Varicose VeinsFor years Rita, a nurse in one of the busiest hospitals inIndia, wore compression stockings for her varicose veins. The veins got bigger and uglier, and the leg pain and leg heaviness worsened as the day progressed. Finally, when she noticed discoloration and early ulcerations around the ankle joints, she decided to do something about it. She consulted a doctor for her troublesome veins.

Varicose veins occur when blood flow to the legs is interrupted and collects in the veins close to the skin. The veins appear blue, twisted and bulging. Heaviness, and swelling around the ankles are also symptoms.

There could be other symptoms too –

  • Pain in the legs
  • Night cramps
  • Knotty veins
  • Changes in skin color
  • Sores

Spider veins are very similar to varicose veins but are smaller and are closer to the surface of the skin.

When to see a doctor for varicose veins?

You should consult a doctor if –

  • The symptoms hamper your daily activities
  • The vein is swollen, red or tender
  • The varicose vein begins to bleed
  • A rash appears on the leg or near the ankle or the skin changes color

How do varicose veins develop?

In a normal leg with no varicose veins, valves which regulate blood flow from the leg upwards to the heart function normally and do not allow reverse flow of the blood into the leg. In case of varicose veins, these valves do not function well and the blood leaks back into the vein leading to pooling of blood in the superficial veins of the leg. This causes  varicose veins.

Although not everybody suffers from the condition, there are a few factors that could put you at risk for developing varicose veins. They are :

  • Age
  • Female gender, especially those who are 50 years or older
  • Family history
  • Being overweight
  • Pregnancy, especially multiple pregnancies
  • Lack of exercise
  • Standing or sitting for long stretches of time
  • Smoking

Treatments

Varicose veins are not considered life threatening, so unless it gets painful or ugly, treating them is not absolutely required. Wearing compression stockings can help relieve the pain for some people. Doctors advise wearing them even after the treatments in most cases.

Treatment of varicose veins normally involves either shrinking the veins and drying them off so that blood can’t flow into the vein, or, tying the affected vein and completely removing them surgically. 

If you decide to go in for treatment, there are a number of options, like:

Sclerotherapy: It is a common treatment for varicose veins wherein vascular surgeons inject chemical substances into the veins. The chemical causes the vein walls to collapse and shrink thereby stopping blood flow into the vein. The vein shrivels and turns into scar tissue. The procedure may have to be repeated about 4 to 6 weeks apart. Compression stockings need to be worn for 10 days after each session to ensure faster healing.

In recent years ultrasound guided foam sclerotherapy (UGFS) has become an increasingly popular treatment for varicose veins. Philip Coleridge Smith, vascular surgeon and Reader in Surgery at UCL Medical School, London, in his review of medical literature database concerning treatment of varicose veins using UGFS, suggested that foam sclerotherapy with the optimum ratio of gas to liquid as 4:1 is far more effective than liquid sclerotherapy and that ‘ultrasound imaging allows the treatment to be delivered accurately to affected veins’.

However, the most common side effects of UGFS are blood clotting in the veins (thrombophlebitis) and skin pigmentation. So, to reduce the incidence of side effects, researchers from Vascular Surgical Unit,DerrifordHospital,Plymouth,UK, suggested using carbon dioxide instead of air to make the foam.

Coil embolisation: Is another procedure where a catheter is inserted into the problem vein with the help of ultrasound. A platinum coil is then placed into the vein through the catheter. Measured amount of alcohol is then injected into the vein. The alcohol then destroys the problematic vein.

Another treatment alternative is surgical vein stripping which is a surgical procedure where surgeons tie off the concerned vein and completely remove them from the leg through small cuts in the skin. This procedure however has the usual side effects of surgery along with possible permanent scars and possible nerve damage around the treated vein.

A better surgical procedure is the ambulatory phlebectomy where hooks are used to pull the vein out of the leg by making tiny cuts in the skin. Local anesthesia is used for this procedure and usually the patient does not require more than one treatment. Moreover, very large varicose veins can be removed with minimal scars. Side effects could be slight bruising and temporary numbness.

Recent studies have shown that endovenous laser treatment or endovenous laser ablation therapy (EVLT or EVLA) combined with ambulatory phlebectomy (AP) could be a safe and effective treatment modality for varicose veins in the leg.

EVLA is one of the newest vein treatments where a laser fiber is inserted directly into the varicose vein. The laser heats and damages the lining within the vein, and causes it to collapse, shrink, and eventually disappear. Large varicose veins in the legs can be treated with this technique and the whole procedure takes less than 30 minutes to perform. If the patented 810 nm diode laser sold by Diomed is used then the procedure is called EVLT.

Introduction of minimally invasive endovenous ablation therapy has revolutionized the treatment of varicose veins. EVLA and radiofrequency ablation (RFA), where radiofrequency waves are applied instead of laser, are the two minimally invasive procedures approved by the National Institutes of Health (NIH) and suitable for patients with varicose veins from great saphenous vein (GSV).

The advantages are:

  • Fewer post treatment complications
  • Minimal post procedural pain
  • Faster recovery time

But RFA is slightly better it seems. A study published in the British Journal of Surgery, found that although both procedures have clinical and quality of life improvements at six weeks, patients treated with radiofrequency ablation reported less post-procedural pain than those treated with endovenous laser ablation.

What doctor to consult for varicose veins?

General and vascular (blood vessel) surgeons provide surgical treatment. Sclerotherapy is done by dermatologists too in addition to the mentioned doctors. You may consult a plastic surgeon too for sclerotherapy. It is wise to consult more than one doctor for the type of treatment that would suit you.

What happens if varicose veins are left untreated?

If you don’t treat varicose veins in time, it may leave you with many adverse consequences such as continued symptoms of pain, fatigue and swelling on the leg. More severe ones are –

  • Chronic inflammation and hyperpigmentation (skin becomes dark and discolored).
  • Lipodermosclerosis, where the tissues become woody and firm because of skin and associated fat inflammation.
  • Venous leg ulcer that is painful and difficult to heal.
  • Spontaneous bleeding from the veins.
  • Superficial thrombophlebitis (ST), an inflammation of a vein due to decreased blood flow through the vein, damage to the vein and blood clotting.
  • Deep vein thrombosis (DVT) that causes serious medical problems and you notice it when there is a painful pulling sensation in the calf of the lower leg.

All said and done, your doctor is the right person to determine what type of treatment would suit your varicose veins the most. Any hospital where they have vascular surgeons or general surgeons, plastic and cosmetic clinics, dermatology clinics, and even laparoscopic surgery centers can treat your varicose vein problems.

Lastly, don’t ignore your varicose vein and do get them treated as early as possible.

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  • Maroof Azam

    My brother aged 14 suffers from varicose vein with multiple swelling in leg and foot. Saphenofemoral and Saphenopopliteal complex incompetent in upper and lower third leg. Kindly give advice as doctors in patna are unable to deal the case.