Understanding the Aetiology Behind Varicose Veins
Our blood circulates with the pumping action of our heart. Outgoing blood travels through our arterial system to the body’s lungs, digestive tract, and the body’s periphery, including the legs. This blood supply is distributed via our arteries to our capillaries and veins. Basically, our venous system receives that blood from those capillaries and routes it back to the heart for re-circulation.
The heart is a pump. That pump produces pulsations that are hydraulically conveyed through the circulation system. Back pressure to the heart would allow backflow within the circulation except for one small piece of engineering. Veins have a valve system that allows circulation to flow only toward the heart, not back into the arterial component of the system. When that system fails, a condition known as reflux occurs.
If your heart beat has a cadence of sixty beats per minute, your venous system’s valves must open to permit flow toward the heart and close sixty times per minute to limit backflow to that pump. The veins are nature’s pipe system, but the pipes may fail. The cause of failure is not always clear. Genetics? Peripheral disease? Ageing? Other causes? We do know that veins change. They age. They stretch. They lose their elasticity. Whether genetics, disease, or just plain ageing, they take more time to open and close those valves. Simply put, veins may weaken and fail.
The purpose of the veins is to return blood to the heart. The venous valve system augments the return process. When the valve system fails, the blood fluid in the system changes direction with each pulse. This causes the pump’s efficiency to be lost and blood to pool in the veins. The veins swell. That swelling adds to the weakening of that venous system. That failure presents as varicose veins.
Although aetiology for varicose veins is not always clear, there are a number of factors in a person’s health history that appear to co-occur with the malady. The majority of sufferers are female. If there is pregnancy, the problem may be more likely. This vein anomaly may occur in families. Older age, heavier body weight, a job history of standing for extended times, and so forth may play a part in development of varicose veins.
People with varicose veins are functional in daily living activities and generally do not require treatment unless they have discomfort, pain, overt irritation and ulceration
of the skin overlying the veins involved, or there is sleep disturbance. A visit to one’s GP will result in a formal assessment. A history of onset, basic genetics, and an examination of lesion site, including source of pain, deviation of colour from normal, co-occurring skin conditions (e.g., eczema or ulceration), palpable hardness in involved veins, and evidence of past healing. Further evaluation by a vascular specialist on GP referral may employ ultrasound or other imaging technology.
Medical/Surgical Management for Varicose Veins
Varicose veins are part of the human condition, occurring in less than 15% of men and about a quarter of adult women according to the National Institute for Health and Clinical Excellence (NICE). When life spans were short, there may have been less awareness of the condition because of age effects in previous generations, but the general consensus is that varicose veins have been and will continue to be present in people, some of whom will seek intervention. Early surgical intervention has involved working from the “outside” of the vein and “clipping” the saphenofemoral, actually stripping veins, or altering deeper venous structures (e.g., phlebectomy, perforant vein intervention, etc.) for more than a century. Less invasive procedures have been introduced in more recent times that modify the “inside” of vein, but such procedures may still be supplemented with conventional surgery.
NICE is a readily available resource for materials that discuss varicose vein intervention strategies. Many people desire minimal treatment or are limited to treatment not complicated by underlying health concerns (e.g., pregnancy). Medications or surface creams in these situations may be desirable or compression hosiery may be suggested, especially if direct superficial lesion-oriented management is to be avoided.
There are a variety of alternative minimally invasive procedures that potentially may ameliorate varicose veins. They fall into two basic strategies, either injecting a chemical-based obstruction into the vein to limit blood flow or placing a thin-walled tube into the vein and adding heat to the vein walls to limit the flow. These strategies go by various names, but the names the public may encounter are discussed here. The more recent innovation relates to the use of laser endoscopy to accomplish blockage. People with tortuous veins, clotting problems, limited mobility, compromised health, or pregnancy are not good candidates for either variety of procedure.
Superglue Sclerotherapy begins with delineation of the involved varicose vein and its related venous network. The surgeon will introduce a hypodermic needle into the problematic vein and inject a sealing agent into it. Cyanoacrylate glue cures quickly in the vein, sealing it. Clotting of the varicose vein is immediate and relief from symptoms comes quickly. A local anaesthetic is used, but pain is minimal. The patient may return to regular activities immediately. Bruising and scarring are minimal. Unlike other procedures, compression hose is not required after the procedure.
Foam. Foam sclerotherapy is performed in a similar manner. A foam is injected with ultrasound guidance into the varicose vein. The foam causes scarring and thickening of the vein’s cell walls resulting in coagulation and clotting. Irritation at the injection site may be present with bruising, pain, or swelling. Blood trapped by the foam in the vein may discolour skin. Scarring and skin colour changes related to the procedure resolve within a year. Multiple foam injections may be required to fully manage varicose problems.
Ablation Therapy via Introduction of Heat into the Vein (Endothermal Ablation)
Radiofrequency Ablation Therapy. The surgeon makes an incision into the vein at knee level and threads a catheter (using ultrasound imaging) into the vein to the area compromising the vein’s inelasticity. Local anaesthesia may be used. A radiofrequency generator is threaded through the catheter to the focal site for the actual ablation (or it may already be present in the catheter). Medium frequency radio waves (ranging from 300 kHz to 500 kHz) are generated when the non-functioning venous structures are reached within the varicose vein. This electricity-based radiation induces a cell wall temperature of 85 degrees C. These waves continue as the catheter with its radio wave generator is slowly withdrawn. That is, the whole vein undergoes this heat exposure. The heat-radiation damage caused within the vein results in scarring or thickening of the vein walls. The patient typically leaves after the procedure without significant side effects, although a sense of ache, pain, or burning may present. Compression hose may be used for a short period of time post-procedure. Varicose vein problems are resolved via this procedure in close to 90% of sufferers.
Endovenous Laser Treatment of the Long Saphenous Vein (EVLT) or Endovenous Laser Ablation (EVLA). With laser treatment, the heat source is altered, but the procedure is similar. The surgeon makes a small incision at the knee, and a laser fibre is introduced into the varicose vein and threaded through the vein to the area to be destroyed, guided by ultrasound imaging. Local anaesthesia is used. Laser energy is introduced through the laser fibre, inducing scarring and thickening of the cell wall via laser-heat generated. Circulation in this focal point of the venous system is limited. Some patients may require removal of small veins related to the varicose problem using small incisions in a process called avulsion after laser energy application. Support hose may be used for a week or so and most recovery is within a couple weeks. Any pain or bruising resulting resolves in two weeks.
Related Articles on Endovenous Laser Treatment
- Endovenous Laser Treatment Aftercare
- Endovenous Laser Treatment FAQs
- How Endovenous Laser Treatment has Replaced Surgery
- What to Expect from Endovenous Laser Treatment
- NICE Guidelines to Varicose Veins Management
- Veinwave Treatment FAQs