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What are varicose veins?
Veins are the blood vessels that carry blood back to the heart. Varicose veins are abnormally swollen (dilated) veins that are visible just below the surface of the skin. Smaller veins in the skin itself are sometimes called "thread veins" or "spider veins". Although these may be unsightly they are not the same as varicose veins.
Varicose veins affect what are known as superficial veins. The main veins in your leg are the deep veins.
What causes varicose veins?
Varicose veins are due to a fault in the one-way valves inside the veins. These valves normally only allow the blood to flow up the leg towards the heart. If the valves leak, then blood can flow back the wrong way on standing. This reverse flow causes increased pressure on the veins which swell and become varicose.
Varicose veins often run in the family and as you get older they are more likely to occur. They may also be caused by pregnancy or weight gain that increases pressure on the leg veins.
What trouble do they cause?
Varicose veins are very common and often give no symptoms at all, although they may look unsightly. However, aching in the leg is common, especially after a day of standing, and ankle swelling may occur. Aching, itching, throbbing and swelling are common symptoms.
Occasionally, severe varicose veins can damage the skin of the leg above the ankle causing itchiness and discolouration (eczema). Without treatment an ulcer may eventually occur. Sometimes one of the varicose veins can become red and tender. This inflammation is called "phlebitis".
What tests are required?
In most cases a simple examination plus a painless test with an ultrasound machine is all that is needed to enable me to decide what needs to be done. Occasionally a more detailed scan or x-ray will be needed before advice about treatment can be given. This is especially likely if your varicose veins have recurred following previous treatment.
What treatment is available?
Support Stockings.
These may be all that is required if aching and swelling are the main problems. Properly fitted medium-strength compression stockings usually work best.
Injections (Sclerotherapy).
A small amount of a special chemical (Sclerosant) is injected into each vein and the leg bandaged firmly for a few weeks. The vein shrivels up and eventually becomes less visible. This treatment is not suitable for those veins where the valves have failed and a high pressure in the veins has developed. Injections are quite good for thread veins.
Operation.
Most varicose veins are amenable to surgery. The visible varicose veins are removed (avulsed) through a series of small cuts. More importantly the leaky valves are tied off in the groin or behind the knee. The vein in the thigh may also be removed (stripped) to reduce the risk of varicose veins returning.
New techniques are also now available (VNUS, EVLT )
How good is the treatment?
No treatment can completely remove every visible varicose vein or prevent varicose veins from occurring. Nor is there any such thing as an "invisible mend", as injections may cause some skin staining and surgery some scarring.
New varicose veins often appear even after satisfactory treatment. However it may be many years before they return.
How can I help myself?
Avoid being overweight and wear support stockings if you have to stand up a lot of the time. Regular exercise such as walking also helps to pump the blood out of the leg. Dry itchy skin can often be helped by moisturising (emollient) creams or bath additives available at the chemist
Varilase,EVLT & VNUS are the latest minimally invasive techniques for the treatment of varicose veins.
They both adhere to the same principle of introducing a fine catheter tube into the vein to be treated and then by generating heat within the vein, a contracture reaction is initiated which will lead to the obliteration of the vein. This can treat the problem of venous reflux, the cause of varicose veins. Varilase and EVLT use a laser light to generate the heat, VNUS uses a thermal radiofrequency generator.
Varilase & EVLT (as featured in The Daily Mail)
Endovenous laser treatment is one of the latest techniques for the treatment of varicose veins.
Using a fine catheter tube, passed into the vein, a laser is used to heat the vein to be treated and this results in obliteration of the vein. The catheter is introduced through a tiny cut which will need no stitches and guided using ultrasound to the area of vein to be treated.
Patients who might normally require a cut in the groin and a stripping procedure or an operation to the vein system behind the knee could undergo Varilase or EVLT instead.
The advantages are minimal scarring (no cut in the groin or behind the knee), potentially less discomfort and bruising and in some cases treatment as an outpatient under local anaesthetic instead of an operation.
For more information about EVLT visit the website:
www.evlt.com
About Sclerotherapy.
Injection (sclerosant) therapy is usually only suitable for relatively small varicose veins and thread veins, that are unsightly but cause no symptoms. It works by making the vein wall stick to itself, thus obliterating it, and the compression applied after the injection is an essential part of the therapy.
Before your next visit.
Please make sure you have stopped taking the oral contraceptive pill, which theoretically could increase the risk of a serious thrombosis. This should be stopped one month before your appointment but it is very important to think about other contraception methods. There is little evidence that low dose mini-pills and hormone replacement therapy (HRT) need to be stopped.
At the clinic.
A small amount of fluid is injected into the vein at one or more sites and a cotton wool pad applied. A stocking is then put onto the leg.
Usually only one leg is treated at one visit and repeat injections will be required if both legs are affected or you have many veins on one leg.
Afterwards.
For the first 24 hours rest as much as possible, sitting with the feet elevated above the level of the hips. Take a few short walks and try to avoid standing still for any length of time.
After 72 hours you should remove the stocking and cotton wool pads and replace the stocking. This should be worn at all times during the day but can be removed in bed and when taking a bath or shower. You may drive as soon as you feel comfortable.
The success of the injection treatment relies upon the pressure that the stocking applies to the injected area. Wear the stocking for a minimum of two weeks following a treatment.
What to expect after the injections.
Over the first few weeks following the injection, any slight discomfort, redness, hardness or tenderness at the injection site(s) should gradually subside. If there is excessive redness, swelling or tenderness, this means you should rest more with the leg raised so that the heel is higher than the hip.
While most patients experience no problems after injection of varicose veins, a small number may experience one or more of the following:
A persistent hard "cord" in the line of the vein.
Brown staining of the skin in the line of the vein.
Rarely, ulceration of the skin at the injection
site.
Failure of the injection to obliterate the vein.
How long before my veins go?
Many veins take some time before they respond to the injection treatment. It may be many (6 or more) months from the completion of treatment before the final result is noticeable.
The type of veins that are treated by injections can occur again and often for the long term, many treatments may be necessary.
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