WHAT ARE VARICOSE VEINS?

Varicose veins are dilated (swollen) and prominent superficial (near the skin) veins of the legs. They occur more commonly in females, and tend to occur after pregnancy. There is also a genetic predisposition. Males can get the problem as well.

They may be associated with leg swelling, "bursting" sensation in the legs, burning pain, or night cramps. Some may bleed with minor trauma.

Long-standing varicose veins can lead to hyperpigmentation, or darkening, of the skin of the leg especially around the ankle, chronic leg swelling and eventually ulcers (breaks in the skin).

How it starts?

Varicose veins usually start when a valve in the vein at the level of the groin malfunctions, allowing blood to pool in the veins of the leg, especially when standing. This is known as Venous Reflux. Over a period of time, the veins start to distend with all this pooled blood. Eventually, the veins are so distended, they can be seen and felt as greenish-blue lumps on the skin surface. This is more obvious below the knee, as the veins here are closer to the skin surface.

DIAGNOSIS

Clinical examination clearly reveals the location of the varicose veins. But the most important piece of information required is the location along the vein at which the disease originates. This is identified by performing an ultrasound scan of the veins. The ultrasound can also determine if a patient has had deep vein thrombosis (aka economy-class syndrome) before, which in some cases, is a contra-indication to surgery.

AVAILABLE TREATMENT

The available treatment options are as follows:-

a. Conservative management with compression stockings.

b. Conventional open surgery

c. Laser ablation of the vein

Conservative management consists of wearing a tight stocking that helps channel blood away from the leg. This helps reduce swelling and reduce the risk of developing ulcers. However, it is rather uncomfortable, even more so in our hot weather. It does not cure the varicose veins, but merely controls them. This means that wearing the stockings is life-long.

Conventional surgery involves removing the thigh segment of the malfunctioning vein through 2 incisions, one in the groin and one at or just below the level of the knee joint. Multiple stab incisions are used to treat the varicosities in the calf area. This procedure requires a general or spinal anaesthetic, with their attendant risks.

LASER ABLATION OF VARICOSE VEINS

Laser treatment of the diseased vein is a recent innovation. This is a minimally-invasive method where only a tiny stab incision is required to insert a laser fibre into the malfunctioning vein. When the laser is activated, it causes the wall of the vein to heat up, resulting in shriveling and occlusion of the vein. This procedure is only suitable for straight segments of vein that are not too close to the skin. Therefore it is used to treat mainly the thigh segment of vein, which is usually the cause of the disease in the first place. Smaller segments of vein can be removed via small stab incisions.

Most patients walk home after this procedure, and it can be done under a local anaesthetic in our clinic.

When performed by a trained vascular surgeon, the results of laser treatment are comparable, if not superior, to conventional open surgery.

SPIDER VEINS

These are very fine veins that appear on the skin, that look like little blue or red "flares". They are less than 1mm in diameter. The significance of these veins is that in up to 30% of patients, they are caused by underlying venous reflux disease, the same condition that can lead to varicose veins. Close questioning usually reveals that a fair number of patients with spider veins actually have similar leg symptoms as those patients with the much bigger varicose veins eg, swelling, cramps, and a bursting sensation.

This means that patients with spider veins should consider an ultrasound scan of their venous system, especially if they have symptoms in their legs. If venous reflux is shown, then the appropriate treatment is ablation of the large vein.

The spider veins themselves are treated by injection an irritant drug into the vein. This drug causes the vein to collapse and close off. Usually, several sessions are required for complete treatment. Frequently, symptoms improve once the spider veins have been treated.