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Sclerotherapy

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Traditional Varicose Veins Surgery

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Sclerotherapy

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Traditional Varicose Veins Surgery

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What Are Varicose Veins?

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Enlarged, twisted (gnarled), swollen veins commonly seen in your lower legs are known as varicose veins or varicosities. These occur when your veins become dilated and overfilled with blood, typically raised and bluish-purple or reddish-green. They can be extremely painful, causing discomfort and negatively impacting your quality of life. 

Varicose veins may appear different when different veins are affected with varying patterns and progression. These include:

Saphenous varicose veins

  • The condition affects the saphenous veins, a problematic vein that begins inside the ankle and extends up to the groin.
  • The veins appear rope-like due to excess twisting that initially appears colorless and later becomes prominent as they bulge out.

Spider veins

  • Spider veins are milder forms of varicose veins that are usually esthetically unpleasant.
  • They appear as tiny, red or blue clusters branching out, giving a spider web appearance.

Reticular veins

  • These bluish-purple varicose veins appear around your knees and ankles, affecting the reticular veins.

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Causes of Varicose Veins

Veins have a one-way valve system that prevents blood from flowing backward. When these valves fail, weaken, or get damaged, the blood pools around the affected vein instead of continuing toward your heart. This causes increased pressure within the vein leading to the stretching of the vein walls and enlarging them.

Some potential risk factors increase your likelihood of developing varicose veins, such as:

  • Family history: Varicose veins could be inherited if it runs in your family.
  • Aging: People above the age of 45 years are the most vulnerable.
  • Gender: The condition is more common among women than their male counterparts.
  • Obesity: Being overweight since increased weight can exert excess strain on the lower part of the body.
  • Prolonged standing or sitting: This can adversely affect the veins in your lower legs due to increased pressure exerted.
  • Hormonal imbalance: As seen during pregnancy, the growing fetus's hormonal changes and weight impair valve function.
  • Smoking: This leads to vasoconstriction (narrowing of the veins), which increases muscle tone and inhibits normal blood flow.
  • Restrictive clothes and footwear: Wearing tightly-fitted clothes and high heels can further increase your risk.

Stages of Varicose Veins

Stages of Varicose Veins

Description: Small, thin veins that appear close to the surface of the skin, typically red, blue, or purple in color. They often form web-like patterns, hence the name.

  • Common Locations: Legs, face.
  • Symptoms: Usually cosmetic, but can sometimes cause mild discomfort or itching.
  • Treatment Options: Sclerotherapy, laser therapy, and lifestyle changes such as regular exercise and avoiding prolonged standing.

Description: Medium-sized veins that are blue or purple and appear slightly raised or flat under the skin. They are larger than spider veins but smaller than varicose veins.

  • Common Locations: Back of the legs, inner thighs, and around the knees.
  • Symptoms: Can cause discomfort and a feeling of heaviness in the legs.
  • Treatment Options: Sclerotherapy, laser treatment, and compression stockings.

Description: Large, bulging veins that are often raised above the surface of the skin. They are usually twisted and can be blue, purple, or flesh-colored.

  • Common Locations: Legs, especially the calves and thighs.
  • Symptoms: Aching, throbbing, and heaviness in the legs. Can lead to swelling, cramping, and skin changes.
  • Treatment Options: Endovenous laser treatment (EVLT), radiofrequency ablation (RFA), vein stripping and ligation, and sclerotherapy.

Description: A condition where the veins have trouble sending blood from the limbs back to the heart, often due to damaged vein valves.

  • Symptoms: Swelling in the legs and ankles, pain, cramping, a feeling of heaviness, and skin changes such as hyperpigmentation and eczema.
  • Complications: Can lead to venous ulcers if left untreated.
  • Treatment Options: Compression therapy, lifestyle changes (e.g., weight management, regular exercise), medication to improve blood flow, and vein surgery in severe cases.

Description: Open sores that develop on the skin, usually around the ankle, due to prolonged venous insufficiency and increased pressure in the veins.

