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​Varicose veins

Dec. 3, 2017

Varicose veins

Everyone will be familiar with varicose veins – the tortuous and distended blue blood vessels that creep over up to 25% of adults' legs. These affect women three times more than men and they run in families. If your mother has them there is a 60% chance you will get them, and a 20% chance if your father has them. If both parents have them your risk is over 95%.

They are most commonly found in the calf or thigh and are due to failure of the one-way valves in the superficial veins. When these valves fail the blood is no longer effectively pumped back to the heart and blood flow is reversed. The superficial blood vessels become engorged with blood and gradually distend. At first this is worse after long periods of standing and is relieved by elevating the legs. With time, they worsen and become ever present.

We know that carrying extra weight, aging, having a history of a deep vein thrombosis (clot), pregnancy and menopause increase risk.

Whilst varicose veins have in the past been labelled as a cosmetic problem it is not a fair description.

Suffers often describe aching of their legs, ankle and feet and often get swelling. Some people get swelling without any obvious distension of their veins. With time, the skin surrounding the varicose veins becomes hardened, starts getting itchy and discoloured (varicose eczema). The condition is progressive and if untreated can lead to venous ulcers – a miserable situation where large wounds develop, often around the ankle that do not always heal. These can become very deep – exposing muscles – and have a tendency to infection. Pictures have not been inserted so not to upset the squeamish, but do google "varicose ulcers images" if you are interested.

The public hospitals have been resistant to offering treatment for anything but the very worst varicose veins – normally only if the patient has had some major haemorrhages from their veins. Whilst this may seem harsh, the hospitals have limited resources and have to make choices about how to spend their dollars the most effectively. For the majority of us, private treatment is the only realistic option.

In the past, the gold standard treatment for varicose veins was surgical stripping of the veins. This is a rather brutal procedure, where the vein is pulled out through a series of incisions in the leg. It is done under a general anaesthetic and there is a recovery time of 4-6 weeks. Whilst it remains a really effective treatment, we are now fortunate that this procedure, that has been routinely done for over 100 years, has now been matched in effectiveness by new techniques. It is still the standard treatment for very complex cases, or when a patient would prefer treatment under general anaesthetic.

Vascular surgeon, Mr Venu Bhamidi, talks very positively about new techniques and jokes about "lunch time veins". He frequently treats varicose veins in a patient's lunch hour, with the treatment being so quick and easy that they are literally able to return to work subsequently. His preference is for Radiofrequency Ablation.

Radiofrequency Ablation is a type of endovenous thermal ablation. Endovenous means within a vein and ablation means to close off. In this procedure, a small incision is made in a vein to allow a thin catheter to be passed along the vein and radiofrequency energy is used to heat the vein wall. Some local anaesthetic is used along the vein to ensure there is minimal discomfort. The blood in the vein clots and gradually the vein fibroses and shrinks away. The whole procedure lasts about 45 minutes and patients can walk out afterwards. This minimally invasive procedure is an ideal way to slow down the progression of the disease.

Some centres offer Endovenous Laser Ablation. Whilst it too is minimally invasive only a small area can be treated at any one time, and there can be inflammation of the veins subsequently.

Sclerotherapy has been used extensively in the past by some vein clinics, it is when a medical detergent is foamed up and injected into a vein to block it off. It has inferior results for primary treatments, but can be a useful adjunct to one of the other types of therapy.

A really promising option for the future is Endovenous Glue Ablation, where the vein is literally sealed shut with cyanoacrylate.

Whatever treatment option is used it has to be noted that recurrence is common. It is rare for a treated vein to open up again, however new veins grow and when their valves fail there are new varicose veins. Also, veins that had competent valves at the time of treatment, may start becoming incompetent later on, allowing varicosities to develop in other veins.

If you wish to consider having your varicose veins treated do come and talk to your Medplus GP who will be happy to refer you to a vascular surgeon. Some health insurance policies do cover treatment for varicose veins.