What are varicose veins?
Varicose veins are veins that have become enlarged and tortuous.
Why do varicose veins occur?
Veins have leaflet valves to prevent blood from flowing backwards (retrograde). Leg muscles pump the veins to return blood to the heart, against the effects of gravity. When veins become varicose, the leaflets of the valves no longer meet properly, and the valves do not work. This allows blood to flow backwards and they enlarge even more.
What causes varicose veins?
The four main causes are:
- Heredity
- Female hormones, especially those of pregnancy
- Gravitational force (such as prolonged periods of standing or sitting)
- Muscular compartment forces which travel to skin level (superficial) veins through faulty perforator or connecting veins, creating higher pressure in the superficial veins which leads to enlargement of the vessels .
Where do varicose veins occur?
Varicose veins are most common in the superficial veins of the legs, which are subject to high pressure when standing.
What are signs and symptoms of varicose veins?
- Aching, heavy legs (often worse at night and after exercise).
- Appearance of spider veins (telangiectasia) in the affected leg.
- Ankle swelling.
- A brownish-blue shiny skin discoloration near the affected veins.
- Redness, dryness, and itchiness of areas of skin, termed stasis dermatitis or venous eczema, because of waste products building up in the leg.
- Minor injuries to the area may bleed more than normal and/or take a long time to heal.
- In some people the skin above the ankle may shrink (lipodermatosclerosis) because the fat underneath the skin becomes hard.
What are the complication of varicose veins?
Most varicose veins are relatively benign, but severe varicosities can lead to major complications, due to the poor circulation through the affected limb.
- Pain, heaviness, inability to walk or stand for long hours, thus hindering work
- Skin conditions / Dermatitis which could predispose skin loss
- Skin ulcers especially near the ankle, usually referred to as venous ulcers.
- Development of carcinoma or sarcoma in longstanding venous ulcers. The rate is reported as 0.4% to 1%.
- Severe bleeding from minor trauma, of particular concern in the elderly.
- Blood clotting within affected veins. Termed superficial thrombophlebitis. These are frequently isolated to the superficial veins, but can extend into deep veins becoming a more serious problem.
What is the treatment of varicose veins?
Surgery is the mainstay of treatment of varicose veins. Medicines and graduated compression stockings are supportive treatment. Elevating the legs often provides temporary symptomatic relief.
What is open surgical treatment of varicose veins?
Sapheno-femoral junction ligation and vein stripping operation consists of removal of all or part of the saphenous vein main trunk after giving skin incisions over groin and leg. The complications include deep vein thrombosis, pulmonary embolism, and wound complications including bleeding, infection,etc.
What is laser treatment of varicose veins?
Endovenous laser ablation is a less invasive alternative to standard vein stripping The underlying goal of this procedure is to deliver sufficient thermal energy to the wall of an incompetent vein segment to produce irreversible occlusion, fibrosis, and ultimately disappearance of the vein.
How is laser treatment done?
The leg being treated will be sterilized and covered with a surgical drape. The diseased vein is punctured at ankle or below knee under doppler guidance and a wire is inserted into the vein. The catheter is advanced over the wire inside the vein up to the top of the leg. The wire is removed and the laser fibre is inserted inside catheter till the tip of laser fibre is 2-3 cm beyond catheter and accurately positioned in the top of vein , as monitored by doppler machine. Some fluid is injected around the vein to be treated to prevent heat damage of surrounding tissues. The laser fibre is activated and energy is applied as the catheter is slowly withdrawn. This heats the vein, causing them to shrink and eventually leading to closure of the vein.
How long does the procedure take?
The procedure takes about 45 minutes to one hour in each leg.
What happens after the procedure?
A compression stocking or crepe bandage is applied after the procedure to help reduce bruising, tenderness, and the slim possibility of forming blood clots. The patient is usually discharged on the subsequent day.
What is recovery like after endovenous laser ablation?
The procedure leaves no scars, and is associated with minimal postoperative pain, a rapid recovery period and provides almost immediate relief from symptoms. Minor soreness and bruising can be treated with over the counter pain medication. After the procedure, patients are encouraged to walk and resume their normal activities. A follow up appointment is made with the doctor in the week after treatment, to evaluate the success and progress of the endovenous laser ablation.
What are the risks associated with endovenous laser ablation?
- Mild numbness around the thigh area
- A pulling sensation which may last a week
- Phlebitis (redness and tenderness of the skin is quite common but is mild in nature and easily treated with over the counter pain medications. Most cases of phlebitis resolve in 3-7 days
- Deep venous thrombosis. This is a very rare complications following endovenous laser ablation. The best way to prevent this rare complication is to wear compression bandage or compression stocking and to walk right after the procedure
- Infection at an incision site is a rare occurrence and usually resolves on its own
- Bruising is common after the procedure, but it is usually mild and resolves in 1-2 weeks.
Is destroying the saphenous vein harmful?
No. Because most of the blood in the legs is returned by the deep veins, the superficial veins, which return only about 10 per cent of the total blood of the legs, can usually be removed or ablated without serious harm.
How safe is endovenous laser ablation treatment?
Medical lasers work by delivering light energy to the targeted tissue with extreme precision so as not to harm the surrounding tissue. Lasers are proven to be safe and effective for treating many health issues. In the hands of a skilled physician, lasers offer far less risk and complications than conventional surgery. Endovenous laser ablation is generally a complication-free and safe procedure.
How successful is endovenous laser ablation?
All data indicate that endovenous laser ablation is a safe and effective procedure. The FDA has approved it for the treatment of varicose veins. Endovenous laser ablation is minimally invasive and enjoys a 98% success rate with a recurrence rate of 7% after two years.
What is sclerotherapy?
It is a commonly performed non-surgical treatment for varicose and "spider" leg veins in which medicine is injected into the veins to make them shrink. It is safe, proven and effective.
What is the sclerotherapy procedure like?
Prior to the procedure, you will have an initial consultation to determine if you are eligible for sclerotherapy. This includes an ultrasound of the veins to evaluate the full extent of the problem causing the spider veins. The larger vein must be treated before sclerotherapy is performed. If the vein causing the problems is not treated first, other spider veins will appear after the sclerotherapy is complete.
During,sclerotherapy, small injection of irritating solution is injected into the vein, which causes the vein to close. Two or more sessions are usually required to achieve optimal results.
Are there any side effects of the sclerotherapy treatment?
Complications from sclerotherapy are extremely rare. Risks include the formation of blood clots in the veins, severe inflammation, adverse allergic reactions to the sclerosing solution and skin pigmentation that could leave a small but permanent scar.
