Ehlers-Danlos syndromes (EDS) are a group of thirteen related inherited disorders that affect the body’s connective tissues. These tissues provide support and structure to many parts of the body, including the skin, joints, bones, and the walls of blood vessels. Varicose veins are characterized as enlarged and twisted veins, which become swollen and raised, most often appearing in the legs and feet. The underlying tissue fragility in EDS can make individuals more susceptible to developing varicose veins. This connection stems from the genetic foundation of EDS and its direct impact on the structural components of the venous system.
The Connective Tissue Link
The fundamental connection between Ehlers-Danlos syndrome and varicose veins lies in the composition of blood vessel walls. A primary protein responsible for providing strength and structure to veins is collagen. In individuals with EDS, genetic mutations disrupt the synthesis, processing, or structure of collagen, leading to more fragile tissues. Specifically, many forms of EDS involve defects in collagens such as type III collagen, a major component of blood vessels and hollow organs.
This faulty collagen results in vein walls that are weaker and more distensible. Veins contain small one-way valves that open to allow blood to flow toward the heart and close to prevent it from flowing backward. The structural weakness in the vein walls of people with EDS means the veins can stretch and widen more easily. This dilation can pull the leaflets of the venous valves apart, causing them to fail and allowing blood to leak backward and pool in the lower extremities, a condition known as chronic venous insufficiency.
The constant pooling of blood increases pressure inside the vein, which further exacerbates the stretching and twisting of the vessel, causing it to become varicose. Because the underlying tissue fragility is present from birth, individuals with EDS often develop varicose veins at a significantly younger age than the general population.
Associated Symptoms and Risks
The symptoms experienced by individuals with both EDS and varicose veins often mirror those in the general population but can be intensified by the underlying condition. Common complaints include a persistent aching or throbbing pain in the legs, a sensation of heaviness, and noticeable swelling, particularly after periods of standing or sitting. Itching or irritation of the skin directly over the affected veins is also frequently reported. These symptoms arise from the pressure and inflammation of pooled blood.
For people with EDS, the presence of varicose veins introduces heightened risks directly related to their tissue fragility. The skin and blood vessels are inherently delicate, meaning even minor bumps or pressure can cause significant bruising around the varicose veins. The skin overlying the veins may be thin and prone to breaking down.
A more serious concern is the elevated risk of developing venous stasis ulcers, which are open sores that can form on the skin, typically near the ankles. In the context of EDS, these ulcers can be particularly problematic due to impaired wound healing, another characteristic of the syndrome. Furthermore, the rarest and most severe form, vascular EDS (vEDS), carries an extreme risk of spontaneous vessel rupture due to profoundly fragile arteries and veins.
Management and Treatment Approaches
The management of varicose veins in patients with Ehlers-Danlos syndrome is centered on conservative, low-risk strategies to mitigate symptoms and prevent complications. The primary approach involves consistent use of compression therapy. Medical-grade compression stockings or garments apply gentle, graduated pressure to the legs, which helps support the weak vein walls and enhance circulation. Regular leg elevation can also alleviate swelling and discomfort by using gravity to assist blood flow.
Engaging in appropriate physical activity is another component of conservative management. Low-impact exercises such as swimming, walking, or cycling are recommended because they activate the calf muscles, which act as a pump to push blood through the veins without placing undue stress on hypermobile or unstable joints.
When conservative measures are insufficient, procedural interventions may be considered with significant caution. Sclerotherapy may be less effective in EDS patients and carries risks due to tissue fragility. Endovenous ablation, which uses heat to seal a vein, presents challenges related to healing, and surgical options like vein stripping are a last resort. The inherent risks of poor wound healing and scarring are magnified by the connective tissue disorder. Any decision for procedural treatment requires a careful discussion between the patient, a vascular specialist, and a physician knowledgeable about their specific type of EDS.