What are varicose veins ?
Varicose veins are enlarged , dilated and tortuous veins that usually occur on lower limbs. You may notice them mainly in legs( below knee) but may see above knee as well. You may notice them as blue or dark purple, and are often lumpy, bulging with twisted appearance.
Why you get varicose veins?
Veins are the tubes that bring deoxygenated blood from distal tissues towards the heart. There are one way valves inside those veins which only open towards the heart and prevents back flow. Varicose veins develops when these small veins are not working properly or incompetent. When these valves are incompetent back flow cause the veins become dilated and tortuous.
There are some contributing factors and risk factors for developing this condition like,
- Female gender
- Family history
- Increased age
- Long period of standing
Addition to these conditions history of DVT ( deep vein thrombosis- blood clot formation within deep veins of the leg) and tumours in the pelvis that compress the major veins inside the pelvis may contribute to this.
What are the symptoms you may experience?
With related to varicose veins you may feel heavy , aching uncomfortable legs, and swelling around the ankle and foot and skin changes like discolouration and itching most of the times just above the ankle. Even muscle cramps may be a symptom of varicose veins. These symptoms are usually worsen during warm weather or if you’ve been standing up for long periods of time but may improve when you are walking by resting with raised legs.
When to see a doctor?
If the varicose veins do not cause any discomfort you may need not to see a doctor, but if you noticed any
a. pain or discomfort
b. Irritation of soreness over the skin
c. If there an ache that disturbing your sleep
better to consult a doctor.
How to diagnose Varicose veins ?
Clinical history and examination is enough for diagnosis. But the doctor will order a venous duplex scan of the limbs to see the exact location of the valvular incompetence.
If the clinician thinking of secondary cause , he will plan necessary investigation like Ultrasound scans , CT or MRI.
How to treat varicose veins?
Treatment option depends on the clinical stage of your disease , impact on the quality of life of the patient, patient preferences and the availability of resources.
Initial treatment would be conservative if the commotion is uncomplicated and not serve.
The initial measures are
- compression stockings
- Regular exercise
- Avoiding prolonged standing
- Elevate the lower limb when resting
Compression stockings steadily squeeze your legs to improve venous drainage. They’re often tightest at the ankle and get gradually looser as they go further up your leg. This improves blood to flow towards the heart.
There are different sizes and classes (class 1-light compression or class 2 – medium compression) of stockings. depending on the clinical stage of your disease your doctor would decide the stockings most suitable are you. So always you should consult a vascular specialist rather than deciding yourself to have stockings.
Sometimes you may have to wear them life long to relive your symptoms but have to replace them once 3-6 months.
Other treatments include,
- Endothermal ablation
- Form sclerotherapy
- Surgery – ligation and stripping
Endothermal ablation would be the first treatment of choice. Here the affected veins would be sealed off the using heat. The energy source would be either laser or high-frequency radio waves. The commonly practiced in Sri Lanka is the laser treatment. This could be done either in surgical theatre by surgeons or in the interventional radiology lab by the radiologists. This could be done under General anaesthesia, spinal or even under local anaesthesia.
In endovenous laser treatment ( EVLA) a catheter inserted into your vein and using an ultrasound scan to guide it into the correct position. Then a tiny laser is passed through the catheter and positioned at the top of the varicose vein. The laser tip delivers energy that heat up the vein and seal it off. Then laser probe is slowly pulled out along the vein allowing the entire length of the vein to be sealed off.
Then the whole limb would be wrapped with cotton and crape bandage. Would would be discharged from the hospital an the same day of following day morning.
Sometimes after the procedure you may feel mild pain and discomfort with numbness of the leg which would be temporary .
Form Sclerotherapy involves injecting special foam into your veins. The foam scars the veins, which seals them closed. This can be performed in a minor surgical theatre under local anaesthesia as an outpatient procedure. Here the doctor will inject a special form in to the veins after ultrasound guided marking or even without ultrasound scan if the varicosities are obvious. After the procedure, they will apply a bandaged with cotton and crape to the limb or you may ask to wear a compression stocking for about one week.
Surgery is the option for who are not suitable for above treatment options.
This surgery is carried out under general anaesthesia or spinal anaesthesia. It involves making two incisions in your affected limb one near the groin and other distal most of the time just below the knee. Through the upper incision , surgeon will ligate and divide the major vein and it branches( Tributaries, then he will pass a flexible wire through the vein and take it out through a lower incision. Then at the upper end of the vein , he will tie the vain to the wire tightly and strips off the vein through the lower incision.
This may cause some bleeding but it does not affect the blood circulation of your limb as the deep veins take off the work of superficial veins.
Most of the time you may bale to go home on the following day.
The newer treatment options like transilluminated powered phlebectomy, and cyanoacrylate glue occlusion are still emerging .
What are the complications of varicose veins?
The major complications associated with varicose veins are bleeding , skin change and ulcerations associated with venous hypertension.
If you have feature of varicose veins or complications of varicose veins you should consult either a vascular surgeon or a general surgeon. There are vascular clinics in all tertiary care hospitals in Sri Lanka where you can get proper treatment under consultation of vascular surgeons.