Are Varicose Veins Inherited?

Do You Have Your Mother’s Legs?

One of the strongest risk factors for varicose veins is a family history. We often see mothers and their daughters, fathers and sons, siblings, and some times the entire family for similar varicose vein issues. This picture demonstrates a mother and her daughter with ironically the same varicose vein pattern of distribution. Don’t want your mother’s legs? Stay on top of your vein condition and have them treated or maintenance treatment to avoid bulging varicosities.

Varicose veins may be hereditary. This picture demonstrates a mother and daughter who have the same distribution of varicose veins.

Varicose veins may be hereditary. This picture demonstrates a mother and daughter who have the same distribution of varicose veins.

Recognize Signs of Venous Disease

Recognize the signs and symptoms of venous disease:

heavy, tired and aching legs

swollen legs and or ankles

cramping in the legs

dull or sharp pain in the calf

varicose veins and spider veins

red or warm veins

itching around the veins

skin changes around the ankles such as pigmentation, brownish discoloration, eczema, new red and blue veins, breakdown of the skin

 

Heaviness

Heavy legs are a common symptom of venous insufficiency and varicose veins.You should see your vascular specialist for any of the above signs and sympto

 

 

 

What Are Vein Valves?

GSV valve 2

The valves inside the leg veins can be seen on ultrasound. The arrow points to a valve in the great saphenous vein within the leg.

healthy_and_diseased_valves

Leg veins have one-way valves that prevent blood from flowing backward. Diseased valves are ‘leaky’ and allow blood flow both forward and backward, eventually causing bulging of the veins, i.e., varicose veins.

In the circulatory system, the veins carry de-oxygenated blood back to the heart. The leg veins carry blood toward the heart, against gravity. Therefore, the leg veins have one-way valves the prevent back flow of blood. When the valves do not function properly, they allow blood to flow backward, causing pooling of blood. This  is referred to as venous reflux or venous insufficiency. Eventually, the backflow of the blood will cause varicose veins to develop and symptoms related to the increased pressure in the leg veins such as leg heaviness, aching, swelling, restless legs, night cramps, throbbing and pain. 

Muscle Hernia or Varicose Veins?

Muscle herniations of the legs frequently are confused with varicose veins. Patients may present with bulging along the outer part of the shin, that looks like a varicose vein. It may or may not be painful. It goes away with flexing the foot (pointing your toes to your head).  But, to experienced vein care specialists, it is clearly a muscle herniation.

A Muscle herniation is a focal protrusion of muscle tissue through a defect in the deep fascial layer. Anterior tibial muscle is the most commonly affected muscle of the lower extremities because its fascia is the most vulnerable to trauma. Clinically it is characterized by asymptomatic or painful, skin-coloured, soft, subcutaneous nodules of various size depending on the position. The diagnosis is usually made clinically based on its typical manifestations, but ultrasonographic examination is useful for detecting the fascial defect and excluding other conditions caused by soft tissue tumours such as lipomas, angiolipomas, fibromas, schwannomas or varicosities.

Usually, surgical treatment is not needed, but may be necessary for increasingly painful hernias.

At La Jolla Vein Care, we frequently see muscle herniations that are confused with varicose veins. Using ultrasound technology and a clinical examination, we can make the accurate diagnosis.

Blood Clotting Mutation Affects 1-2% of the Population

A point mutation (G20210A) in the Factor II (prothrombin) gene is the second most common cause of inherited blood clots and accounts for 20% of the inherited blood clotting disorders. The incidence of this mutation in the Caucasian population is 1-2% and in African Americans it is 0.1%. Carriers of this mutation have an increased risk (3x) of developing a blood clot in the deep veins (deep venous thrombosis or DVT).  A test for this mutation is usually only recommended if there is a family history of blood clots (DVT) or in cases where the cause of the blood clot is not clear or in pregnant women with recurrent miscarriages.  A more common cause of a blood clotting disorder that is inherited from the parents is the Factor V Leiden mutation.

Preventing Vein Disease

It is impossible to prevent an inherited tendency toward having varicose veins, but it is certainly possible to take measures that will help. Remember that varicose veins are veins that have been stretched so often that they have become chronically dilated. The trick is to limit the opportunity to distend the veins.

