What are varicose veins?

Varicose veins are veins, usually in the leg, that have become enlarged because blood is not able to flow through them properly. Veins take deoxygenated blood back to the heart, and blood returning from veins in your legs and feet have to flow upwards, against gravity. In order for this to work, your veins have one-way valves which prevent the blood from flowing the wrong way. If some of the valves become “leaky” and do not work properly you can develop varicose veins where the blood pools in the veins in the legs instead of being returned to the heart. This is known as chronic venous insufficiency. Over time, this will lead to the veins swelling and the formation of varicose veins.

Where do varicose veins occur?

Varicose veins most commonly affect veins in the legs. Within the legs there are two systems of veins: deep veins and superficial veins.

Deep veins run close to the bones and drain over 90% of blood from the foot to the heart. It is uncommon for there to be problems with the valves in the deep veins.

Superficial veins run closer to the surface of the skin, and blood from the superficial veins drains into the deep veins before it returns to the heart. Varicose veins are much more likely to develop in the superficial veins of the leg rather than the deep veins.

Why treat varicose veins?

If left untreated, varicose veins can eventually lead to swelling and irreversible skin damage in the lower legs which can result in skin ulcers (breakdown of the skin). Venous ulcers are the major cause of leg ulcers in our community and require specialist medical and nursing care and often require dressings for several months. Varicose veins can have a big impact on someone’s life. Varicose veins can cause discomfort and pain, and affect a person’s ability to work leading to a decreased quality of life. They can also affect a person’s emotional wellbeing as they can present as a cosmetic concern.

What causes varicose veins?

There are a number of risk factors that put someone at higher risk of developing varicose veins. These include a family history of varicose veins, increasing age, being female, and pregnancy. New cases of varicose veins are most likely in women between the ages of 40 and 50 years.

Varicose veins symptoms

For many people, varicose veins and spider veins (a common, mild variation of varicose veins) are simply a cosmetic concern. However, varicose veins can also cause symptoms for many patients and these can include:

  • An achy or heavy feeling in your legs
  • Burning, throbbing, muscle cramping and swelling in your lower legs
  • Worsened pain after sitting or standing for a long time
  • Itching around one or more of your veins
  • Bleeding from varicose veins (can be high volumes due to the high pressure in the veins)
  • A painful cord in the vein with red discoloration of the skin (known as thrombophlebitis)
  • Swelling of the ankles (oedema)

Diagnosing varicose veins

Your doctor will take a comprehensive history and perform an examination before diagnosing varicose veins. Throughout the history they will be looking out for details regarding risk factors and symptoms that you may be experiencing.

In the examination they will be looking, first and foremost, for the presence of dilated veins, but also for other signs such as ulceration, skin pigmentation and ankle swelling. Duplex ultrasound can be used to check if the valves in the veins of the legs are working properly and to measure the diameter of affected veins.

Without treatment, varicose veins will steadily get worse over time. Choice of treatment will vary between patients and depend on the severity of their varicose veins as well as their overall health and age. Some treatment options include sclerotherapy, endovenous laser, surgery and venous embolisation.

Sclerotherapy

Sclerotherapy is a widely used procedure for superficial varicose veins. Small and medium sized veins can be injected with a solution that makes the vein collapse. As a result, the treated vein can no longer carry blood and in a few weeks the varicose veins should fade. After injection, compression is applied to the area. An advantage of sclerotherapy is that is does not require anaesthesia and can be performed in Dr Shakibaie’s office.

There is the possibility for complications with sclerotherapy injections. Skin discolouration (such as red patches) may occur after injections and there may be bruising or swelling which tends to subside over a few weeks. If you have any concerns, discuss these with your doctor.

Endovenous laser therapy (EVLT)

Being minimally invasive, this is the preferred treatment for treating the underlying vein that is causing the varicose veins. Using ultrasound guidance, a thin tube (catheter) is inserted into the varicose vein. When in place, the tip of the tube is heated using laser energy and the tube is then removed. This causes the vein to collapse and thus no longer allow the blood to flow back towards the feet. This procedure can be performed under local anaesthetic and is usually performed in Dr Shakibaie’s office.

It is a safe and effective treatment of varicose veins and patients can usually return to normal activities, including work, within 24-72 hours. Pain and bruising are the most commonly reported side effects. Nerve injury, skin burns and deep vein thrombosis are very rare. EVLT is considered a safe treatment for varicose veins in the legs.

Radiofrequency ablation

Radiofrequency ablation works in a very similar way to endovenous laser therapy. A tube is guided into the vein using ultrasound. A device, which gives off radiofrequency energy, is put through the tube. This heats up the vein and causes it to close. Side effects can occur but are uncommon and include inflammation and abnormal sensation in the area.

Surgery

Surgery can improve the cosmetic appearance of your legs and improve symptoms you may be experiencing such as aching. Surgery is performed in a hospital and involves making an incision in the groin and another incision at the knee. The vein usually tied near the incision at the groin and then stripped (removed) through the incision at the knee.  Importantly, removing the vein will not affect circulation in your leg due to the fact that the deeper veins are responsible for draining larger volumes of blood.

