A varix (plural varices) is a medical term for an enlarged blood vessel, most often a vein. This condition results from an underlying issue that causes the vessel to swell and lengthen, frequently becoming tortuous or twisted in appearance. While the term encompasses common conditions like varicose veins in the legs, it also refers to more serious internal dilatations that form in organs like the esophagus or stomach. Recognizing the difference between superficial and internal varices is important, as the latter often indicate a significant systemic health problem.
How a Varix Develops
The formation of a varix is directly related to a buildup of pressure within the circulatory system, known as venous hypertension. Veins are designed to carry deoxygenated blood back toward the heart. When the normal path of blood flow is blocked or restricted, pressure increases behind that obstruction. This elevated pressure forces the blood to seek alternate routes, redirecting it into adjacent, smaller veins.
This process is known as collateral circulation, where the body attempts to bypass the high-pressure area. This utilizes vessels not designed for such a large volume and pressure of blood. These smaller veins often have thin walls, causing them to balloon out and become permanently dilated and twisted under the strain. The resulting enlarged, fragile vessel is a varix. The size of the varix is directly correlated with the pressure inside the vessel, with larger varices posing a greater risk of rupture.
Where Varices Commonly Occur
Varices are broadly categorized into superficial and internal types. Superficial varices are most frequently observed in the legs, where they are commonly known as varicose veins. They develop due to weakened vein walls and faulty valves within the leg veins, which allow blood to pool, causing the vessel to swell and become visible just beneath the skin.
Internal varices occur particularly in the gastrointestinal tract, such as esophageal varices in the lower esophagus and gastric varices in the stomach. Their formation is strongly linked to portal hypertension, which is elevated blood pressure in the portal vein system that carries blood to the liver. When scarring of the liver tissue, typically from cirrhosis, obstructs this blood flow, the pressure backs up and forces blood into the smaller, more fragile veins surrounding the esophagus and stomach. Other internal locations include the rectum, where they are termed rectal varices or hemorrhoids, and the area around the umbilicus.
Signs of a Complication
Internal varices often produce no noticeable symptoms until a serious complication, such as bleeding, occurs. Bleeding from a ruptured varix is a medical emergency because the vessel walls are thin and the pressure inside is high, leading to rapid blood loss. The most immediate and visible sign of a ruptured esophageal or gastric varix is hematemesis, the vomiting of blood. This blood may appear bright red, indicating a rapid, fresh bleed, or it may resemble dark coffee grounds if the blood has been partially digested in the stomach.
Another sign of internal bleeding is melena, which refers to dark, tarry, and foul-smelling stools. Melena occurs when blood travels through the digestive tract, where it is chemically altered before excretion. Systemic symptoms of significant blood loss include lightheadedness, paleness, a rapid heart rate, and low blood pressure. In severe cases, uncontrolled blood loss can lead to hypovolemic shock.
Treatment and Prevention Strategies
Management of varices involves primary prevention and intervention for existing or bleeding vessels. Primary prevention focuses on addressing the underlying cause, which in many internal cases is liver disease. Lifestyle modifications, such as avoiding alcohol and maintaining a healthy weight, are important to reduce damage and limit the progression of liver scarring. For patients with known varices, medication such as non-selective beta-blockers (NSBBs) is often a first-line treatment. These drugs lower the pressure within the portal vein system, which reduces the likelihood of a varix rupturing.
For varices at high risk of bleeding or that have already bled, interventional procedures are used to control the vessel. Endoscopic variceal ligation (EBL) is a common technique where small rubber bands are placed around the base of the varices, cutting off blood flow. This causes the varix to shrink and eventually fall off. Another option is Transjugular Intrahepatic Portosystemic Shunt (TIPS), a procedure that involves placing a stent within the liver to create a shunt. This effectively reroutes blood flow and drastically lowers the portal pressure. These strategies are often used in combination to manage the risk and prevent recurrent bleeding.