Varicose Veins

Varicose Veins

What are varicose veins?

Varicose stems from the Latin word "varix", which means, "twisted". Varicose veins are bloated or bulging, twisted veins which are typically bluish purple and visible through the skin.

They are often painful and aesthetically displeasing. They are most often located in the legs but also can develop in other parts of the body such as the vaginal area.

Groups of Veins

There are three groups of veins in your legs.

Varicose VeinsSuperficial veins reside in the fatty layer underneath your skin. Generally, these veins are visible on your feet and ankles. Superficial veins are the ones usually vulnerable to varicosities and they transform into large, tortuous veins that bulge from the surface of the skin anywhere in the legs and thighs.

Deep veins are larger than superficial veins and are located deep in your legs. Muscles or group of muscles surrounds them.

Perforating veins act as conduits that transport blood from the superficial veins to the deep veins. They are referred to as perforators since they "perforate" the leather-like tissue layer that encloses the muscles to connect with the deeper veins. They transport blood from the superficial veins to the deep veins.

Circulation of Blood in the Veins

The heart pumps blood throughout the tissues of the body to distribute oxygen and collect carbon dioxide. When the heart contracts, it produces a high pressure wave that pushes blood through the arteries and continues into the smaller branches called arterioles and finally through the capillaries everywhere in the body.

The blood leaves the capillaries and makes its way into the venous network. The veins set off as small veins and gets larger in size as they get nearer and drain blood into the heart.

Vein Valves

Blood from your legs is circulated back to the heart against gravity especially if you are in the erect position. Every time your leg muscles contract they apply pressure on the deep veins of your feet and legs, mimicking the pumping action of the heart.

One-way flapped Valves, built inside the walls of your veins keep the flow of blood in the upward direction - towards the heart. During muscle contraction the valves in the deep veins open and during muscle relaxation, the valves close. This way, blood is prevented from flowing back down the legs.

Causes

If you are standing (or even sitting) for a long time your leg muscles are not contracting.

With no pumping action applied on the deep veins, blood accumulates and as a result, pressure in the veins is increased. This is referred to as venous hypertension.

The deep and perforating veins can handle brief intervals of increased pressure. But, if you happen to be a susceptible person, your veins can stretch or expand if you frequently sit or stand for a long time.

Venous Hypertension and Reflux

Venous hypertension performs a significant function in the development of the disease. It causes the walls of the veins to stretch and expand (dilatation). Vein dilatation leads to distortion, leakage, and altered shear stress. All these factors lead to inflammation.

The inflammation will result in vein valve and wall changes - the reason for the reflux (back flow of blood). Reflux further raises the venous hypertension.

When the valves of the deep group malfunction, blood leaks back (Reflux) to the superficial group of veins and you will develop varicose veins. When the superficial group has defective valves, you may develop varicose and spider veins. Spider veins are similar to varicose veins only very much smaller in size.

Risk Factors

The following conditions predispose an individual to varicose veins and spider veins:

  • Pregnancy. Blood volume increases and may have an impact on venous hypertension. Also, the uterus puts pressure on the veins.
  • Obesity
  • Heredity
  • Hormonal changes during puberty, pregnancy and menopause

Signs and Symptoms

  • Aching or cramping pain in the legs
  • Tiredness, restlessness or heaviness in the legs
  • Increased pigmentation in the skin
  • Swelling
  • Blood clots

Evaluation

Evaluation is necessary to determine the type of treatment for your specific problem.

This includes a number of tests including a physical exam and ultrasound scans.

Doppler ultrasound is a medical device that can detect blood flow. This will provide your doctor with information regarding the direction of blood flow in your veins and whether your valves are working perfectly.

An ultrasound scan (duplex). This device enables your doctor to examine your deep veins more closely. Duplex ultrasound can be used to:

  1. Map the venous system of the leg and measure vein diameter
  2. Detect reflux in superficial and deep veins
  3. Detect occlusion in superficial and deep veins (thrombosis or sclerosis)

Treatment

Your treatment will depend on the results of your evaluation (size of the varicose veins, the presence of reflux, the presence of any symptoms and the location of the veins). Treatment options include:

Endovenous Laser Ablation (EVLA)

Endovenous Laser Ablation (EVLA) is a procedure that is generally used in treating the large varicose veins in the legs and normally requires 30 minutes to an hour to complete.

Endovenous Laser AblationEVLA is the least invasive of all treatment procedures and can be carried out even in a clinic with the right equipment.

After applying anesthesia to the vein, your doctor will begin the procedure by inserting a laser fiber through the skin and straight into the vein that is incompetent, ugly and often painful.

The insertion is guided by ultrasound until it reaches the incompetent segment. Then the fiber is gradually withdrawn while at the same time the right amount of laser light is delivered into the walls of the vein.

Endovenous Laser Ablation

This causes the vein walls to react by producing fibrous tissue resulting in irreversible occlusion and ultimately disappearance of the vein.

Any incompetent or varicose vein is unhealthy to the circulatory system and its destruction has no undesirable effects on the body.

Advantages of EVLA Over Other Treatments

  • A low possibility of developing stasis ulcer
  • Lower recurrence
  • Lower risk of scarring
  • Substantial relief from pain, heaviness and aches
  • Restores effective circulation immediately
  • Improves appearance
  • Normal activities can be resumed immediately
  • Only local anesthesia is needed

Recovery

EVLA is conducted under local anesthesia and demands little or no downtime. Patients are motivated to walk immediately following treatment to facilitate circulation.

