Varicose Veins are abnormally and permanently enlarged, tortuous surface veins that affect approximately 2 out of 10 people.
They are caused when the normal valve function within the surface veins are lost. These valves are one way, designed to facilitate flow back up to heart. This commonly affects the two main surface veins; the long and short saphenous veins. Weakness in the vein walls results in the valves stretching so that they do not close properly and the blood can flow back along these veins towards the feet – this is called venous reflux. This leads to high pressure within the superficial venous system which results in dilatation of the branches of the main veins – varicosities, and the smaller veins which become spider veins. In the skin rashes, pigmentation and finally ulceration can occur.
In many cases varicose veins cause no symptoms, however they may cause aching, itching, discomfort, heaviness, burning or throbbing. If left untreated may cause skin rashes, discoloration and skin ulcers. Larger veins can also be easily damaged by minor trauma and can cause bleeding. Of course you may like to have them treated purely because of their unsightly appearance.
There is no specific cause for varicose veins however the following factors may exacerbate the condition: a positive family history, pregnancy, excess weight and increasing age.
To determine which veins are affected an ultrasound is performed. This is assessed and treatment advised accordingly. There are several treatment options available to you, they include:
- Radiofrequency ablation if where thermal heat is used to damage the wall inside the vein. The varicose tributaries need to be treated as well as the feeding veins with either injections or surgical removal.
- Endovenous laser where a laser fibre is used to close the vein. The varicose tributaries will need to be treated as well as the feeding veins with either injections or surgical removal – phlebectomies. This may be done immediately or in a delayed fashion.
- Sclerotherapy, either liquid or foam injected with ultrasound guidance. This is performed as an outpatient.
- Venocuff where the valves of the veins are repaired with an implanted cuff.
- Conventional surgery, where the affected veins are stripped from the leg. Removal of the varicose veins does not affect blood flow because other normal veins take over their job.
Possible complications from surgery:
- 1% of patients suffer a Deep Venous Thrombosis (DVT) – this is a clot that forms in the larger veins deep inside the leg. If this occurs you need to be on blood thinners for 3 to 6 months.
- The veins come back – the chance of that depends on the type of treatment offered. All modalities have a recurrence rate. In general it is around 10-20% at five years.
- Infection in the wounds – if this occurs it is generally superficial and resolves with oral antibiotics.
- Damage of peripheral nerves. These may be stretched or bruised during removal. This may leave numbness in the distribution of the veins for up to 3 months. In a small percentage it can be permanent.
Information has been derived from the patient education pamphlet “Treatment of Varicose Veins and other Problems with Veins”, Royal Australasian College of Surgeons and published by Mi-tec Medical Publishing. The complete pamphlet is available from our rooms.