  • Common Locations: Ankle and lower leg.
  • Symptoms: Painful, non-healing wounds that can become infected.
  • Treatment Options: Wound care (cleaning and dressing the ulcer), compression therapy, medications to treat infection, and advanced treatments such as skin grafts or vein surgery to address underlying venous issues. Regular monitoring and care from a healthcare provider are essential to promote healing and prevent recurrence.

Symptoms of Varicose Veins

The most classic sign of varicose veins is the presence of bluish-purple or reddish-green veins in your lower legs. Other symptoms include:

  • Prominent bulging veins: The affected veins appear twisted and enlarged and a bulge near your inner thighs, behind the knees, and ankles.
  • Heaviness in your legs: The muscles around the affected area may feel heavy and sluggish due to increased blood pooling and pressure, especially after physical activity.
  • Itching: Pooling of blood and skin stretching can cause excessive itching around the affected areas.
  • Pain and discomfort: Increased vein pressure can cause pain and discomfort. Your legs may be sore or achy, accompanied by muscle cramps.
  • Swelling: Your legs, ankles, and feet may swell up due to blood pooling around the affected veins.
  • Skin changes: These begin as discoloration and gradually progress to ulcers and sores if left untreated.

How Varicose Veins Are Diagnosed

Varicose veins are easy to diagnose due to the characteristic features such as twisted and enlarged bluish-green veins in your lower legs. Your doctor will evaluate your symptoms and record your medical history to rule out other pre-existing medical conditions like diabetes (increased blood sugar levels), hypertension (high blood pressure), blood disorders, and other diseases related to your heart, lungs, or kidneys.

Your provider/doctor will conduct a physical examination and order a few diagnostic tests to confirm varicose veins. 

Physical examination

  • Your doctor will clinically examine your legs while standing and sitting to check for signs of swelling and bluish-purple veins.
  • He/she will press against your affected leg to check for any tenderness and discomfort.
  • Your doctor will also examine for skin changes and ulceration.

Diagnostic tests

  • These are mostly imaging tests that help to confirm the presence of varicose veins, which gives the doctor a clear understanding of the stage of varicose veins being suffered.
  • This helps the doctor determine the treatment that best suits your condition.

Venous Doppler Ultrasound Scan

  • This scan uses high-frequency sound waves to check the blood circulation within the affected vein. 
  • It shows the presence of any blockage in the veins by blood clots formed due to abnormal pooling of the blood.

Colour Duplex Ultrasound Scan

  • This scan uses a device to distinguish the blood flow through different colors. The blue color on the scan indicates normal blood flow, whereas the red color indicates abnormal blood flow through the suspected veins.
  • This test provides a detailed picture of any blockages within the blood vessels, faulty valves, and incorrect blood flow, which is known as ‘reflux.’

Venogram 

  • During this test, your doctor will inject a special dye into your lower legs and captures the X-ray images.
  • The dye appears on the X-ray images indicating normal blood flow. Any break or discontinuity of the dye on the images indicates a blockage.
  • These diagnostic tests also help rule out other blood disorders that may mimic symptoms like pain and swelling in your legs.

Treatment Options For Varicose Veins

Treatment of varicose veins depends on the stage and severity of the condition, although you cannot permanently cure it. Treatment usually helps to cosmetically benefit your legs' appearance and relieve symptoms like pain, swelling, and skin changes. 

Conservative Treatment

This is the first line of treatment option when you observe early signs of varicose veins, such as spider or blue veins. Your doctor may suggest the following:

 Self-care

  • Avoid standing or sitting for long periods to reduce pressure on your lower legs.
  • Make sure to elevate your legs using a small stool to improve the blood circulation in your lower legs since it prevents abnormal blood pooling.

