Understanding varicose veins
Varicose veins can be unsightly and uncomfortable but are they dangerous? What causes them and what can be done to treat them?
Varicose veins are bumpy, raised, darkish-blue veins most commonly found on people’s legs. While this is a common condition affecting one in three women and up to 15 per cent of men, there’s no known cause.
Risk factors include having a family history, being overweight, pregnancy and occupations that involve standing for long periods of time. Their prevalence tends to increase as we age.
Varicose veins are not related to vascular conditions such as high blood pressure or narrowed/blocked vessels. These conditions involve the arteries, which carry the blood away from the heart, not the veins.
Varicose veins develop when the superficial veins under the skin become congested.
Ordinarily, deoxygenated blood is carried back to the heart through veins in the muscles (the deep, high pressure system) and skin (superficial, low pressure system). The two systems connect at the saphenofemoral junction in the groin and the saphenopopliteal junction behind the knee, as well through smaller perforating veins elsewhere in the leg.
Valves at each of these junctions act like a one-way gate, preventing blood from exiting from the deep high pressure system and entering the superficial low pressure system.
If these valves, or the valves in the superficial vein below the junction, become leaky or incompetent, blood is able to flow from the high pressure to the low pressure system. Over time, this causes the veins to distend or bulge, becoming varicose veins.
Symptoms and health implications
People with varicose veins experience a range of symptoms as a result of this congestion and the build up of pressure in the superficial veins and tissues.
These include swelling, heaviness, aching and cramping. Some people may also develop itchiness and redness around the ankles caused by the seepage of cells and fluid into the tissues. Symptoms may be more acute after a day spent standing or in warmer weather.
While these symptoms may be upsetting and uncomfortable they’re not generally dangerous to overall health.
“The majority of varicose veins are benign and can be left alone,” says Vascular Surgeon Adrian Ling.
“However if treating them is going to improve a person’s quality of life, even if the problem is only cosmetic, it can be worth looking into the options. Especially as there are minimally invasive treatment options available.”
“Changes to the skin of the lower legs such as pigmentation, generally a brown or pinkish discoloration, and any hardening of the skin around the veins, is more concerning,” says Mr Ling.
“This kind of chronic inflammation can lead to ulceration and should be seen by a vascular surgeon as a matter of urgency.”
• Conservative: Wearing a compression stocking is one of the simplest, non-invasive options. It treats the symptoms but not the underlying problem and may not suit everyone. Stockings can be quite uncomfortable and difficult to put on. Maintaining a good weight and exercising will also help.
• Surgical: For centuries, varicose veins have been treated surgically. A surgeon makes incisions at the saphenofemoral or the saphenopopliteal junction, stripping out the saphenous vein (which it can be helpful to imagine is like the trunk of the tree). The branches of the tree, or the varicose veins, are removed at the same time using a procedure called a phlebectomy. This is an invasive operation performed under general anaesthetic.
• Thermal: Uses heat, delivered via laser or radio frequency, to destroy the saphenous vein (the trunk of the tree). The varicose veins are then injected with a substance that causes them to contract known as sclerotherapy. These methods can be performed under local tumescent anaesthetic in a surgeon’s consulting rooms and are as effective as surgery.
• Non-thermal: A glue substance has recently become available which enables surgeons to treat the saphenous veins without the need for heat or stripping. The procedure does not require multiple needles or general anaesthetic. Early results are promising, however, the long-term efficacy is not yet known.
It’s important to note that varicose veins have a recurrence rate of 20 – 30 per cent over a ten-year period.
“A vascular surgeon can offer the full range of treatments, and if it is done as a day procedure in an approved hospital, the majority of costs are likely to be covered by insurance,” says Mr Ling.
“Each treatment option has pros and cons,” he adds. “It’s important patients are informed about the range of options available and discuss which one suits their particular circumstances with their surgeon.”
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