A B C D E F G H I J K L M N O P R S T U V W

VARICOSE VEINS

What are Varicose Veins ?

There are two types of veins in the legs. The deep veins are largely amongst the muscles and fat. They take blood back from the leg towards the heart. Superficial (or surface) veins also do this to some extent, although their main job is to act as a heat conductor and cool the legs. Blood should normally flow up the leg through superficial veins. If the valves within these veins are leaky however, blood flows backwards down the veins. They will then become bulging and tortuous (varicose). Because they lie just beneath the skin, they can be easily seen. The lower down in the leg they are, the more they are subjected to pressure and the varicose veins will increase in size. Varicose veins are much more common in women,possibly as a late effect of pregnancy (which exerts more pressure on the veins and has hormonal effects on the blood vessels as well). Varicose veins also occur in people who stand for long periods, such as barmen, hairdressers and surgeons!. However, teenagers may also suffer from varicose veins, in which case it is quite common to find a family history. Inherited factors do play a part.

How do Varicose Veins occur ?

There are many reasons for treating varicose veins. If they are not treated there is a risk of developing an unpleasant rash known as varicose eczema. Untreated varicose veins may develop a condition called phlebitis which is a painful inflammation due to clotting in the vein. The most severe complication is the formation of an ulcer which may be very difficult to treat effectively. However, most people ask for treatment because of aching pains in the leg or because they wish to have the appearance improved. There are three main ways for treating varicose veins. Firstly they can be treated simply with support stockings. Tight elasticated stockings greatly relieve the cramp and discomfort associated with varicose veins. Of course, they do nothing to improve the cosmetic appearance. The second method is sclerotherapy. This means injecting the varicose veins with a substance which will scar the inside of the vein and make it collapse. This is a reasonable treatment for mild varicose veins. However there is always the chance that the varicose veins will return at some stage in the future. The third way of treating varicose veins is with surgery. The surgery consists of removing the varicose veins. This is possible because there are many other veins deeper in the leg which can take over the job of carrying the blood.

Why do Varicose Veins occur ?

Many operations for varicose veins are now being done routinely as a day case. An overnight stay is not always necessary. However, some surgeons prefer to admit their patients to hospital usually for just a few days. If the surgery required is very minor there will be little time lost from work. But, if the surgery is more extensive, and especially if both legs are being treated, it may be several weeks before heavy work can be restarted. No specific preparation is necessary for you before surgery, but any known allergies should be notified to the doctors concerned.

Treatment involved for Varicose Veins

It is usually possible for the doctor to see how extensive your varicose veins are by simple examination. Sometimes it may be necessary to do an ultrasound scan or dye x-ray of the leg to work out accurately at which part of the vein system the problem starts. The ultrasound scan will show the veins of the leg and also indicate if the valves are working properly. It may also be necessary to have an x-ray (venogram) to show the veins more clearly. This involves an injection of dye into your foot. The dye flows up through the veins of the leg while x-rays are taken. In most cases, the valve damage begins high up the leg and so the surgeon ties the varicose veins where they start in the groin. The prominent, enlarged veins are then removed either by multiple tiny incisions over the vein or by stripping the vein using a metal rod. This is why the surgeon will mark the varicose veins with a pen before the operation. It is possible to do this surgery under local anaesthetic. Many patients will have a general anaesthetic or a nerve block such as an epidural. An epidural is an injection in the back which numbs the nerves in the leg and allows surgery to be carried out in complete comfort. This is exactly the same procedure that is performed for women during childbirth.

During Treatment

The risk of serious complications after this kind of surgery is low. Just as with any surgery, there will be some discomfort after the operation but this will be controllable by simple painkillers. There is always a slight risk of infection in the wounds, which may then require antibiotic treatment. If a general anaesthetic is necessary there is a marginal risk of a chest infection. Stopping smoking well before any anaesthetic will reduce this risk.

After Treatment

Severe varicose veins may lead to varicose ulcers. Most patients would simply have to put up with discomfort in their legs or with their appearance. For many patients it may be reasonable to do nothing unless the veins appear to be getting worse.

If Varicose Veins are left untreated

At the time of surgery, it will be necessary for you to wear strong support stockings or bandages for a few weeks. It should be possible to bathe within a day or two. It is not unusual to feel tired for a few days after any sort of surgery. There may have been stitches which will need to be removed 1 to 2 weeks later. It is probable that a single follow-up visit will be arranged to ensure that the wounds have healed satisfactorily. The pain following surgery should decrease quickly and you should be able to walk freely after a few days. At this stage it is advisable to walk regularly for up to 30 minutes each day. Returning to work will depend on what kind of work is involved but should not be delayed for more than 2 to 3 weeks. The wounds will continue to heal for up to one year after the surgery and it may be this long before the best cosmetic result can be expected.