs, often accompanied by skin discoloration. Lipodermatosclerotic skin may result in venous ulcers, which are much more difficult to heal.

Lipodermatosclerosis

In this condition, it appears on the skin, indicating areas with significantly reduced blood supply. These patches are susceptible to ulceration. Venous hypertension may lead to thrombosis of small vessels at the capillary level, resulting in scarring of the skin. Atrophie blanche is characterised by irregular, whitish skin patches, mostly appearing at the ankle, and is also prone to developing into skin ulceration.

Atrophie Blanche

Varicose Eczema is a long-term skin condition that affects the lower legs, commonly in people with varicose veins. Varicose eczema of the affected skin can become itchy and swollen, dry, flaky, scaly, and crusty. Varicose eczema is usually caused by valve failure, resulting in increased pressure in the leg veins (venous hypertension). This increases the pressure in the veins, which can cause fluid to leak into the surrounding tissue. It’s thought that varicose eczema may develop because the immune system reacts to this fluid.

Varicose Eczema or Stasis Dermatitis

Faulty valves in the varicose veins cause blood to pool in the leg, leading to increased pressure in the veins.  Fluid in the blood may leak out, leading to a buildup of fluid in the tissue of the lower legs. Sometimes this swelling is evident only at the end of the day, while some swelling may persist throughout the whole day.

Leg Swelling

Leg swelling, and venous skin changes make the skin more susceptible to cracking, compromising its normal barrier function. These cracks in the skin can allow bacteria to enter, leading to infection and inflammation of the skin and subcutaneous tissues, a condition termed cellulitis. Moreover, the swelling can impair the normal immune response in the affected area, reducing the skin’s ability to fight off bacterial infections, thus making cellulitis more likely to occur.

Cellulitis

Those who have varicose veins can take the necessary steps to manage their condition by being aware of these potential complications. This may include lifestyle modifications, medical interventions, or in some cases, surgical procedures. Remember, being informed is the first step towards maintaining your vascular health!

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