VARICOSE VEINS

WHAT ARE VARICOSE VEINS?

Varicose veins are abnormal, dilated blood vessels caused by a weakening in the vessel wall.

Your veins carry blood back to the heart. In your leg, this means the blood has to flow upward, against gravity. Consequently, these veins have one-way valves to prevent the blood from back flowing. Over time these valves can fail to close tightly allowing blood to pool and causing the bulging and twisting characteristic of varicose veins.

WHAT CAUSES VARICOSE VEINS?

Women are more likely than men to develop varicose veins. Varicose veins usually affect people between the ages of 30 and 70.

Pregnant women have an increased risk of developing varicose veins, but the veins often return to normal within 1 year after childbirth.

Women who have multiple pregnancies may develop permanent varicose veins.

High blood pressure inside your superficial leg veins causes varicose veins.

 

Factors that can increase your risk for varicose veins include having a family history of varicose veins, being overweight, not exercising enough, smoking, standing or sitting for long periods of time, and having a history of Deep Vein Thrombosis (DVT).

WHAT ARE THE SYMPTOMS OF VARICOSE VEINS?

Some people do not have symptoms but may be concerned about the appearance of the veins.

If symptoms occur, they may include:

  • Swollen legs
  • Muscle cramps, soreness or aching in the legs
  • Tiredness, burning, throbbing, tingling or heaviness in the legs
  • Soreness behind the knee
  • Itching around the vein
  • Brown discoloration of the skin, especially around the ankles

Symptoms often worsen after prolonged standing or sitting. In women, symptoms may be worse during menstruation or pregnancy. Sometimes the condition leads to more serious problems, such as, a painful blood clot, referred to as superficial phlebitis (inflammation of a vein), or skin ulcers.

HOW ARE VARICOSE VEINS DIAGNOSED?

During a physical exam, the doctor will check your legs while you are standing.

You will also need to attend the vascular lab for a non-invasive duplex ultrasound scan to check the blood flow in the superficial veins (near the skin’s surface) and deep veins.

TREATMENTS

VEIN STRIPPING

Vein stripping is the gold standard if intervention is needed for varicose veins.

To perform vein stripping, your surgeon disconnects and ties off all varicose veins associated with the saphenous vein, the main superficial vein in your leg. This vein is then removed from your leg. A procedure, called ‘small incision avulsion’ can be done alone or together with vein stripping. Needle avulsions allow your surgeon to remove additional varicose veins branches from your leg using hooks passed through small incisions. The skin is closed using steri-strips (sticky paper strips) and if possible no stitches are used. You are usually let home on the same day.

COMPRESSION STOCKINGS

Your doctor may prescribe compression stockings, which are elastic stockings that squeeze your veins and stop excess blood from flowing backward.

Compression stockings also can help heal skin sores and prevent them from returning. You may be required to wear compression stockings daily for the rest of your life.

 

SKIN CAMOUFLAGE

The purpose of skin camouflage is to alleviate the psychological, physical and social effects that can have on people’s lives by the simple application of specialised products.

The specialist products are designed to be long lasting and contain sun protection.
Venous disease is often associated with spider naevi and telangiectasia (tiny veins on the surface of the skin). Skin camouflage is effective in hiding these often unsightly skin changes.

 

15 MINUTES THAT COULD SAVE YOUR LIFE

Learn More About Screening

POST-OPERATIVE INSTRUCTIONS

You are encouraged to walk as soon as possible.

You can return to work within one week post vein stripping. You may have some bruising and soreness for 7-10 days after the treatment, and you will be given a prescription for some anti-inflammatory pain medication.

Day 3: Remove the first (Class II) elastic stockings from leg, leaving 2nd elastic compression stocking in place for one week

Day 7: Remove elastic stocking from leg and soak in warm bath, with Savalon or salt. This will remove the steristrips. Reapply elastic stocking and continue to wear for at least two more weeks.

Week 6: You will have a check-up appointment. Options for treating rare small persistent veins or spider veins, e.g. photoderm therapy, can be discussed at this point.

COMPLICATIONS

However, a few complications are associated with vein stripping.

  • Bruising or tender lumps may occur along the course of the removed vein. These resolve within 6-8 weeks.
  • Swelling of the foot and ankle may occur but usually disappears within a few weeks. A few simple measures help alleviate this, such as, wearing compression stockings, avoiding long periods of standing, sitting with you feet elevated, taking short walks and keeping mobile.
  • Rarely, the procedure can damage superficial nerves that lie near the stripped vein, causing a patchy area of numbness in the leg. The nerves usually recover, however, and sensation returns within 6 to 12 months.

ENDOVENOUS RADIOFREQUENCY THERAPY

EVLT is a, minimally invasive, percutaneous endovenous technique for ablation of the incompetent long saphenous vein.

It is a safe, fast, durable and well tolerated procedure for eliminating LSV reflux allowing patients to be discharged one hour post-procedure.

However not all patients are suitable for this therapy and the option should be discussed in more detail with your vascular surgeon.

REFERENCES

  1. Mwaura B, Hynes N, Connolly CE, Sultan S. The impact of differential expression of extracellular matrix metalloproteinase inducer, matrix metalloproteinase-2, tissue inhibitor of matrix metalloproteinase-2 and PDGF-AA on the chronicity of venous leg ulcers. Eur J Vasc Endovasc Surg. 2006 Mar; 31(3):306-10. PMID: 16169261
  2. Hoary M, Sultan S. Advances in Ablation of the greater saphenous vein in the 21st Century: Development of an Endovenous Upward Perforate Invaginate (EUPIN) stripping device and procedure based on best medical practice. Vascular 2008 16 (2) S103
  3. Hynes N, Sultan S. Comparison of Endovenous Upward Perforate Invaginate Stripping (EUPIS), Downward Invaginate (DIS) and High-energy Endovenous LASER ablation (HE-EVLA) for Varicose Veins: Factors Influencing Complication Rate, Long-term Recurrence, Quality of Life and Cost-effectiveness. Vascular 2008 16 (2) S154-155:
  4. Tawfick W, Sultan S. Early Results of Topical Wound Oxygen (TWO2) Therapy in the Management of Refractory Non-Healing venous Ulcers (RVU); superior Role over Conventional Compression Dressings (CCD) Vascular 2008 16 (2) S156-157:
  5. Hynes N, Sultan S. The down slope of endovenous laser therapy for primary varicose veins. Technology is still lacking. J Cardiovasc Surg (Torino). 2007 Jun;48(3):S1;50