Surgery usually requires a general anaesthetic, and although very effective, it may involve a longer recovery and more discomfort post-procedure than some of the other treatment options. You may feel sore and experience discomfort for several weeks after surgery. There are also more risks associated with surgery than the other treatment options. For example, there is the possibility of being allergic to the anaesthetic, bruising, having numb patches on your legs or bleeding during or after surgery.

Venous embolisation

This procedure is reserved for when the source of the leg varicose veins originates from the veins higher up in the pelvis and abdomen. A small catheter is placed inside the vein at the groin and guided under X-ray’s to the pelvis to the source of the varicose veins (usually the ovarian vein in women and testicular vein in men). Once there, a small device (coil) is deployed which will then stop flow in that particular vein and hence remove the pressure being transmitted to the leg varicose veins.

Although it is minimally invasive and done under a local anaesthetic, it requires sophisticated X-ray equipment and is done as a day case in a hospital. Recovery takes only a few hours.

Before the operation

  • Please refrain from eating or drinking any food or drinks for at least 6 hours before the scheduled operation time.
  • Please take your regular medications (unless otherwise instructed) at your normal time with sips of water.

After the operation

Following treatment for varicose veins it is important to take proper care of yourself. This makes sure that the treatment is as effective as it can be and also minimises any discomfort you may experience.

  • Your operated leg will be tightly wrapped up in bandages overnight. These will be replaced by compression stockings when you are ready for discharge.
  • Please DO NOT DRIVE yourself home. Driving can be resumed after 3 days only if you feel it is comfortable to do so. Please use your common sense to decide when it is safe for you to drive.

Stockings and dressings instructions

  • You will be discharged home wearing the compression stockings.
  • It is important that you wear the compression stockings throughout the day (from when you wake up until when you go to sleep) for 2 weeks.
  • You can take the stockings off for showers but put them back on soon after.
  • You may have a 5x4cm dressing in the groin or back of knee (or both). Please keep this one on for 5 days then remove.
  • You will have some steri-strips all over the leg (small white sticky tapes 4x1cm long). Please leave these as they will fall off themselves, after 1-2 weeks.
  • All sutures used are dissolvable and there is no need to remove any sutures.

Symptoms and activities

  • Pain, discomfort, bruising and swelling on the operated leg is to be expected. This will slowly resolve over a period of 1-3 weeks. Simple painkillers (e.g. paracetamol) will usually suffice to make the discomfort more tolerable. If pain is severe, please contact Dr Shakibaie’s office for an early appointment.
  • After the swelling resolves, there may be hard “lumps” felt under the skin close to any scars. This is normal and will resolve over a few weeks.
  • It is important to walk for at least 30min each day even if it requires painkillers.
  • Please refrain from swimming for 2 weeks post surgery.

Follow-up

  • Please make a follow-up appointment to see Dr Shakibaie for a review approximately 8 weeks after surgery.
  • It is not necessary to have a follow-up appointment if you feel the wounds are healing well and have no questions.

Before you go home

  • Please walk for 10-15 minutes prior to going home to get the circulation going in the legs.

Stockings instructions

  • Wear the compression stockings continuously for the first 3 days (i.e. wear them to sleep).
  • After the first 3 days, wear the compression stockings for at least a further ten days but you may remove them when you sleep at night.
  • You can take the stockings off for showers but please do not take a shower on the day of the procedure.
  • Remove any dressings/tapes when you take the first shower after sclerotherapy.

Symptoms

  • Bruising, mild pain and mild swelling may be experienced in the first few days. Simple painkillers (e.g. paracetamol) can be taken but are rarely needed
  • The injections sites may go red in the first few days. This may then change into a brownish discolouration but should settle over a few weeks.

Exercise/activities post sclerotherapy

  • You are welcome to do any activity (including driving) you desire as long as you keep the stockings on as per above instructions. Some activities may be more uncomfortable than others but you will not be causing any damage to your legs.
  • Swimming after 5 days post sclerotherapy is allowed as long as you put the stockings back on straight after your swimming

Follow-up

  • If you need more sclerotherapy sessions, please make a booking. Otherwise, follow-up is not necessary unless you have any questions or concerns.

Before you go home

  • Please walk for 10-15 minutes prior to going home to get the circulation going in the legs.
  • If you have been given sedation for the procedure, DO NOT drive home as the medications you have been given can make you drowsy.

Stockings instructions

  • Wear the compression stockings continuously for the first 3 days (i.e. wear them to sleep).
  • After the first 3 days, wear the compression stockings for at least a further ten days but you may remove them when you sleep at night.
  • You can take the stockings off for showers but please do not take a shower on the day of the procedure.
  • Remove any dressings when you take your first shower after laser.

Symptoms

  • Bruising, mild-moderate pain and swelling are normal in the first few days. Simple painkillers such as paracetamol and anti-inflammatories (e.g. nurofen) will help with the pain, so please take them if you need.

Exercise/activities post laser

  • You are welcome to do any activity (including driving if not sedated) you desire as long as you keep the stockings on as per above instructions. Some activities may be more uncomfortable than others but you will not be causing any damage to your legs.
  • Swimming after 5 days post laser is allowed as long as you put the stockings back on straight after your swimming.

Follow-up

  • You will be having an ultrasound approximately one week after the procedure to check on the results. A follow-up appointment will be arranged for you between 2-8 weeks after the procedure.