Varicose veins are veins that have become enlarged and tortuous. The term commonly refers to the veins on the leg, although varicose veins can occur elsewhere. Many patients who suffer with varicose veins seek out the assistance of physicians who specialize in vein care. These physicians are called Phlebologists.
Veins have leaflet valves to prevent blood from flowing backwards (retrograde). Leg muscles pump the veins to return blood to the heart, against the effects of gravity. When veins become varicose, the leaflets of the valves no longer meet properly, and the valves don't work. This allows blood to flow backwards and they enlarge even more.
Varicose veins are most common in the superficial veins of the legs, which are subject to high pressure when standing. Besides cosmetic problems, varicose veins are often painful, especially when standing or walking. They often itch, and scratching them can cause ulcers. Serious complications are rare. Non-surgical treatments include sclerotherapy, elastic stockings, elevating the legs, and exercise.
The traditional surgical treatment has been vein stripping to remove the affected veins. Newer, less invasive treatments, such as radiofrequency ablation and endovenous laser treatment, are slowly replacing traditional surgical treatments. Because most of the blood in the legs is returned by the deep veins, the superficial veins, which return only about 10 per cent of the total blood of the legs, can usually be removed or ablated without serious harm. Varicose veins are distinguished from reticular veins (blue veins) and telangiectasias (spider veins), which also involve valvular insufficiency,by the size and location of the veins.
Causes
Varicose veins are extremely common occurring in over 30% of the population. They can be inherited. Pregnancy and obesity are also important causes. They are more common in females than in male
Symptoms
Aching, heavy legs (often worse at night and after exercise).
Appearance of spider veins (telangiectasia) in the affected leg.
Ankle swelling.
A brownish-blue shiny skin discoloration near the affected veins.
Redness, dryness, and itchiness of areas of skin - termed stasis dermatitis or venous eczema, because of waste products building up in the leg.
Minor injuries to the area may bleed more than normal and/or take a long time to heal.
In some people the skin above the ankle may shrink (lipodermatosclerosis) because the fat underneath the skin becomes hard.
Restless legs syndrome appears to be a common overlapping clinical syndrome in patients with varicose veins and other chronic venous insufficiency.
Whitened, irregular scar-like patches can appear at the ankles. This is known as atrophie blanche.
Prevention of Varicose Veins
Strategies for the prevention of varicose veins include a program of exercise, healthy eating, and weight management. Daily exercise such as walking, jogging, swimming, or cycling keeps the pumps in the calf muscle working and promotes circulation. Good circulation is key to keeping blood from collecting in the veins. If you already have varicose veins, overly strenuous exercises should be avoided. Always talk to your physician before beginning any exercise program.
For the prevention of varicose veins, a healthy diet can also help-especially one high in fiber. Good eating habits promote bowel regularity and help people achieve or maintain an ideal weight. Individuals who are overweight or obese are more likely to have high blood pressure, putting an extra strain on blood vessels and making them more susceptible to becoming varicose veins.
For the prevention of varicose veins it is also recommended that you avoid tight clothes, high-heeled shoes, and standing for long periods of time.
Treatment
Compression Stockings : -
For more severe varicose veins, your physician may prescribe compression stockings. Compression stockings are elastic stockings that squeeze your veins and stop excess blood from flowing backward. In this way, compression stockings also can help heal skin sores and prevent them from returning. You may be required to wear compression stockings daily for the rest of your life.
For many patients, compression stockings effectively treat varicose veins and may be all that are needed to relieve pain and swelling and prevent future problems.
When these kinds of treatments alone do not relieve your varicose veins, you may require a surgical or minimally invasive treatment, depending upon the extent and severity of the varicose veins. These treatments include sclerotherapy, ablation, vein stripping, and laser treatment.
Sclerotherapy : -
During sclerotherapy, your physician injects a chemical into your varicose veins. The chemical irritates and scars your veins from the inside out so your abnormal veins can then no longer fill with blood. Blood that would normally return to the heart through these veins returns to the heart through other veins. Your body will eventually absorb the veins that received the injection.
