The ‘twists’ and ‘turns’ of varicose veins

By Dr Anirban Banerjee, MS, MRCS (Consultant Surgeon)

What are Varicose Veins?

Varicose veins are veins in the legs, which have enlarged, and become tortuous. They are very common and do not cause medical problems in most people.

Blood flows down the legs through the arteries, and runs up the legs through veins. There are two main systems of veins in the legs − the deep veins which carry most of the blood back up the legs and subsequently, to the heart; and the superficial veins under the skin, which are less important and which can form varicose veins.

• All these veins contain valves, which should only allow blood to flow towards the heart. A failure of these valves causes blood to flow back down the veins and cause swelling when standing. This excess pressure leads to dilation of the veins and the appearance of varicose veins.
        
What causes varicose veins?
Varicose veins and spider veins often run in families and there may be a hereditary component. Women are more likely to suffer from varicose veins and up to 50% of women may be affected.
It is very common for pregnant women to develop varicose veins during the first trimester.
How common are varicose veins?

Varicose veins affect about 50-55% of women and 40-45% of men. Varicose veins usually occur with increased age, family history, pregnancy, obesity, or leg injury.  People who stand for prolonged periods of time also are likely to develop varicose veins.

How do varicose veins present?
Many people have no symptoms at all from their varicose veins, except for the fact that they are noticeable.

Other than cosmetic embarrassment, the symptoms from varicose veins are a dull ache, discomfort, and heaviness in the legs, which usually are worse at the end of the day.

In a few people the high pressure in the veins causes damage to the skin near the ankle, which can become brown in colour. Eczema (a red skin rash) can develop in a few cases. If these skin changes are allowed to progress, an ulcer may result.
                            
Should I see a doctor for my
varicose veins?
Yes, especially if you are experiencing any of the above symptoms. Only a doctor can diagnose the cause and severity of your varicose veins. Your doctor can advise you on an appropriate treatment.

What tests are required to
diagnose varicose veins?
While a simple history and physical examination is all that is usually required to diagnose varicose veins, other tests may be required to determine the cause. The most common diagnostic test is an ultrasound examination. An ultrasound examination is  a noninvasive and painless procedure to determine the condition of the vein valves.

What are the treatment options
for varicose veins?
Surgery: The operation is usually performed under anaesthesia. Through tiny incisions, the varicose veins are removed. To deal with the cause of the veins, an incision is usually made in the groin.
The keyhole technique (subfascial endoscopic perforator surgery or SEPS) involves a small incision in the upper calf through which a telescope is passed under the skin. The veins are then tied under direct vision without any other skin incisions.
There are some new types of venous surgery which are minimally invasive and these include laser ablation and radiofrequency ablation.

Other treatment options
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 the long term outcome requires further evaluation.

Can I help myself?
Simple measures such as wearing support stockings will control the symptoms for many people. Stockings may help to prevent progression or enlargement of varicose veins. If you are overweight you should try and lose weight.