Link between DVT and varicose veins uncertain

Dear Doctors: I inherited my mother’s prominent varicose veins, and despite surgery, they are back. My sister recently told me our mother had deep vein thrombosis when she was older. She told me to be careful, and to watch for symptoms. Am I at risk because of my varicose veins?

Dear Reader: Deep vein thrombosis, or DVT, is a serious condition that is considered a medical emergency. It occurs when a blood clot, also known as a thrombus, forms in the veins deep within the body. Although DVT is most common below the knee, it also occurs in the thighs, arms or abdomen. It can be caused by slow or reduced blood flow due to prolonged periods of immobility, increased blood pressure within the vein, increases in blood viscosity or physical damage to the veins themselves. The danger is that if a blood clot breaks free, it can travel to the lungs and cause a blockage, known as a pulmonary embolism. This can be fatal.

Whether due to genetics or a range of health conditions, some people are at increased risk of coagulation, which also plays a role in DVT. Additional risk factors include being obese, being older, living with chronic heart or airway disease, having a recent surgery, living with cancer and smoking.

Elizabeth Ko, MD and Eve Glazier, MD

DVT can be a silent condition. When symptoms do occur, they include a throbbing sensation or a cramping pain, occurring only in one leg, typically below the knee. The area may feel unusually warm, and skin may appear reddened or a darker hue than usual. In some cases, swollen veins may be visible, which feel tender and are hard to the touch.

Varicose veins, by contrast, are surface blood vessels that have become visibly enlarged or misshapen. This occurs due to increased blood pressure that is beyond what the somewhat-fragile one-way valves in the veins can withstand. The result is that the valves allow some of the blood that is headed to the heart to flow backward, which causes it to pool. This gives varicose veins their characteristic dark blue or purplish color and their raised or swollen appearance. Risk factors for developing varicose veins include older age, being overweight, being female, smoking, using oral birth control or hormone replacement, and inactivity. Although not considered a serious medical condition, varicose veins can be uncomfortable, and even painful.

When it comes to your question about varicose veins being a risk factor for deep vein thrombosis, the answer is not yet entirely clear. A study published in the Journal of the American Medical Association in 2018 found a link between having varicose veins and an increased risk of DVT. However, the patients with varicose veins also had a measurably higher incidence of other medical conditions, including respiratory disease, cardiovascular disease and metabolic conditions such as diabetes. This made drawing a direct connection between the varicose veins and DVT somewhat tricky. To ease your mind, it would be a good idea to become familiar with the symptoms of DVT. If any of them should arise, seek immediate medical care.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA 90025. Owing to the volume of mail, personal replies cannot be provided.)


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