Varix Center

Varix Center

Varix is a problem as old as the history of humanity. Varices are significantly shown in some ancient Greek statues built 2500 years ago. However, it was first defined in Ebers papyri in 1600 BC in a written document. Today it is regarded as a widespread disease affecting 5 to 40 percent of people, lowering life quality and causing severe cosmetic problems, though not life-threatening.

The estimation that minimum 5 million people in our country have varices in different degrees is obviously true. Arterial blood reaching our legs is sent to the lung as venous blood with the effect of pumping in veins caused by the contracting of leg muscles, and gravity causes the blood flowing upward to return back to our legs. The valves of the veins in the leg permit the blood only to flow upward to the heart, and close to prevent gravity from reversing this flow. If these valves are damaged due to some genetic or acquired factors, the blood sent to the lungs flows back (reflux) with the effect of gravity and build up in the veins of the leg. Due to the increased pressure caused by this reflux in years, the veins in the leg swell, expand and ultimately form varices.

What is varix?

Simply defined, varix is a disease specific to humans, characterized by dilation and lengthening of a vein especially in the legs, accompanied by tortuosity. It has not been identified in any other mammalian. The reason of dilation in this system which is responsible for transporting blood from the legs to the heart (bottom to top) is dysfunction of the valves of our veins in the leg (venous insufficiency).

In general there are three types of varices in terms of size and proximity to the skin.

Large varices (varicose veins)

They cause significant protrusion in the skin with diameters between 4 - 15 mm, and often develop due to valvular incompetence in a large superficial vein.

Medium sized varices (reticular veins)

They cause slight protrusion in the skin with diameters between 2 – 4 mm, are green-red in color, and often develop due to valvular incompetence in a smaller superficial vein.

Capillary varices (spider veins)

They do not protrude from the skin, have diameters smaller than 1 – 4 mm, are red-purple in color, and often develop due to valvular incompetence in one or several small superficial veins.

What are the symptoms of varix?

1. Edema: Often edema occurs in the ankle and the calf. Edema occurs especially towards the evening due to prolonged standing, and is not apparent when you get up in the morning.

2. Pain: It is a blunt and deep pain that develops due to prolonged standing and imposes weight on the leg. Pain is relieved by lifting the leg upward or lying for a while.

3. Itching: Itching accompanied by burning sensation and throbbing may develop in and around the ankle especially when change of color occurs.

4. Night cramps, tiredness and tension: Restlessness in legs and the feeling of not knowing where to place your feet which especially occur after prolonged starting or long journeys may be signs of varix.

5. Thrombophlebitis: Thrombophlebitis is characterized by post-traumatic or spontaneous clotting of enlarged bone structures and superficial inflammation. The skin becomes red, hot and excessively sensitive. It may disappear spontaneously or with treatment, but may relapse.

6. Skin changes: Changes may occur in a wide perspective from color changes to open and non-healing lesions.

7. Bleeding: It is the only case that constitutes urgency. Due to high pressure, varix bleedings may be serious. Bleeding is generally stopped with sufficient compression.

What is the course of varix disease?

Complaints such as pain in the legs, cramps constantly increasing within the day, leg ache especially in the first half of the night, swelling in legs and ankles, feeling of heaviness in the legs, numbness and prickling will disappear when treatment is initiated. Delaying the treatment may cause non-healing leg lesions, thickening and hardening of the skin, bleeding, inflammation (phlebitis) in progressed cases, accompanied by severe pain and edema, constantly-increasing and -darkening spots, and as a result, treatment becomes difficult, and symptoms may not be completely recovered despite treatment.

Today, the clinical steps of varix development have been classified:

• C0: Venous insufficiency does not have an apparent symptom.
• C1: Spider and reticular veins are present.
• C2: Varicose veins are present.
• C3: Edema
• C4a: There are dermal symptoms associated with venous insufficiency such as pigmentation and eczema.
• C4b: There are dermal changes that we call lipodermatosclerosis and atrophie blanche.
• C5: Healed venous ulcers in C4.
• C6: There are active ulcers.

How is varix diagnosed?

Edema (swelling), change of skin color and presence of venous ulcers which are clinical signs of chronic venous disease are generally sufficient to diagnose venous hypertension without applying diagnostic methods. However, in some suspicious cases, diagnostic methods are employed to finalize the diagnosis and identify the exact cause (reflux, occlusion or venous pump dysfunction), and to determine the exact location and level of the disease. Today, three major diagnostic methods are preferred:

1. Ultrasound

2. Contrast venography

3. Magnetic Resonance venography

Today, diagnostic contrast venography has been replaced by noninvasive methods like duplex ultrasonography and magnetic resonance (MR) imaging. Other techniques are only employed when there are doubts as to the diagnosis. Briefly, duplex ultrasonography has been a method continually used in the clinic as an easy, reliable, repeatable, non-invasive and inexpensive diagnostic method. In duplex ultrasonography, real-time anatomic views of deep and superficial venous vessels and dynamic evaluation of the blood flows in these vessels can be performed using sound waves, and the problem in the venous system and its location can easily be determined.