1. Wear compression stockings

2. stay fit and maintain a healthy weight

3. exercise: exercising helps your veins pump blood.

4. avoid prolonged sitting or standing

5. avoid prolonged exposure to direct sunlight

runners leg

Exercising the muscles in your legs helps your veins pump blood. This, in turn will reduce the pressure within the veins and can help reduce symptoms related to vein problems.

6. elevate your legs as much as possible

Correlation Between Restless Leg Syndrome and Varicose Veins

Slide1Varicose veins and venous insufficiency are neglected causes for restless leg syndrome.  Restless legs syndrome (RLS) is a neurological disorder characterized by throbbing, pulling, creeping, or other unpleasant sensations in the legs and an uncontrollable, and sometimes overwhelming, urge to move them. Symptoms occur primarily at night when a person is relaxing or at rest and can increase in severity during the night. Moving the legs relieves the discomfort. Often called paresthesias (abnormal sensations) or dysesthesias (unpleasant abnormal sensations), the sensations range in severity from uncomfortable to irritating to painful.

RLS is often felt to be a neurological problem that is treated with medication, but there are other causes such as thyroid disease, anemia, pregnancy, and varicose veins. RLS is actually common amongst patients with varicose veins. La Jolla Vein Care’s Dr. Bunke completed a clinical study at UCSD along with Dr. Maria Alfaro, MD evaluating the correlation between restless leg syndrome and varicose veins.  Eight patients who had restless legs syndrome, and underlying venous insufficiency were study. These patients underwent treatment of their varicose veins either with foam sclerotherapy or endovenous ablation. All patients had either resolution or improvement of their restless legs symptoms, eliminating the need for neurological medications.  The impact of this study is that all patients with RLS should be screened for venous disease clinically by their doctors. If they have signs of venous disease such as varicose veins, Dr. Bunke recommend an ultrasound evaluation.  ‘If RLS symptoms are related to varicose veins, it is correctable by treating the varicose veins, eliminating the need for pharmacologic therapy in many patients and a better nights sleep,’ says Dr. Bunke.

Complications of Varicose Veins #6: Darkening of the Skin

CVI with Ulcer

Untreated varicose veins and underlying venous insufficiency can cause changes of the skin, including darkening of the skin. We call this skin hyperpigmentation. This usually occurs in the inner ankle and can worsen to involve the lower portion of the leg as shown in the picture.

Complications of Varicose Veins #6: Darkening of the Skin Around the Ankles

Untreated varicose veins and underlying venous insufficiency can cause changes of the skin, including darkening of the skin. We call this skin hyperpigmentation.  This usually occurs in the inner ankle and can worsen to involve the lower portion of the leg as shown in the picture.  Over time, the skin becomes firm, dry, eczema like and can even break open, causing a venous leg ulcer.  When the skin becomes darker as a result of a vein problem, this is referred to as chronic venous insufficiency (CVI). This can be prevented by addressing the underlying venous insufficiency and varicose veins early on.

Complications of Untreated Varicose Veins #5: Swelling

Swollen Ankles

Leg swelling is a common symptoms of varicose veins and venous insufficiency. The legs often feel heavy. It is common to notice sock lines around the ankles by the end of the day.

Complications of Untreated Varicose Veins and Venous Insufficiency #5: Swelling of the Ankles/legs

Leg swelling (swelling is also known as edema), is a common complaint related to varicose veins and underlying venous insufficiency. Leg swelling can be present simply from underlying venous insufficiency without visible signs of varicose veins or spider veins. As a result, a venous insufficiency study by duplex ultrasound scanning is part of the recommend work-up for leg swelling.  The swelling usually affects the ankles.  Most people with vein-related swelling experience progressive swelling throughout the day, that is worse at night time and improved in the morning (they usually wake up with normal appearing legs in the morning but by night-time, shoes may feel tight.) Vein-related swelling is worse at the end of the day, with prolonged standing, sitting or with air travel, heat and menstruation.  The degree of swelling varies from one person to another.

Compression stockings and legs elevation will help reduce swelling.   If the swelling can be attributed to the varicose veins or venous insufficiency, correction of the underlying vein problem will reduce swelling.