About Varicose Veins
1. 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", "spider veins", "broken veins" or "flare veins". Although these may be unsightly they are not the same as varicose veins.
2. 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.
3. What trouble do they cause?
Varicose veins are very common and often give no symptoms at all, although they may look unsightly. However, common symptoms include aching, throbbing, cramps and heaviness especially after a day of standing. Itching and ankle swelling (oedema) may occur. Occasionally, severe varicose veins can damage the skin of the leg above the ankle causing discolouration (eczema). These skin changes occur due to chronic venous insufficiency. Without treatment these skin changes can progress and a varicose leg ulcer may eventually occur. Sometimes one of the varicose veins can become red and tender. This inflammation is called "phlebitis".
4. What tests are required?
People with varicose veins should be seen by a vascular specialist and MUST undergo a detailed ultrasound scan (duplex scan) to confirm the venous anatomy before deciding upon the best treatment. Prior to this a simple examination plus a painless test with a hand-held Doppler probe will enable your specialist to advise on the likely treatment options but these must be confirmed with a duplex scan before proceeding. This is particularly important if your varicose veins have recurred following previous treatment (recurrent varicose veins) or if you have history of previous Deep Vein Thrombosis (DVT).
5. Do I need treatment?
Treatment for varicose veins is rarely essential since serious complications occur infrequently. Usually the choice is yours. If your specialist thinks you should have treatment, you will be informed of this at your consultation. Many patients have varicose veins for the whole of their adult life and never suffer any problems with them.
6. What treatments are available?
These may be all that is required if aching and swelling are the main problems. Properly fitted medium-strength compression stockings below the knee usually work best. For many, this is a rather unsatisfactory solution especially in warm weather.
Liquid Sclerotherapy involves a small amount of a special chemical (sclerosant) being injected intoeach vein and the leg is then bandaged firmly for a few days. The veins shrivel up and eventually becomes less visible. This treatment can also be used for thread veins (Microsclerotherapy).
Foam Sclerotherapy is a variation of the established liquid sclerotherapy technique. The liquid sclerosant is forcibly mixed with air or a physiological gas (Carbon Dioxide and/or Oxygen) to make a foam which is then injected into the veins using an ultrasound scanner to guide the injection into the correct place (hence "ultrasound-guided").
This is a new catheter-based treatment in which a catheter is inserted into the relevant veins and "super glue" is injected at various points along the vein as the catheter is gradually withdrawn resulting in sealing and closure the vein.
A laser (ELT) fibre or radiofrequency catheter (Venefit or VNUS closure) is passed inside the vein and used to generate heat which produces thermal coagulation of the vein as the catheter is slowly withdrawn.
This is a new catheter-based treatment in which the mechanical action of a fast rotating tip is combined with controlled dispersal of a liquid sclerosant drug inside the vein. This damages the vein as the catheter is gradually withdrawn.
The most severe varicose veins may require 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 (ligation). Usually, the vein in the thigh is also removed (stripped) to reduce the risk of varicose veins returning.
7. How good is the treatment?
No treatment can completely remove every visible varicose vein. 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.
Click here for more information about recurrent varicose veins.
8. 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.