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Varicose veins

Varicose veins are veins that have become enlarged and twisted. The term commonly refers to the veins on the leg, although varicose veins can occur elsewhere. Veins have pairs of leaflet valves to prevent blood from flowing backwards (retrograde flow or venous reflux). Leg muscles pump the veins to return blood to the heart (the skeletal-muscle pump), against the effects of gravity. When veins become varicose, the leaflets of the valves no longer meet properly, and the valves do not work (valvular incompetence). This allows blood to flow backwards and they enlarge even more. Varicose veins are most common in the superficial veins of the legs, which are subject to high pressure when standing. Besides being a cosmetic problem, varicose veins can be painful, especially when standing. Severe long-standing varicose veins can lead to leg swelling, venous eczema, skin thickening (lipodermatosclerosis) and ulceration.

Sometimes there are smaller thin veins are noticed in your extremities or any other parts of body, this condition is known as Spider Veins. This may require treatment for aesthetic reason.

Treatment

The procedure of varicose vein depends on its location, its severity, amount of tortuosity and the status of valve & perforators.

The procedures to treat varicose veins fall into 2 categories: those that close the veins and those that remove them altogether.

Ways to Close Veins

When a varicose vein is closed off, blood flow simply shifts to other vein. After the vein is closed, it fades away. Several types of procedures can do this. They include:

Sclerotherapy- If there is only dilation & tortuosity of veins but the valves & perforaters are intact, you may get benefited by Sclerotherapy. Your doctor injects a solution into the vein that causes it to scar. It forces blood to change route, going through healthier veins instead. Your collapsed vein is reabsorbed into surrounding tissue. You can have this procedure done in a doctor's office.

You may need several treatments, usually 4 to 6 weeks apart, to completely close off a vein. You won't need anything to numb you, and the only discomfort you'll feel will be the sensation of small needle pricks from the injections. You'll need to wear compression stockings for a few weeks after each procedure.

Ways to Remove Veins

If the varicose veins are associated with incompetent/ damages valves & incompetent perforators, (identified by Colour Doppler examination), you will need surgery.

Ambulatory phlebectomy- This is the less complicated procedure and it is used to remove varicose veins close to the surface of your skin. Your doctor will numb the area and remove veins through small cuts. You remain awake and generally can go home the same day.

Vein stripping and ligation- This is the solution for the most serious cases. You will be given general anesthesia so that you will not be awake during the procedure. Your doctor will make cuts in your skin, tie off the veins, and remove them. You might go home the same day you have the surgery. Recovery time ranges from 1 to 4 weeks.

Ligation of S/F Junction & Perforators- Vein ligation is done at the sapheno-femoral junction after ligating the tributaries at the sephanofemoral junction along with ligation of incompetent perforators without stripping the long saphenous vein provided the perforater veins are competent and absent DVT in the deep veins. With this method, the long saphenous vein is preserved for use as venous bypass grafts in the future (coronary or leg artery vital disease).

You might feel side effects after your treatment. The most common are swelling, bruising, change in skin color, and pain. The doctor may wrap your legs in elastic bandages after your procedure and have you wear compression stockings for a certain amount of time.

The long term outcome of carefully performed varicose veins surgery is excellent. The scars fade to tiny white marks over a period of several months and become very difficult to see.

No matter what procedure you choose, it can only treat existing varicose veins. New ones may develop, but you can take steps to limit them, including-

  • Watch your weight
  • Exercise regularly
  • Raise your feet when you sit
  • Don't cross your legs when you sit
  • Don't wear tight clothes
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