Varicose veins are veins under the skin that have become swollen, twisted and bulging. They are usually seen in the legs and feet. They are quite common, and most of the time do not cause any problems. However, they can be disfiguring and be a cause for cosmetic concern in females. The veins of the lower limb have one way valves that keep the blood moving towards the heart and prevent its backflow. If the valves are weak or become damaged, blood can back up and pool in the veins. Over time, the continuous pooling cause the veins to become stretched, swollen and tortuous. Raised pressure in these veins also causes development of spider veins and discoloured areas which look like bruises.
What causes Varicose Veins?
Varicose Veins is a relatively common condition and may run in families.
It is more common in females with women twice as likely as men to develop them. This is because of hormonal factors like puberty, pregnancy, menopause and use of birth control pills.
It is also seen in people who have to stand for long hours eg. Bus conductors, teachers
Other factors include ageing, obesity, lack of exercise and leg injury.
What is the correlation between Varicose Veins and pregnancy?
During pregnancy, the enlarging uterus puts pressure on the veins that are coming up from the lower limbs, preventing them from adequate emptying. They usually develop during the first trimester. Another factor that contributes to their development is the raised blood volume in the body during pregnancy. Thus, the overloaded veins when compressed by the enlarged uterus, lead to the formation of Varicose Veins.
Do Varicose Veins cause any symptoms/problems?
Most of the time and especially in the early stages, varicose veins do not cause any symptoms and do not interfere with day to day activities. However, at any stage, they do pose a cosmetic problem giving the legs an unsightly appearance. This is specially troublesome in females. Other than the aesthetic problem, the symptoms could include a dull ache, a feeling of heaviness in the legs especially on standing or sitting for a long time, cramping and a throbbing pain in the legs. There may be swelling of the ankles and feet, especially towards the end of the day. There may be pruritus ( itching ) in the area of the ankles and feet and the skin in that part may become discoloured.
Do Varicose Veins lead to any complications?
Although not too serious or life threatening, varicose veins can lead to the following complications :
Thrombophlebitis This is an inflammation of the veins in which a blood clot can form in the affected veins. It causes pain and other problems in the affected area.
Varicose eczema / Dermatitis In long standing cases, the skin in the area around the ankles becomes dry, itchy and discoloured. The resultant scratching may further lead to bleeding, erosions and painful ulceration. It is best to get yourself treated if you reach this stage. These ulcers do not heal easily and over the years can cause cancerous skin changes.
Bleeding Although there is a risk of bleeding as a result of even mild trauma to the swollen superficial veins, it is never worrisome and can be easily controlled.
Lipodermatosclerosis The skin around the ankles loses its elasticity and becomes hard and tough. The skin becomes dark brown with areas of white scarring. Sometimes the skin can become acutely inflamed, red and sore and needs immediate attention.
* Note: Those with diabetes should get their Varicose Veins treated at the earliest and not wait for them to reach an advanced stage as complications are worse in those with high sugar levels.
How are Varicose Veins diagnosed?
Varicose Veins are usually diagnosed by a simple physical examination. However, other tests are needed to assess the extent of the problem and rule out any other condition. Most commonly you will be advised to do a Venous Colour Doppler by your doctor.
Treatment of Varicose Veins
Active treatment for Varicose Veins may not always be medically necessary especially in the earlier stages. However a lot of patients, especially females opt for treatment due to cosmetic reasons. There are a number of treatment options for varicose veins, as described below. Which treatments you are offered will depend on your personal circumstances. Your doctor will discuss these with you to help you make a decision that’s right for you.
I LIFESTYLE MODIFICATIONS
There are certain self-help measures you can take to relieve your symptoms. These include losing any excess weight and doing light to moderate physical activity, such as swimming or walking. Avoid standing for long periods of time as this causes pooling of blood in the veins and may make your symptoms worse. While sleeping keep the legs elevated by placing 2 pillows under the feet. This helps in emptying of the pooled blood from the veins.
II VENOUS STOCKINGS / COMPRESSION STOCKINGS
They help to maintain the blood flow in the leg veins and reduce leg swelling. They also help to reduce the risk of blood clots forming in the veins. They act by enhancing the effect of the natural pumping mechanism of the leg muscles. This helps to increase the blood flow back towards the heart.
The stockings are worn during the day and taken off before going to bed at night. They should be worn again the first thing in the morning.
Tab Daflon may be used. Daflon is a micronized purified flavonoid fraction containing 90% diosmin and 10% other flavonoids expressed as hesperidin. It increases venous tone, it improves lymph drainage, and it protects the microcirculation. It helps to reduce leg swelling, improves skin changes and helps in the healing of ulcers.
IV TRENDELENBERG SURGERY / OPEN SURGERY
If the vein junction where the varicose vein originates has been shown by an ultrasound scan to be incompetent, then the most common surgical treatment is to tie off the varicose vein at this junction - most commonly the upper thigh ( Sapheno-femoral junction ), behind the knee or in the calf muscle. Surgery involves making a small incision in the leg, locating the vein junction and tying off the varicosed vein . The vein is left in place, however blood is prevented from flowing into it.
V LIGATION AND STRIPPING
In this procedure, the affected vein is completely removed. A small incision is made in the skin at either end of the affected vein and the junction where the affected varicose vein joins a larger vein is tied off. A flexible wire is then inserted into the varicose vein and withdrawn – removing the vein in the process.
VI ENDOVENOUS LASER ABLATION ( EVLA )
LEONARDO® laser is a versatile, highly compact diode laser with dual wavelength ( 980nm and 1470 nm ) The ELVeS Radial™ fibers are used in this procedure which increases the precision of the technique. This highly advanced laser was first introduced in the country at Healing Hands Clinic.
Varicose vein surgeries with ELVeS Radial™ fibers are extremely effective: With the 2-phase radial emission of energy through the ELVeS® fibers, the energy can be applied homogeneously to the vessel wall. Thus the vein is sealed accurately. The risk of perforating the vein wall is minimized, side effects of typical varicose vein treatments rarely occur. The ELVeS® fiber with an atraumatic fiber tip is inserted into the affected vein through a small puncture. Due to perfect view via ultrasound the fiber can be monitored and placed perfectly well.
The whole treatment takes approximately 30-45 minutes. During the treatment as well as afterwards the patient hardly feels any discomfort. Patients can return to their daily activities on the next day of the treatment.
The advantage of Leonardo laser over other lasers is its dual wavelength. This reduces the recurrence rate to almost negligible and the pain associated with the procedure is much less as compared to other lasers.