They are enlarged veins lying superficially in the lower limbs that are twisted and elongated. Because of we as human beings function in a vertical position, the blood has to flow against gravity to reach the heart from the lower limbs which leads to varicosity.
What Causes Varicose Veins?
To know the what causes these we study varicose veins under two main categories-
- Primary Varicose Veins
- Secondary Varicose Veins
Primary Varicose Veins
The following groups of people are naturally predisposed to suffering from Varicose Veins based on their physical attributes such as-
Height: The taller people suffer more.
Weight: The heavier the individual, the weaker are the walls of the vessels.
Other causes include the occupation of the individual; those who spend a long time in standing position are more likely to suffer from Varicose Veins, such as
- Hotel workers
Age and gender of the person are not known to have a significant role in predisposing a person to Varicose Veins. Some people may have weak vessel walls right from birth (congenital) that can happen due to defect in the smooth muscles, or due to the absence of valves- valves are the ‘gates’ connecting vessels.
Klippel-Trénaunay Syndrome is a genetic condition that’s also known as ‘valveless syndrome’.
Secondary Varicose Veins
These occur in Women who:
- are pregnant;
- have pelvic tumors;
- are on oral contraceptive pills
Following accidents or surgery, deep vein thrombosis is a condition that’s not uncommon and this may result in the destruction of the valves, thereby causing Varicose Veins.
Now that we have a rough idea of who’s at risk for Varicose Veins, let’s look into the symptoms and signs of the disease– to understand the condition better.
What The Patient Complains About; the Symptoms of Varicose Veins:
- They start noticing dilated( prominent and enlarged) veins on the surface of their legs and feet.
- In more severe cases, swelling is present but no redness
- The patient complains about a dragging type of pain that is of dull nature: the leg feels heavy.
- Some patients complain about cramps during the night times which is caused by the expansion and shrinking of the vessel walls.
- Most patients experience some relief during night times when the foot is elevated and they’re lying down.
- Patients suffering from Deep Vein Thrombosis suffer from a sudden episode of fever and swelling around the ankle.
- Ulcers in the leg, itching, redness, bleeding due to dry skin (eczema) are common.
- Skin thickening is noticed in some cases.
Now let’s get to the main part of this article;
Treatment Of Varicose Veins.
When is Treatment Necessary?
Many cases of primary varicose veins may not necessarily require treatment. Treatment of varicose veins is primarily indicated to provide relief from the symptoms caused- such as itching, pain, ulcers, etc.
Secondary varicose veins disappear with the cause, hence they require only temporary treatment- to control the symptoms while the cause remains, such as during pregnancy.
Complication Of Varicose Veins:
- Dermatitis- inflammation of the skin
- Thickening and toughening of the skin
- Thrombophlebitis- inflammation of the vessel
- Ulcer in the veins also referred to as gravitational ulcer.
- Marjolin’s Ulcer is a type of cancer that can happen when a venous ulcer heals.
To avoid the above complications, treatment becomes necessary and is advised.
What Are The Treatment Modalities Available?
There are five popular treatments available for treating varicose veins, other than surgery.
Elastic Compression Stockings
The affected leg is bandaged and elevated. Since the blood flow lines with gravity, no extra effort is required to pump the blood back to the heart and there’s instant symptomatic relief. This is the most widely used treatment for short-term causes (secondary) causes of varicose veins.
The bandage is worn from the ankle to the knee for the entire day.While lying down, the legs should be elevated and the bandage removed.
This is commonly recommended in case of varicose veins due to pregnancy or deep vein thrombosis.
Injection Line Of Treatment- Compression Sclerotherapy
This is effective for smaller veins that are below the knee, commonly for varicose veins following surgery.
The patient is asked to stand upright and the affected veins are first marked. After inserting a needle attached to a syringe into the veins, the patient is made to lie down and the contents of the syringe are injected.
The syringe contains agents that will lead to the shrinking of the veins by causing thrombosis. Following the shrinking of the vein, an elastic compression bandage is applied tightly.
There are a few complications however that includes allergic reactions, deep vein thrombosis, pigmentation (discoloration of the skin), necrosis- the death of skin cells.
USG Guided Foam Sclerotherapy
This is a method popular in the UK but has its own complications when compared to previous methods for treatment of varicose veins.
The procedure is carried out guided by ultrasound scanning where air along with the agents is injected into the veins.
Complications include- deep vein thrombosis, ulcers of the skin, stroke, and chances of headaches.
Endo-Venous Laser Ablation- EVLA
It’s preferable because it’s a relatively simple outpatient procedure that doesn’t require admission.
It’s comparatively cheaper than other techniques such as RFA.
The results are promising. The procedure uses ultrasound guidance to identify the veins following which they’re catheterized and a laser fiber is inserted following some basic anesthetic agents. The laser energy is then transmitted and the veins then need to be compressed using an elastic bandage.
Radio Frequency Ablation- RFA
It is similar to EVLA but more expensive. The advantages are that it’s even less invasive. Burns and pain are expected complications of the procedure.
Required for the more severe cases of varicose veins; there are different types of surgery available for the treatment of varicose veins.
- Trendelenburg’s Operation
- Subfascial Ligation of Cockett and Dodd
- SEPS- subfascial endoscopic perforator surgery
Recent Advancements In the treatment of Varicose Veins
VNUS closure: A method where using ultrasound, a catheter is used to destroy the veins thereby reducing complications such as pain.
TriVex: TriVex is a complicated method by which the affected veins are sucked out using illuminative substances that are injected into them to guide the procedure.
What Can You Do To Manage Varicose Veins:
The following lifestyle changes can help in the management of varicose veins:
- Try maintaining your legs in an elevated position while at rest, like sitting or lying down.
- Use loose clothing around the legs, so that the blood circulation eases.
- Avoid standing for long periods of time, whenever possible.
- Lose weight- this will put less pressure on the legs and thus the backflow becomes easier. Diet and exercise are the keys.
- In your diet, consume more apples, grapes, blackberries, etc that contain a nutrient called Rutin which has been shown by a study to reduce edema.
By using such simple lifestyle changes you can easily prevent and manage varicose veins at home.