Patients can resume work along with other normal activities the same day while vigorous activities and standing for an extended time should be avoided during the first week after the procedure. Pain is generally insignificant but is treatable with pain medication if needed.

Complications

Just like any medical procedure, there are potential complications. These are the complications that rarely happen:

  • Phlebitis (mild redness and sensitivity of the skin but can be conveniently treated by over the counter pain relief medications. Phlebitis typically resolves in 3 to 7 days.
  • Gentle numbness in the thigh area.
  • Infection at the site of incision that usually heals on its own.
  • Bruising is common but disappears in a week.
  • Deep venous thrombosis is a very rare complication but can easily be prevented by wearing compression bandage or compression stocking and walk immediately after the procedure.
  • Blunders made during the execution of the procedure. This can be avoided by picking a recognized, reputable and experienced physician.

Sclerotherapy

Sclerotherapy stems from the Greek word “scleros”, which means, to make hard and “therapea”, which means, service done to the sick. It is a procedure that is done to remove spider veins and smaller varicose veins.

Direct Injection Sclerotherapy

Spider veins or telangiectasia (tortuous tiny veins visible on the skin) are treated by direct injection sclerotherapy – no need for ultrasound.

Ultrasound-Guided Sclerotherapy (UGS)

UGS is an option for treatment of incompetent (refluxing) veins that are difficult to see on the skin’s surface. Ultrasound is used to locate the affected veins so the doctor can inject sclerosant into them. If an affected vein is long, multiple injections will be needed.

Catheter guided Sclerotherapy (CDS)

Our doctors also perform catheter-guided sclerotherapy (CDS) on big varicose veins. With the aid of ultrasound, a catheter is inserted through a tiny incision in the skin throughout the length of the affected vein (similar process to the EVLA); sclerosant is then introduced into the catheter, spilling out from the catheter tip in to the vein lumen; the catheter is gradually retracted so the whole length of the vein is uniformly subjected to the sclerosant.

Pre-treatment

Before your doctor performs sclerotherapy, he will subject you to a thorough exam. It is critical for your doctor to distinguish between spider veins and large varicose veins, and spider veins and spider angiomas.

Because sclerotherapy can only treat superficial small veins, the doctor must ensure that you must have no other more severe vein disease. Spider angiomas are similar to spider veins but occur in arteries and have a different underlying disease.

The Procedure

The procedure starts when the affected veins are injected with a sclerant (hardening) solution. The needle is inserted a certain distance through the incompetent vein and is gradually withdrawn while releasing the sclerant solution. The solution irritates the inner walls of the veins causing it to release inflammatory substances that cause the veins to harden. Over a period of time the body absorbs the dead vein.

Your body has the ability to redirect blood to deep normal veins and normal blood flow is re-established.

The outward appearance improves significantly. However, bruising may be present for a while as your body copes with inflammation and absorbs the spider veins.

A recent alternative to a sclerosing solution is foam. Among the number of benefits foam has is the ability to make more contact with the vein walls allowing the use of lesser amount of chemical. In addition, the movement of foam can also be monitored by ultrasound.

The use of foam has shown to have a high success rate with lower costs and fewer major complications.

Side Effects of Sclerotherapy

Only a few side effects are associated with the minimally invasive procedure:

  • Mild to moderate itching and burning sensation immediately after treatment that can last a couple of days.
  • Bruising at the sites of injection may occur and can last from several days to a week.
  • In rare cases, allergic reactions, infection at the sites of injection, or complications associated with poor injection techniques are possible.

Picking an experienced specialist to perform the procedure can reduce the potential for side effects.

Vein Ligation and Stripping

Ligation and stripping is a medical procedure done to surgically remove varicose veins. If most of the valves and the vein itself are incompetent, the vein (or the incompetent part of the vein) is “stripped”.

If some of the valves in the vein are competent, the weak part of the vein can be surgically tied off (ligation) and closed.

Vein stripping or phlebectomy is one of the oldest forms of varicose vein treatment and is much less performed today thanks to the emergence of less invasive forms of treatment.

Your surgeon will start the procedure by making two small surgical incisions, one in your groin and the other will be in your calf or ankle. The surgical incisions correspond to the top and bottom ends of the damaged vein.

Your doctor will then insert a flexible plastic wire into the top end of the vein through the incision in the groin and guides the wire through the vein toward the lower end of the vein and out through the incision in the lower leg.

The top end of the vein is then tied to the wire and the lower end of the wire is pulled out through the lower incision, which pulls the vein out with it.

Risks and Complications

Vein stripping is generally safe but as with any other surgical procedure, complications can happen. The following complications include:

  • Blood clots
  • Allergic reactions
  • Bleeding and bruising
  • Infection
  • Scaring
  • Nerve injury
  • Recurrence of varicose veins

After the Procedure

As the vein is stripped off, the attached branch veins are severed. This causes blood to leak into the surrounding tissues. This causes the post-operative pain, soreness and bruising you will experience.

Your legs will be bandaged to control swelling and bleeding for a few days after surgery. You may need to keep them wrapped for several weeks. To prevent recurrence of varicose veins, you will be instructed to wear compression stockings for several weeks.

You will need to take short walks daily for at least 10 minutes. Refrain from standing too long in one place. You can take a shower 2 days after surgery.

You may resume your normal activity at least 2 weeks after surgery. However, you are advised to avoid vigorous activities.

Varicose Vein Treatment Tailored Specifically for You

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