What are Varicose Veins?
Varicose veins are superficial veins of the legs, which have become dilated, tortuous and visible. They are very common.
Arteries take blood down the legs and veins bring blood back up the legs, usually under low pressure, to the heart.
There are two main systems of veins in the legs - the deep veins which carry most of the blood back up the legs to the heart, and the superficial veins, which can form varicose veins.
Veins in the legs contain valves (see diagram), which, under normal circumstances only allow the blood to flow in one direction, back up towards the heart. Failure of the valves allows blood to flow backwards down the veins and increases the pressure in the veins when standing. This excess pressure leads to dilation of the veins and the appearance of varicose veins.
What causes varicose veins?
Varicose veins often run in families and there may be a hereditary component.
Women are more likely to complain of varicose veins and up to 50% of women may be affected. Hormonal factors including puberty, pregnancy, menopause, the use of birth control pills, and HRT can affect the disease.
Jobs involving long periods of standing often make the symptoms of aching worse.
What symptoms do varicose veins cause?
Many people have no symptoms from their varicose veins.
Other than cosmetic embarrassment the commonest symptoms from varicose veins are aching, discomfort, and heaviness of the legs. These symptoms are usually worse at the end of the day or after long periods of standing. Sometimes varicose veins cause swelling of the ankle. These symptoms are not medically serious, but can be treated if they are sufficiently troublesome.
In a few people the high pressure in the veins causes damage to the skin near the ankle, which can appear like brown staining of the skin. Eczema (flaky, itchy skin) can develop as a result of varicose veins.
Ulceration of the leg can occur if these skin changes are allowed to progress, or if the skin is injured.
Bad symptoms and skin changes are a good reason for going to see your GP and for referral to a Vascular Specialist.
In Christchurch there are special leg ulcer bandaging clinics, supervised by specialist nurses. Professor Roake and Mr Lewis have close links with these clinics and may refer you there to improve damaged skin before treatment.
Other problems which varicose veins can cause are phlebitis and bleeding. Phlebitis or thrombophlebitis means inflammation of the veins. This inflammation may be accompanied by some thrombosis (clotting of blood) inside the affected veins, which become hard and tender. This is not the same as deep vein thrombosis (DVT) and is not usually dangerous. The risk of bleeding as a result of injury to varicose veins worries many people, but this is very rare. It will always stop with firm pressure and the veins can then be treated to remove the risk of further bleeding.
What tests can be used to investigate varicose veins?
Most varicose veins originate from faulty valves at groin level or, less commonly, behind the knee.
At your consultation the Vascular Specialist will use a small ultrasound probe to assess your veins. The probe can detect the direction of blood flow in the veins. This test helps indicate where the veins have come from and helps in the planning of any intervention that might be required. The Specialist will explain the findings of this test as he performs it.
A more detailed scan, called a Duplex scan, will usually be required if treatment is planned. This is usually done by appointment with Christchurch Radiology Group on a different day. This scan looks in detail at the superficial veins and deep veins. It can detect leaking valves and evidence of previous blood clots in the deep veins (deep vein thrombosis or DVT). The scan is performed by a specially trained sonographer and is reviewed by the Specialists at CVG.
Treatment
The Vascular Specialists at CVG are able to offer all treatment options for your varicose veins. They will discuss all the treatment options with you weighing up the pros and cons of each treatment. They will help you decide which treatment is best for you.
Compression: Tight compression socks or stockings can help control the symptoms caused by varicose veins. They come in a variety of colours and styles and need to be carefully fitted. These support garments can help to heal skin that has been damaged as a result of varicose veins. Sometimes patients do find these stockings/socks too uncomfortable to wear.
Injection Sclerotherapy: This involves injection of a liquid into the varicose vein that causes an irritation and inflammation in the lining of the vein. Accurate and effective injection usually needs to be guided with an ultrasound machine. This is called ultrasound-guided sclerotherapy (UGS). Following injection the vein is compressed by bandaging the leg or wearing tight stockings. The inflammation causes the walls of the varicose vein to stick together. If this is successful the varicose vein will not be visible.
The Vascular Specialists at CVG do use this technique but do not usually recommend it as a first line treatment if you have significant valve failure (see above). This is because injection is less successful than other treatments that can be used. Injection sclerotherapy can be used successfully if you have a few isolated varicose veins and no major valve problems. It can also be used successfully following other treatments like Laser treatment and surgery.
Laser Treatment: Endovenous laser Therapy or EVLT can be used to treat varicose veins on site at Christchurch Vascular Groups Rooms. The procedure is performed under local anaesthetic and involves passing a laser fibre up the main varicose vein in the thigh. The laser is then switched on and causes a thermal injury to (burns) the inside of the vein as it is withdrawn (see diagram).
If successful this causes the vein to block off and shrivel up which in turn reduces the pressure in the veins lower down the leg so making them less visible. A proportion of patients need injection sclerotherapy after EVLT to “tidy up” any varicose veins that are still visible. You can go home approximately 30 minutes after EVLT.
Surgery: Varicose vein operations are usually performed under general anaesthesia and as a day case. The visible varicose veins below the knee are removed through incisions measuring approximately 2mm in length.
To deal with the cause of the veins the commonest operation involves an incision in the groin. The main varicose vein is tied off and divided. It is then stripped out of the thigh, under the skin, to knee level where another small incision is made to retrieve it.
Is treatment successful?
Stockings are effective in controlling symptoms and preventing skin complications. They are only effective if worn regularly.
Injection of varicose veins can be successful but in this technique has been criticised by specialists because of high rates of recurrent varicose veins.
Surgery and laser therapy are probably as successful as each other at treating varicose veins. There are things for and against both these treatment options. Not every patient is suitable for laser treatment.
More information is included in the PDF files below which you are welcome to download and read.
If you have any questions or wish to discuss anything further, please don’t hesitate to contact us.