Lifestyle changes

  • Maintain a healthy and balanced weight to minimize the strain on your legs. This can be achieved by a nutritious and well-balanced diet loaded with fiber (fruits, vegetables), proteins (eggs, lean meat), and good water intake. 
  • Regular exercise (including walking, jogging, swimming, and cycling) is an important factor that helps maintain an ideal weight and improves blood circulation. 

Compression stockings

  • Your doctor may prescribe compression stockings that help improve your blood circulation.
  • These aid in providing consistent pressure on your legs, promoting blood flow to your heart.

Surgical Treatment For Varicose Veins

Your doctor may recommend surgery if the above non-surgical methods fail to provide relief.

Invasive Surgery (Vein Ligation and Stripping)

This is a traditional surgery performed under general anesthesia (a numbing agent that sedates your whole body and puts you to sleep during the surgery). It involves large, extensive incisions or cuts to access the affected vein, which is surgically removed (stripped). The cut ends are tied together (ligated) to stop the blood flow.

Minimally Invasive Surgery

These are minimally invasive since the procedure involves small incisions or cuts to access the affected vein.

  • Ambulatory phlebectomy- This procedure helps to remove varicose veins close to your skin surface. It involves small cuts to access the affected veins and removal of the diseased varicose part of the vein.
  • Sclerotherapy- Your doctor will inject a special chemical solution directly into the affected vein, which causes the vein walls to stick together. These form scar tissue which eventually fades away.
  • Endoscopic Vein Surgery- During this procedure, your doctor will make small keyhole-sized incisions near the affected vein. An endoscope (consisting of a tiny camera and light source) will be inserted through the incision to gain access and capture images of the surgical site. Tiny surgical instruments will be inserted through other incisions to remove the diseased varicose vein.
  • Radiofrequency Ablation- This procedure involves using a device that emits radiofrequency energy to heat up the vein walls. The heat destroys the walls of the diseased varicose vein and seals it.
  • Laser Vein Surgery- This involves using a laser beam targeted at the diseased varicose veins. The light energy emitted from the laser source penetrates the tissue layers and gets converted to heat energy to close the diseased veins.

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Complications associated with not treating Varicose Veins

Treating varicose veins to relieve symptoms that can negatively impact your quality of life is important. However, if left untreated, it can lead to a series of complications that can vary according to the severity of varicose veins. The complications may usually develop several years after the initial diagnosis.

Phlebitis

  • Also known as thrombophlebitis, it refers to the inflammation of the veins that leads to the formation of blood clots.
  • Symptoms include- swollen, painful, reddened skin around the inflamed veins.

Bleeding

  • Bleeding through a ruptured varicose vein can be alarming since it can cause a significant amount of blood loss quickly.

Deep vein thrombosis (DVT)

  • Occasionally untreated varicose veins can cause blood clots within the deeper veins of your legs. These clots can break and dislodge into your bloodstream and travel to other organs.
  • One such complication is the dislodgment of the blood clot in your lungs, causing a pulmonary embolism, which can be fatal (cause death).

Venous insufficiency

  • If the blood flow in the affected vein is disrupted for an extended period, it can affect the oxygen exchange and processing of the nutrients within them.

Venous ulcers

How to Prevent Varicose Veins?

You may not be able to prevent varicose veins if it is inherited; however, you can reduce your chances of developing them by the following preventive measures.

  • Elevate your legs to improve blood flow from your leg veins to your heart.
  • Get rid of excess weight (by consuming a healthy and well-balanced diet) to reduce pressure inside your leg veins.
  • Avoid long periods of standing or sitting and take regular breaks in between to encourage normal blood flow.
  • Stay active through regular exercises such as walking, jogging, swimming, cycling, etc. A sedentary/inactive lifestyle can sluggish blood flow, putting excess pressure on your leg veins.
  • Quit smoking since it damages your blood vessels and slows the blood flow.
  • Use compression stockings to help compress or squeeze your veins to help in blood circulation.
  • To encourage blood flow, wear clothes that fit properly.
  • Avoid wearing high heels that compromise your body posture and strain your lower legs excessively.

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