Varicose veins are one of the most widespread health complaints in Western society with over a third of men and women developing them at some point, a figure that rises to around 50% in people over 50.
What are Varicose Veins?
Veins carry blood in a one-way flow from the body to the heart. Usually, blood is prevented from flowing backwards in veins by a series of one-way “leaflet” valves. However, if, for some reason, these valves become inefficient, backflow will occur, creating greater pressure below the valve and causing the vein to stretch and enlarge. Eventually the vein will become visible beneath the skin and assume a characteristic dark-blue, contorted, bulging appearance.
Varicose veins are most commonly found in the superficial veins of the legs, though they can occur elsewhere in the body, and they tend to be more prevalent with age. They are usually situated close to the surface and range from 2 millimetres to 3 centimetres in diameter. They should not be confused with “spider” veins which are finer and sit within the skin itself.
What Makes Them Worse?
It is not known what causes the initial weakness in the valves, but factors which exacerbate varicose veins include:
- Standing for long periods
- Chronic constipation
Heredity also plays a role and varicose veins are observed to run in families.
Should I Be Worried?
In most cases varicose veins pose no serious threat to health. Often their greatest nuisance is their unsightly appearance. There are, though, a range of associated symptoms common to the condition. The most prevalent of these is an aching or pain in the affected area – often made worse by exercise or standing for long periods. Other symptoms include:
- Swelling of the ankles or legs
- Feelings of heaviness and fatigue in the legs
- Itching, dryness, redness of the skin (venous eczema)
- Restless leg syndrome
- Shiny, brownish skin discolouration near affected veins
More Serious Complications
More serious complications can, however, arise due to compromised blood circulation in those with severe varicosities:
Superficial thrombophlebitis, in which the veins become inflamed, can result in increased levels of pain and the formation of blood clots.
Chronic venous insufficiency, characterized by shiny brownish discolouration, indicates the occurrence of extensive tissue damage.
Ulcers, especially near the ankle, resulting in skin loss and the exposure of tissue. In a very small number of cases, the development of carcinoma or sarcoma has been seen in longstanding venous ulcers.
What You Can Do
Though some relief from less severe symptoms can be gained by elevating the leg, avoiding long periods of standing, and by the use of compression stockings, varicose veins cannot be cured. Instead, if more aggressive alleviation of the condition is required, they must be treated either surgically or non-surgically.
As the superficial leg veins carry only 10% of blood flow (and as varicose veins are not performing efficiently anyway), varicose veins can generally be removed without any adverse consequences. Blood flow is simply carried by other, healthier veins.
Surgical treatment is the traditional, and still the most common, approach to treating varicose veins. The two techniques used are ligation and stripping.
When ligation is used, small incisions are made, generally in the upper thigh and behind the knee, and the varicose vein is ligated, or tied off, at its junction with a healthy vein. Blood is thus prevented from flowing into the vein and the vein is left in place.
When a vein is stripped, incisions are made in the skin at either end of the affected vein. The varicose vein is then tied off at its junction with a healthy vein and a wire is inserted into it and withdrawn – entirely removing the vein in the process.
Ligation and stripping are performed under general or spinal anaesthetic and a stay in hospital may be required. Compression stockings or bandages must be worn for up to six weeks after the operation, and one to two weeks off work is required.
Sclerotherapy. In this non-surgical technique, a special solution is injected into the vein that causes it to harden (sclerose) and close off. Blood can no longer pass through that vein and is carried by other, healthy, veins instead.
Sclerotherapy can be performed without anaesthetic and is obviously less invasive than surgery, though it still required compression stockings and a period of recovery. It may not be suitable for pregnant women or people with blood clotting disorders.
Endovenous Laser Treatment (EVLT). A relatively new treatment in which a laser catheter is guided into the vein by ultrasound. The laser is then activated and the vein is completely destroyed. Recovery time is rapid, time off work minimal, and compression stockings are not required.
Radio Frequency Ablation. Similar to EVLT, but using high frequency alternating current instead of a laser.
Regardless of which technique is employed to treat varicose veins, thorough preoperative investigation must be carried out. This should include a Colour Flow Duplex Scan – a detailed ultrasound that enables your physician to determine the most effective treatment for you.
Benefits of Treatment
For those affected by varicose veins the range of available treatment is reassuring. Traditional vein stripping is well tested and effective, while newer, non-surgical treatments offer faster recovery time and a reduction in side-effects. Benefits from either style of treatment can be dramatic. The appearance of the leg can be improved, in some cases almost miraculously, and the elimination of chronic aching pain is, for many, a transformative experience.
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