Men are not immune from varicose veins. In fact, studies suggest an overwhelming 45% of all men suffer from varicose veins at some point in their lives. While varicose veins in both women and men strongly correlate with their family history, lifestyle factors can also play a major role. Other risk factors for men include standing jobs, advanced age, lack of physical activity, weight gain and even trauma. While varicose veins can affect men of almost every age, the risk increases significantly with age as they start experiencing a loss in their muscle mass and tissue tone along with weakened venous valves.
Just like women, varicose veins in men can be a direct outcome of prolonged periods of standing or sitting. During these times, there is poor movement of blood from the legs resulting in increased pressure within the leg veins. Contraction of our leg muscles is needed to squeeze the blood out of our leg veins and move the blood towards the heart. Without these occasional muscle contractions, as occurs during prolonged standing, blood pools within the veins.
With persistent pooling and elevated pressure in the veins, there is slow damage to the one way valves within our veins. These one way venous valves are present to keep blood flowing in one direction, that is against gravity and towards the heart. As these valves become damaged, the elevated pressure in the veins causes the vein to dilate and bulge resulting in a varicose vein. Over time, as things worsen, the person may then start to develop symptoms of venous insufficiency including leg aching, pain, cramping, fatigue, tiredness, restlessness and ankle swelling. Along with these symptoms, the patient will usually note a slow but progressive worsening in their varicose veins.
While varicose veins can be painful and symptomatic, complications arising from varicose veins can be far more detrimental to one’s health. Men and women may suffer from the same types of complications including:
Superficial Thrombophlebitis: With slow flow and stagnant blood within varicose veins, there is the risk of clotting of blood. When a superficial vein becomes clotted and inflamed, superficial thrombophlebitis has developed. This will demonstrate as an area of redness which may be firm and usually painful. Left untreated, superficial thrombophlebitis may worsen and progress to a deep venous thrombosis.
Deep Vein Thrombosis: Although the risk is low, clot from a superficial thrombophlebitis may progress and extend into a deep vein. Clot that involves a deep vein in our body is call a deep vein thrombosis. Deep venous thrombosis requires medical management and usually involves the need for blood thinners. Depending on the extent and severity, in rare circumstances patients may require hospitalization and medications to breakup blood clots called thrombolytics. Commonly these patients have a blood clotting disorder or a significant inciting factor like hormonal therapy.
Hyperpigmentation: With prolonged pooling of blood and elevated pressure within varicose veins, the red blood cells, which should remain in the vein, may migrate out of the vein and towards the skin. These red blood cells will be broken down within the connective soft tissues underlying the skin and lead to areas of darkening called hyperpigmentation. These areas of darkening may vary in color including reddish, purplish and bluish.
Stasis Venous Dermatitis: With progression of venous disease, inflammation of varicose veins may extend to involve the overlying skin. These areas of inflammation may cause areas of small reddish dots that are itchy. This inflammation of the skin from venous disease is called stasis venous dermatitis. Initially these areas of inflammation may be cyclic and come and go depending on how much time the patient is spending standing or on their feet. With continued worsening, the areas of dermatitis will persist until treatment is initiated, including use of graduated compression stockings, ambulation, weight loss, leg elevation, anti-inflammatories and possible vein treatment.
Lipodermatosclerosis: Lipodermatosclerosis is a complication of long standing venous insufficiency that changes the color and texture of the skin. In some patients, underlying inflammation of the subcutaneous soft tissues leads to areas of fat deposit and scarring. This shows as areas of brownish dots which may coalesce into larger areas. The scarring of the tissues changes the texture of the skin to a leathery feel. This is a non reversible complication of venous disease.
Leg Ulcer: In the final stage of venous disease, patients develop a breakdown of the skin, usually around the medial ankle. This breakdown of the skin is called a stasis venous ulcer. These ulcers are usually not painful and appear to weep fluid from the ulcer. This represents the last stage in the international CEAP classification of venous disease. Without treatment, patients may deal with wound care of this ulcer for the rest of their lives.
The treatment of varicose veins in men is the same as in women. Initially treatment begins with conservative management for alleviation of symptoms including the use of graduated compression stockings, ambulation, leg elevation, use of anti-inflammatories and even changing jobs to reduce the amount of time spent standing.
If conservative management is unsuccessful in reducing symptoms and there is progression of complaints and limitations of daily activities, the patient may need a more permanent treatment of their varicose veins and venous insufficiency. These treatments include radiofrequency ablation (RFA), endovenous laser ablation (EVLT), venaseal and sclerotherapy.
If you’re suffering from varicose veins, visit the Center for Varicose Veins in Wilton, CT and book an appointment with Dr. Vinay Madan. Dr. Madan is a board certified Interventional Radiologist and Phlebologist with more than 25 years of experience treating vein disease. He has successfully treated thousands of men suffering from varicose veins and their complications.