Ablation : -
Ablation uses a thin, flexible tube called a catheter inserted into a varicose vein. Tiny electrodes at the tip of the catheter heat the walls of your varicose vein and destroy the vein tissue. As with chemical sclerotherapy, your varicose vein is then no longer able to carry blood, and it is eventually absorbed by your body.
Laser Treatment : -
Laser treatment is another way to treat varicose veins. Your physician inserts a tiny fiber into a varicose vein through a catheter. The fiber sends out laser energy that kills the diseased portion of your varicose vein. The vein closes and your body eventually absorbs it.
Vein Stripping : -
To perform vein stripping, your physician first makes a small incision in the groin area and usually another incision in your calf below the knee. Then your physician disconnects and ties off all major varicose vein branches associated with the saphenous vein, the main superficial vein in your leg. Your physician then removes the saphenous vein from your leg.
A procedure, called small incision avulsion, or sometimes ambulatory phlebectomy, can be done alone or together with vein stripping. Small incision avulsion allows your physician to remove individual varicose vein clusters from your leg using hooks passed through small incisions. In a similar procedure called TIPP, your physician shines an intense light on your leg to show your veins.
Once your physician locates a varicose vein, he or she passes a suction device through a tiny incision and suctions out the vein. Although these procedures sound painful, they cause relatively little pain and are generally well tolerated. Your vascular surgeon will advise you regarding which procedure is the best for your particular situation
Complications
This is when problems occur during or after the operation. Most people are not affected. The main possible complications of any surgery include an unexpected reaction to the anaesthesia, excessive bleeding during or soon after surgery, or infection. A blood transfusion may be required to replace the lost blood, or antibiotics to treat an infection.
Some of the complications specific to varicose vein surgery are listed here : -
After surgery, it's possible to develop a blood clot (DVT) in the deep veins in the leg. In most cases this is treatable, but it can be a life-threatening condition. Compression stockings and blood-thinning injections may be used to help prevent DVT.
Damage to the nerves in the skin, resulting in small numb patches on your legs. The feeling usually returns but may take a few weeks or months.
Rarely, nerve damage near the knee can affect movement in the ankle which may be permanent.
Occasionally hard, tender lumps appear near the scars or along the line of the removed veins. These usually disappear after several weeks. Rarely, small patches of brown skin form where the veins were removed.
There is a chance the varicose veins may re-occur in other veins.
Side Effects
Possible side effects from this surgery may include the following : -
There is a risk of heart and breathing problems from the general anesthesia.
Bleeding and congestion of blood can be a problem; however, the collected blood usually settles on its own and does not require any further treatment.
Wound infection, inflammation, swelling, and redness.
Permanent scars.
Damage of nerve tissue around the treated vein. It is hard to avoid harming small nerve branches when veins are removed. This damage can cause numbness, burning, or a change in sensation around the surgical scar.
A deep-vein blood clot. These clots can travel to the lungs and heart. Injections of heparin, a medicine that reduces blood clotting, reduce the chance of these dangerous blood clots. Heparin also can increase the normal amount of bleeding and bruising after surgery.
Significant pain in the leg and recovery time of one to four weeks, depending on the extent of surgery, is typical afterwards.
Result
Q. How long can I expect results to last ?
Sclerotherapy will permanently erase noticeable varicose and spider veins. However, no treatment will prevent new veins from emerging in the future. Most patients are very pleased with the results of sclerotherapy. Your skin will appear younger, clearer and healthier. Speak with your plastic surgeon about the benefits of sclerotherapy and varicose and spider vein treatment today.
FAQs
Q. What causes varicose veins ?
Varicose veins occur when the one way valves in the veins in the leg fail allowing blood under pressure to flow the wrong way. The veins are not designed to cope with this increased pressure so they enlarge and become prominent and more visible.
Q. Who gets varicose veins ?
Venous disease is largely inherited. It affects men and women equally but starts earlier in women often beginning in pregnancy. It is not caused by standing for long periods but the symptoms may be increased. They are not related to weight, blood pressure or smoking, nor are they caused by crossing the legs.
Q. How does the Doppler Scanner work ?
The Doppler machine emits high frequency ultrasound waves which bounce off the blood corpuscles and the reflected sound frequency depends on the direction of blood flow enabling incompetent veins to be identified with ease. This prevents misdiagnosis and ensures veins are treated in the correct way.
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