Varicose Veins

About

    • Varicose veins are leg veins sitting under the skin which expand to 3mm or greater when standing or sitting

    • Reticular veins, telangiectasias or spider veins are smaller veins that are visible under the skin

  • Almost one-in-four people have varicose veins.

  • Risk factors for varicose veins include:

    • Pregnancy

    • Prolonged standing

    • Female gender

    • Obesity

    • Prior DVT

    • Family history - 90% chance if both parents. If one parent, 60% risk for females & 25% for males.

    • Uncommonly, congenital valve disorders.

  • The veins of the legs are designed to move blood from the feet back to the heart. There are valves at several points along each vein, to ensure blood can only move in one direction, away from the feet.

    However, often the valves become ‘incompetent’, which means they no longer function to stop blood moving backwards down the leg.

    This causes blood to pool in the veins of the lower leg, resulting in bulging visible veins, extra fluid in the leg, as well as the other symptoms below.

  • ·      Pain

    ·      Swelling

    ·      Feeling of heaviness

    ·      Visible veins – larger veins, or small spider veins

    ·      Superficial clots (thrombophlebitis)

    ·      Bleeding

    ·      Eczema

    ·      Skin staining

    ·      Ulcers

  • Assessment begins with a thorough discussion about your medical history, followed by clinical examination.

    An ultrasound, called a venous incompetence duplex, often follows, which the gold standard for imaging potential varicose veins.

    The ultrasound will also determine which veins are not working properly, and will help determine which type of management is best.

TREATMENT

How do you treat varicose veins?

There are various treatment options for varicose veins, depending on their severity, and the type of veins that aren’t working properly. These include:

  • Conservative measures – such as leg elevation and massage.

  • Compression stockings – custom-made, firm stockings which cover from the toes to the knee, compresses the veins and removes extra fluid from the leg.

  • Stripping – this surgery involves tying off and often ‘stripping’ the vein, which is removing the entire vein that is not working, via several incisions.

  • Endovenous methods – these include endovenous laser therapy or radiofrequency ablation, via keyhole methods. Endovenous laser therapy has been shown to be more effective than stripping or radiofrequency ablation.

  • Sclerotherapy – used mostly for spider veins, involves injecting a medication designed to cause these small veins to block off.

  • Transcutaneous laser – used only for telangiectasias or spider veins, but is recommended only if sclerotherapy is not appropriate.

We will discuss which treatment option may be most suitable for you, with consideration of your preferences and factors such as:

  • The severity of your symptoms

  • The cosmetic impact of their appearance

  • Which veins are not working

  • The anatomy of the veins themselves

  • Your medical history

“What happens if you remove these veins, don’t I need them?”

The veins are only being removed because firstly they are not functioning as they are supposed to, and more importantly, they are doing the opposite of what they should be doing (since they are allowing the blood to flow backwards towards the lower legs). By removing these malfunctioning veins, it allows the veins that are working correctly to remove the blood from your legs.

Why Have My Veins Come Back?

Unfortunately, ‘recurrence’ of varicose veins (where the veins return after treatment) is not uncommon, and rates may be as high as 60% in the decades following surgery.

There are several main causes of this recurrence:

  • The most common cause is previously functioning veins becoming diseased and allowing backwards flow.

  • The second most common cause is development of entirely new varicose veins.

  • Uncommonly, there was incomplete treatment or treatment of the wrong vein. This was more common in previous decades, and fortunately is becoming less common with improved imaging and techniques.

Treatment of recurrent veins:

Endovenous surgery, phlebectomies (small incisions to remove the new veins), or sclerotherapy are considered the gold standard for recurrent veins. We try to avoid repeat surgery/stripping, due to the higher risk of complications in these situations, and the effectiveness of the less invasive options.

What are the risks of treatment?

Any operation requiring a general anaesthetic has risks like stroke, heart attacks, respiratory failure, or death. As such, we avoid general anaesthetics in people who are at high risk of these complications.

The main risks of interventions for varicose veins are listed below. These are often prevented by careful planning and treatment. While these can be life-threatening, they are actively watched for, and if they occur are immediately managed:

  • Bruising

  • Deep vein thromboses (DVTs or blood clots)

  • Nerve injury

  • Infection

  • New wounds

Do I need to follow up with my Vascular Surgeon after the operation?

Dr Shiraev will want to see you 1-2 weeks after your operation, to make sure you have recovered well, your wounds are healing, and answer any questions you may have.

Dr Shiraev will then see you again at 6 weeks after the operation, to make sure your wounds have completely recovered.

This advice is general, and is not intended to replace a formal clinical assessment and discussion with a health professional.