Varicose Veins Explained

Varicose Veins Treatment Options


Varicose Veins

The word "Varicose" comes form the Latin word "Varix" which means Twisted. Any vein can be varicosed where there is an increase of pressure and the smooth blood flow is compromised.

Elongated, dilated, tortuous superficial veins (usually in the legs) with incompetent valves, permitting reversed flow.

The most commonly affected veins are those in the legs and feet. Varicose veins are a common condition and it affects one in five people, more common with age and more common in women.

What are Varicose Veins?

There is a one way valve within the vein to ensure that, when the calf squeezes, the blood travels in an upwards direction only - when this stops working, or becomes less efficient, causing the blood to flow backwards allowing the vein to bulge and become swollen and distorted.

Where else can you get Varicose Veins?

Any part of the body where there is a build up of pressure. Vulval Varicosities are a common occurrence in Pregnancy.

Why do we get Varicose Veins?

Many reasons but three main ones.

  1. There is a genetic tendency
  2. Occupations involving standing for long periods
  3. Pregnancy
What are the symptoms?

Symptoms vary from no major symptoms to quite severe and are very individual. Patients can report any of the following:

  • Heavy, achy, uncomfortable legs getting worse over the day
  • Dry, Itchy skin
  • Venous Eczema
  • Swollen ankles
  • Lipodermatosclerosis - where the the skin over the ankle and above the ankle shrinks as the fat underneath becomes sclerosed or hard
  • Brown discoloration around the veins
  • Heavy bleeding as a result of minor injury
  • Phlebitis - painful inflammation of the varicose veins
  • Venous leg ulcers may be the result of any of the above conditions not being treated
Can they be prevented?

Yes - in many cases!
Regular exercise for the legs will keep the blood flowing and prevent varicose veins. Avoid excess weight; don't smoke; don't stand still for long periods of time.

How are they treated?

Varicose Veins will not resolve untreated. Whichever way you decide to have your veins treated, a thorough investigation of your venous pathway is essential. This establishes exactly where the incompetence is occurring, which veins are affected and the best type of surgery for the condition. A hand held Doppler or a Duplex ultrasound scan will be performed to establish this. A decision will then be made between:

  • Traditional open surgery
  • EVLT - Endovenous Laser Therapy
  • VNUS - Radiofrequency therapy
The Operations available to treat Varicose Veins

Traditional Open Surgery
The main feeder vein (identified by Duplex and marked) will be tied off through an incision in the groin and/or behind the knee. All marked, visible varicose veins are then avulsed through a series of small incisions. The operation can take anything from a half hour to an hour and a half, depending on the extent of the varicose veins.

EVLT Endovenous Laser Therapy
The Duplex scan will have identified that your condition will respond very well to this procedure. Local anesthetic will be injected around the vein before the laser is used. Once the laser is turned on, it will slowly be withdrawn down the leg. As the fibre is withdrawn the laser energy burns the inside of the vein sealing it from the inside. A compression bandage is then applied to the leg. You can walk about straight away and go home immediately.

VNUS - Radiofrequency therapy

Leg Bandaged
When do I go home?

Either immediately or the next day depending on the type of surgery you have had.

What happens when I get home?

Bandage:

If you stay overnight, the bandage will be removed by a nurse the following day and the white elastic stockings will be put on. This stocking is to be kept on day and night for the first week and throughout the day for three weeks following this. If you go home on the same day, you will need to take your bandage off the following day and apply your stocking yourself. In that situation, you will need to unwrap your outer bandage and underlying wool bandage (if present). Then, take off the stocking that is already in place and don't worry if any paper stitches come off at the same time. Finally, put on the white elastic stocking that was provided over the paper stitches.

Pain, bruising, altered sensation and swelling can be side effects to the surgery but not in all cases.

Pain

Day 1 The pain can be described as uncomfortable
Day 8 The pain in the leg can be at it's most uncomfortable
Day 14 All pain should have completely resolved.
Your surgeon will ensure that you have a prescription for painkillers adequate to keep your level of pain at bay. It is important that you take them to keep yourself pain free and available to mobilize fully.

Bruising

Most people experience bruising after the surgery. The larger the area of surgery the more bruising is likely to occur. It can take up to four weeks for this bruising to fully resolve. During this stage you may experience some swelling to the skin. This is an inflammatory reaction in the tissues around the operation site. It is part of the healing process and is normally resolved within three weeks. Occasionally you may also feel small lumps; these are caused by a collection of blood where the vein used to be. They normally resolve on their own, but can take up to six months to fully resolve.

Altered Sensation

As all veins are surrounded by nerves, it is not unusual to have some disturbance to normal sensation after vein surgery. If you have had your surgery under local anesthetic this is a normal effect of the drug and will wear off after 24 - 48 hours. Sometimes this numbness or tightness you feel will last for longer even six months to a year. This should not stop you leading a normal life.

Swelling

It is not unusual to have some swelling around the operation sites. You may also have slight swelling around your ankle. The operation on your veins will have disturbed you normal blood supply; this will in time settle down and as a result of the surgery will improve. To help prevent swelling make sure you elevate you leg, as high as your hips when resting.

Movement

Walking and movement is essential. A good guide is about 5 minutes every hour in the beginning building it up gradually. Avoid standing still or sitting with your feet down during the first week - when sitting make sure your legs are elevated as high as your hips.

Bathing/Showering

You can shower or bath once the wounds have settled and are completely dry. This is usually 2 days after the surgery. Remove stockings for the time of the shower but put them back on straight after. The paper stitches may come off during this - don't worry - your wounds will heal anyway. Bleeding may occur - again, don't worry - lie down, raise your leg, and apply pressure with a clean dry towel for 10 minutes. The paper stitches can come off after one week but they may well start coming off naturally even after the first day after surgery.

Driving

You can drive when you can comfortably make an emergency stop. It should be about 3 days after surgery, but you should also check with your own insurance company.

Are there complications?
  • Surgery or EVLT will eliminate varicose veins, although 1 in 15 patients will develop recurrence over a ten-year period
  • Not all leg symptoms in patients with varicose veins are caused by these veins. Aching, itching and swelling may be improved by surgery but not in every case.
  • The cosmetic result is usually good but incisions become red and quite obvious over the first 6-9 months. The redness then fades.
  • Wound infections are unusual but may occur in approximately 1 in 50 patients
  • A small nerve to the skin may be damaged while avulsing varicose veins causing numbness for 2-3 weeks after which the absence of sensation, although permanent, is not noticeable.
  • Deep vein thrombosis may occur following any surgery, particularly under general anesthetic. Without treatment to prevent this, the risk is only 7 per 1000 operations but for patients at risk, we will give a blood thinning agent to prevent this.
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