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Forum Name: Miscellaneous Cardiology Topics

Question: Sudden onset of varicose veins.


 NicolaSam - Sun Jul 25, 2010 11:46 pm

Hello,

I am a 27 year old active and fit female. I swim 4 days a week and am 5'6" and 125 lbs. In the last year and a half, I have noticed several veins on each of my lower legs have begun to buldge out when I stand or am up on my feet. I have had one varicose vein on the back of my thigh since I was about 13, and that one has gotten slightly worse, but all the new ones along my shins and near my ankles have just appeared recently. My parents have passed away, but I do remember that my mom had moderate varicose veins.

I went to a cosmetic vein doctor last summer, who did an ultrasound and didn't see anything abnormal with my veins. I have been putting off getting any cosmetic surgery done to them because I fear they will just get worse once I do it and my money will have been wasted.

Is this normal for someone my age? Should I be concerned about how quickly they are appearing? Should I go through with surgery to fix them now, or would it make more sense to wait until they are worse? Unfortunately, I do not have medical insurance so I am just left to search the web for advice and worry myself sick over it. Any advice anyone can give me would be greatly appreciated. Thank you!
 Dr.M.Aroon kamath - Tue Jul 27, 2010 10:29 am

User avatar Hi,
Development of lower limb varicose veins at the age of 13 is uncommon but not unknown. Varicose veins do occur in otherwise normal children and adolescents as some studies indicate.

There are may known predisposing factors for the development of varicose veins, some of which are,
- genetics, increasing age, female sex, pregnancy, multiparity, obesity, positive family history, Prolonged standing, lifestyle, Past history of DVT, trauma,alcohol,smoking etc.

There is a striking geographic variation in the occurrence of
varicose veins.The prevalence of incompetence of the sapheno-femoral junction(according to some studies) is higher in subjects with positive family history of varicose veins compared to those with negative one. Others dispute this.

Oral contraceptives, Hormone replacement therapy show only a weak association.

I will provide you with a few causes of varicose veins in children and adolescents and few unusual causes of varicose veins.

Although there is much evidence supporting a relationship between primary varicocoele and venous incompetence of the saphenofemoral junction in adults, there is no evidence for such a relationship during adolescence.

Between 10 and 12 years of Bochum study I, isolated refluxes were found at the saphenofemoral junction (internal saphenous vein 2.9%, external saphenous vein 0.2%), but no varicose vein was yet visible at the trunk level. In the adolescents aged between 14 and 16 years, of Bochum study II, the number of refluxes of the internal and external saphenous vein had greatly increased, and isolated varicose veins were found at the trunk level.
http://www.ncbi.nlm.nih.gov/pubmed/2093907

One study demonstrated high concurrence of varicocoele and valvular incompetence of the saphenofemoral junction in adolescent males affected by primary varicocoele in order to detect the early diagnosis of venous insufficiency of the lower limbs among these patients.
(Mirace Yasemin Karadeniz-Bilgili et al, Pediatric Radiology; Volume 33, Number 9 / September, 2003)

Varicose veins are known to occur in young people afflicted with Joint hypermobility syndrome [vascular Ehlers-Danlos syndrome (Type IV)]. Arteriovenous fistulae may also occur.

Klippel-Trenaunay syndrome consists of three symptoms often seen together: port wine stains, varicose veins and limb hypertrophy.Varicose veins in this condition are much larger and are distributed over a wider area than normal varicose veins. They may involve the whole lower limb,sometimes even the buttocks and abdomen and may become more visible as the child grows.

A persistent sciatic vein is frequently associated with Klippel-Trenaunay syndrome. A persistent sciatic vein has also been reported to occur as an isolated primary entity.

In all probability, you most likely have simple varicose veins of earlier onset.
The usual indications for surgery in simple varicose veins are, recurrent episodes of thrombophlebitis, failure to respond to conservative measures(such as the graduated compression stockings) after 6 months and bleeding. Of course, even in the abscence of these indications, one may opt for surgery for purely cosmetic reasons.Your doctor will be able to guide you regarding the management.
Good luck!

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