A varicose vein is a condition wherein the veins get twisted and enlarged. The veins in the legs are most affected by this condition due to the increasing pressure on the lower body while standing and walking upright. For some people, varicose veins and spider veins – a mild variation of varicose veins, are a cosmetic concern but for others, it is a serious problem causing aching pain and discomfort. In some cases, varicose veins can lead to serious health problems like rupture or develop into varicose ulcers on the skin. Immediate medical help is recommended if the condition worsens.
Causes
Having a damaged or weak valves can lead to varicose veins. Arteries and veins play a major role in transporting blood from the heart to the rest of the tissues in the body and back to the heart. The veins in our legs have to work against gravity to return the blood back to the heart. During this process, the muscle contractions in the legs act as a pump which helps the veins to return the blood back to the heart. Here the tiny valves in our veins act as a door for the blood to flow. It opens when the blood flows towards the heart and closes to stop the blood flowing backwards. Sometimes, due to weak or damaged valves, the blood flows backwards and pool in the vein, causing the vein to stretch or twist, which leads to varicose veins.
Symptoms
Initially, the varicose veins may not cause any pain. The following symptoms can be seen during this phase –
- Dark purple or blue coloured veins
- Twisted and bulging veins appear like cords on legs.
The painful signs and symptoms of varicose veins include –
- Achy or heavy feeling in the legs
- Swelling, muscle cramps, burning and throbbing sensation in lower legs
- Worsening of pain after sitting and standing for a long time
- Itching around the veins in the lower legs
- Skin discolouration around the varicose veins
Spider veins which are similar but smaller than varicose veins can also be found on the skin’s surface. They often appear red or blue in colour and are usually found on legs and also on the face in some situations.
Diagnosis
The doctor will first conduct a physical examination by checking for any swelling on the patient’s legs while standing. Here, the doctor may ask the patient to describe any pain or aching in their legs. The patient may need to take an ultrasound test to check if the veins are functioning normally and to find for any evidence of a blood clot. Through this non-invasive test, the images of the veins in the legs are transmitted back to the display monitor for further study by the doctor.
Treatment
Compression Stockings
The most common approach to treating varicose veins is by wearing compression stockings. They squeeze the legs, helping veins and leg muscles to move blood more efficiently. The different types and brands of these stockings determine the amount of compression on the legs. Knee-high stockings providing 20 – 30 mmHg can often help in relieving the symptoms such as aching or swelling. These stockings prevent the blood from travelling down and pooling in the legs. For stockings to be effective they must be suitable to the size and shape of your legs- have always had your legs measured before purchasing stockings.
Stockings and compression therapy ARE NOT A CURE- they can provide symptomatic relief as long as they are worn, but once removed the condition returns to the same as before.
Ablation Therapy
When compression stockings provide insufficient relief, ablation therapy can become a patient’s second option. Laser, radiofrequency and mechanical injections are few forms of ablation therapy. In ablation therapy, a vascular surgeon treats the patient’s legs. The procedure begins by thorough cleansing of the patient’s legs after which sterile drapes are placed over their legs. Once this is done, the surgeon will inject a numbing medication into the veins followed by the insertion of a catheter. The doctor inserts a probe into the catheter, which emits energy. The energy heats up the vein, causing its walls to collapse, effectively closing it and sealing it shut. This procedure is preferred for larger varicose veins. It typically doesn’t take long and can be done under local anaesthesia if the veins are minor. After the procedure, the leg is wrapped with a compression bandage.
Micro-phlebectomy
This is the technique by which the side branches that aren’t suitable for laser therapy are removed. This involves tiny cuts of 1-2 mm size through which the damaged vein is removed. This is often combined with ablation procedures to achieve as much clearance of varicose veins as is possible.
Sclerotherapy
Sclerotherapy may be recommended if the affected veins are twisted and not sufficiently straight. With the help of ultrasound, a small needle is inserted through the vein to inject sclerosant – a chemical that causes the vein to spasm and clot. The clot developed due to sclerosant is not dangerous because it is broken down by the body’s natural processes so that the varicose vein disappears. With the help of sclerotherapy, small “spider” veins can also be treated.
Post-treatment, the patient should continue wearing compression stockings to prevent the formation of new varicose veins and to speed up the healing process.
Prevention
The following things are recommended to reduce the risk of developing varicose veins –
- Get plenty of exercises, for example, walking
- Maintain a healthy weight
- Avoid standing still for too long
- Do not sit with the legs crossed
- Sit or sleep with your feet raised on a pillow
- Anyone who has to stand for their job should try to move around at least once every 30 minutes
Dr. Robbie George | Chief of Vascular & Endovascular Surgery | Mazumdar Shaw Medical Center, Bommasandra, Bangalore