Taichung Armed Forces General Hospital

1. Varicose veins (commonly called “bulging veins”) are the most common disorder of the venous system. They are mainly caused by prolonged standing or sitting, leading to blood pooling in the lower limbs, damaging vein valves, increasing venous pressure, and resulting in vein dilation.

2. Symptoms and Risk Factors:
Varicose veins appear as twisted, enlarged veins resembling spider webs or earthworms, as hard nodular masses, common symptoms include heaviness in the legs after prolonged standing, easy fatigue, depressive mood, thickened or discolored veins, itching skin and complications like swelling, bleeding, ulcers, and infections.
In Taiwan, about 20–25% of women and 10–15% of men are affected. High-risk groups include the elderly, pregnant women, individuals with a family history, obesity and those who stand for long periods. Factors like genetics, oral contraceptives and pregnancy also contribute.

3. Management:
Varicose veins are irreversible but can be managed conservatively to prevent progression and alleviate symptoms.

• Diet: High-fiber, low-fat diet with added vitamin C and E intake.
• Lifestyle: Weight control, avoid tight clothing and high heels, avoid crossing legs, limit prolonged sitting/standing, elevate legs before bedtime, and sleep on the left side to reduce pelvic vein pressure.

4. When Treatment is Needed:
Most varicose veins are mild and do not require treatment. Prevention and self-care are crucial. However, severe cases may cause ulcers, infection, and bleeding. Avoiding inappropriate treatments and consulting specialists is vital.

5. Treatment Options:
I. Compression Therapy: Wearing compression stockings (preferably thigh-high), especially after elevating the legs for 15 minutes.

II. Sclerotherapy: Injection of hypertonic solutions into varicose veins to cause vessel sclerosis. Limited to small varicose veins; side effects include pain, pigmentation, inflammation, and ulceration. High recurrence rate.

III. External Laser Therapy: Similar to cosmetic laser procedures. Advantages include minimal pain, no scarring, and outpatient treatment, but mainly suitable for small spider veins and requires multiple sessions (self-paid).

IV. Endovenous Laser Ablation: A small incision is made to insert a laser fiber into the vein, which collapses the vein with heat. Benefits include local anesthesia, no hospitalization, minimal pain, no scars, and high success rates. Severe or large varicosities (>8 mm) may require additional treatments like microphlebectomy.

V. Microphlebectomy (Endoscopic Powered Phlebectomy): Uses endoscopy and suction to remove varicose veins through small incisions. Better cosmetic results but still requires anesthesia and self-payment.

VI. High Ligation and Stripping Surgery: Under regional or general anesthesia, the great saphenous vein is ligated and stripped. Requires 2–3 days of hospitalization, and may cause subcutaneous bruising and pain.

6. Prevention Tips:
Elevate legs frequently, wear compression stockings, elevate the foot of the bed, limit high heel use, maintain a healthy weight, avoid tight clothing, use caution with oral contraceptives, avoid smoking, and walk regularly.

7. Stretching Exercises for Varicose Vein Prevention:

• Heel Raises:
  Stand on a thick book (10 cm height), let your heels hang off, and slowly lower and raise them 10 times.
• Seated Hamstring Stretch:
  Place one leg on a chair, point toes upward, bend over and reach for your toes. Hold for 5 seconds, then switch sides.
• Cross-Leg Forward Bend:
  Cross your legs while standing, bend down slowly, and try to touch your ankles. Hold for 3–5 seconds.
• Wall-Assisted Quad Stretch:
  Stand near a wall, hold your ankle behind you, and stretch the front of your thigh for 5–10 seconds. Alternate sides.
• Leg Elevation:
  After completing the exercises, lie on your back and place your legs vertically against a wall for 10–15 minutes to promote blood return.
• Calf Muscle Pump Exercises:
  While lying down, flex and extend your feet repeatedly to strengthen calf muscles and help venous return.