Varicose veins are large swollen veins that develop on the legs and ankles. The veins may appear blue, green or purple and enlarge gradually over time. Mild varicose veins develop on the ankles where patients develop swollen, sore legs and ankles. Advanced varicose veins can be extremely painful, leading to internal clots, rupturing, and bleeding. Sometimes, the patients develop ulcers or permanent eczema, which does not heal.
Symptoms of varicose veins include:
- Development of heavy, uncomfortable legs
- Throbbing or burning legs
- Dry and itchy skin on the affected vein
- Muscle cramps in the legs, especially at night
These symptoms worsen during warm weather or if you have been standing for extended periods. In extreme situations, varicose veins are associated with:
- Spontaneous bleeding develops due to thinning of the skin over the varicose veins. The veins become incredibly delicate as clothing easily injures them.
- Superficial phlebitis; an inflammation of the vein below the skin surface. A reduced flow of blood, blood clotting and damage to the vein cause inflammation. The condition also increases a patient’s risk of developing deep vein thrombosis.
- Venus leg ulcers that form when the enlarged vein does not provide enough drainage of fluid from the skin or the swollen skin does not receive adequate oxygen
Causes of Varicose Veins
The body has two types of blood vessels; arteries that transport oxygen and nutrient-rich blood from the heart to body organs and veins that return used blood to the heart. The deep veins found under the muscles carry up to 90% of the blood from the legs to the chest, while the other 10% flows through veins under the skin’s surface.
While the leg muscles help the veins pump blood upwards, the real work is performed by a system of one-way valves preventing blood flow to the legs. The walls of the veins may become stretched and lose elasticity, thus weakening the valves. Varicose veins develop due to chronic dilation of the veins (varicosity) that make it difficult for the muscles to push blood upwards.
Blood begins to form pools in the veins instead of flowing from one valve to another, which mounts pressure on the veins. The veins begin to twist and bulge, thus developing varicose veins.
Risk Factors Associated with Varicose Veins
Different factors increase the chance of developing varicose veins:
Women are more likely to develop varicose veins than men. The American College of Phlebology cites that up to 50% of American women develop varicose veins or other vein-related diseases.
Older adults are more likely to develop varicose veins. Women are especially vulnerable where the varicose vein becomes more pronounced as they age.
- Genetic Propensity
When to Treat Varicose Veins
The condition does not always need treatment. If the veins are not painful or causing any discomfort, there is no need of pursuing treatment. Patients should only consider treating varicose veins to:
- Ease the symptoms- if the veins are causing discomfort or pain
- For cosmetic reasons
- To treat complications that caused by varicose veins, such as skin discolouration, leg ulcers or swelling
As such mild varicose vein symptoms may be treated by performing simple exercises to help keep the blood flowing, compression stockings to relieve swelling and aching and elevating the legs to aid in the flow of blood from the legs to the heart, especially during the night.
However, if the condition does not respond to the simple remedies, the doctor may suggest more invasive treatments. In most cases, the doctor performs a duplex ultrasound scan that provides a detailed image of the veins in your legs. It shows the blood flow and allows the vascular specialist to identify any damaged valves that lead to the development of varicose veins.
The procedure is performed using two techniques: through radiofrequency ablation and laser treatments. The first involves heating the wall of the varicose vein through radiofrequency energy. A small cut is made to access the vein, and a narrow tube (catheter) is guided using the ultrasound scan. Then, a probe is inserted into the catheter to send the radiofrequency waves.
The energy should heat the vein until it collapses, seals and shuts. When the vein gets shut, blood is naturally redirected to other healthy veins. Catheter-assisted treatment through radiofrequency ablation may require the administration of local or general anaesthesia. Patients may experience short-term side effects like needles and pins, and the doctor may recommend wearing compression stockings for a week.
Endovenous Laser Treatment
The procedure involves inserting a catheter into the vein and using an ultrasound scan to guide it to position. The laser is used to transmit bursts of energy to heat and seal the vein. The laser should pull along the vein using the scan to allow the entire length of the vein to be closed. After the procedure, the patient may experience tightness in the legs and pain.
The procedure involves injecting the varicose veins (small and medium-sized) with a solution that seals off the affected vein and allowing other veins to allow blood flow. The varicose vein becomes less visible over time as it no longer allows blood flow. The patient may need more than one appointment, but the procedure is pretty effective.
It does not require the administration of anaesthesia and can be performed in a doctor’s office. The procedure is, however, known to cause side effects like headaches, lower back pain, fainting, blood clots in other leg veins and temporary vision problems.
Foam Sclerotherapy for Large Veins
Foam Sclerotherapy is similar to sclerotherapy only that a foam solution is injected into large veins. Foam sclerotherapy is performed under local anaesthesia to numb the area being treated.
It is ideal where sclerotherapy and ablation treatments are unsuitable. Conventional surgery is performed under general anaesthesia. Patients are discharged the same day, although the doctor may recommend an overnight stay if the surgery is performed on both legs.
Vein Stripping and High Litigation
The procedure involves tying off the affected vein before joining the deep vein and removing it using small incisions. The removal of the vein does not affect blood circulation in the leg as veins located deeper in the leg are involved in transporting large volumes of blood.
Litigation and stripping may cause bleeding, pain and bruising. Severe complications involve the development of a blood clot or nerve damage. The procedure requires up to three weeks of recovery before resuming normal operations. The doctor may also recommend compression stockings for a week to aid in recovery.
Transilluminated Powered Phlebectomy
It is a relatively new treatment that involves making one or two incisions in the leg. The surgeon places a special light-endoscopic transilluminator- under the skin to see the affected veins. They are cut before removal through the incisions made using a suction device. After the procedure, the patients may experience some bruising or bleeding.
The occurrence of varicose veins does not always require surgery. Patients with varicose veins that don’t cause any pain or discomfort may not even need to visit a doctor or specialist.
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- Varicose Veins Diagnosis & Management Guidelines by NICE