I wear compression hose to work every day. After 25 years of vascular surgery practice, my leg veins have taken a beating. If I don’t wear compression hose, my legs ache, swell, and I tend to not sleep well because my legs trash around at night. About 30% of the so called “restless legs syndrome” is actually related to vein issues rather than some type of neurologic problem. Before you try medications such as Requip for restless legs syndrome, wear good medical grade compression hose daily for a week and see how your legs feel.
There are numerous risk factors for vein problems or Chronic Venous Insufficiency (CVI). Women tend to get the problem more than men. Family history of varicose veins is a big risk factor, as well an occupation where you sit or stand all day. Cosmetologists, nurses, physicians, hair dressers, truck drivers, teachers especially come to mind when thinking of occupations that predispose to vein problems. I also see plenty of secretaries and airplane stewardesses and other people who tend to be on their feet or sitting for prolonged periods of time. The typical signs and symptoms of CVI are swelling, particularly at the ankle and calf, varicose veins, a dull aching and discomfort in the legs below the knees. There can be a brown skin discoloration. Sometimes when the legs swell and contract, you can get a red rash like skin changes, that eventually turn brown. The latter stages (what we class class V or VI) venous stasis disease is when one develops ulcers, typically over the inner or sometimes over the outer ankle, although it can also form at other sites. I have been doing this so many years, I can spot it a mile away. CVI is so under diagnosed quite frankly because the primary care physician has so many other things to take care of that they dont’ have a chance to really look at the legs. Vein problems are actually far more prevalent that arterial problems but far less diagnosed. If you have unexplained leg swelling, its a good bet that is is either from vein problems, or medications, and less likely a del vein thrombosis. Other contributors to swelling include congestive heart failure, liver and kidney disease, and lymphatic issues.
The treatment of CVI is usually conservative. I recommend 30 minutes a day of walking at a steady pace. Its not good enough to be walking all day short distances as most patients tell me they do. Its the continuous long distance walking that helps. When you walk, the calf muscles have a pump mechanism that helps to push the vein flow up. CVI and varicose veins occur because the one way valves are not working well (more at a later date). There is no god medication for CVI, so the whole goal is to get the vein blood out of the legs. Weight control is also important. The more weight you carry, the harder the veins have to work, just simple hemodynamics. Elevate your legs as much as possible when you are not walking. The analogy I use is when I drop my hands, my veins really pop out. When I lift them up, they collapse. So you want the vein blood to get out of your legs by elevating them. Lastly, I wear compression hose every day. I use 20-30 mmHg compression hose. I put them on in the morning after I shower, and take them off when I work out. You will notice that some long distance runners wear compression hose when they are running. I don’ find it necessary to wear them when I am working out, but if it makes your legs feel better, there is no harm done. You certainly don’t need to wear compression hose when you go to bed because your legs are already elevated.
There are more aggressive approaches to vein problems, but I will get into vein issues in depth at a later stage. I would recommend to people that they stay away from the vein centers that are popping up all over the place. I hate to make sweeping statements, but I would suggest to you that if your only tool is a hammer, the whole world looks like a nail. Vein centers support themselves by doing procedures. Get another opinion from a physician who tries conservative management first before recommending vein surgeries.
One last note on prevention. I recommend that all women who learn that they are pregnant wear at least knee high 20-30 mmHg compression hose throughout their pregnancy. The blood volume and hormonal changes of pregnancy can cause irreversible changes to veins that show up at a later date. I also recommend if you have a strong family history of vein problems, or are in an occupation where you sit or stand a lot, you wear compression hose. I will really get into leg vein issues and work-up of swelling of the legs at a later post. It is a long and complicated discussion, but I see at least 5 new patients a week for work-up of leg swelling. It is a poorly understood issues, and again most primary care doctors just have too much on their plate with documentation and requirements etc to really spend time on working this problem up.