Varicose Veins

Varicose veins are veins that have become enlarged and twisted. The term commonly refers to the veins on the leg, although varicose veins can occur elsewhere. Veins have pairs of leaflet valves to prevent blood from flowing backwards (retrograde flow or venous reflux). Leg muscles pump the veins to return blood to the heart (the skeletal-muscle pump), against the effects of gravity. When veins become varicose, the leaflets of the valves no longer meet properly, and the valves do not work (valvular incompetence). This allows blood to flow backwards and they enlarge even more.

Varicose veins are most common in the superficial veins of the legs, which are subject to high pressure when standing. Besides being a cosmetic problem, varicose veins can be painful, especially when standing. Severe long-standing varicose veins can lead to leg swelling, venous eczema, skin thickening (lipodermatosclerosis) and ulceration.

Life-threatening complications are uncommon, but varicose veins may be confused with deep vein thrombosis, which may be life-threatening.

Signs and Symptoms:

• Aching, heavy legs (often worse at night and after exercise).
• Appearance of spider veins (telangiectasia) in the affected leg.
• Ankle swelling, especially in evening.
• A brownish-yellow 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.
• Cramps may develop especially when making a sudden move as standing up.
• Minor injuries to the area may bleed more than normal 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.
• Restless legs syndrome appears to be a common overlapping clinical syndrome in patients with varicose veins and other chronic venous insufficiency.
• Whitened, irregular scar-like patches can appear at the ankles. This is known as atrophie blanche.

Complications:

Most varicose veins are reasonably benign, but severe varicosities can lead to major complications, due to the poor circulation through the affected limb.

• Pain, tenderness, 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. Over 100 reported cases of malignant transformation have been reported at a rate 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.
• Acute fat necrosis can occur, especially at the ankle of overweight patients with varicose veins. Females are more frequently affected than males.

Investigations:

Traditionally, varicose veins were investigated using imaging techniques only if there was a clinical suspicion of deep venous insufficiency, if they were recurrent, or if they involved the sapheno-popliteal junction. This practice is not now widely accepted. Patients with varicose veins should now be investigated using lower limbs Venous Ultrasonography (Dopplers Study).

Causes:

Varicose Veins are more common in women than in men, and are linked with heredity. Other related factors are pregnancy, obesity, menopause, aging, prolonged standing, leg injury and abdominal straining. Varicose veins are unlikely to be caused by crossing the legs or ankles. Less commonly, but not exceptionally, varicose veins can be due to other causes, as post phlebitic obstruction or incontinence, venous and arteriovenous malformations. Varicose veins in the legs could be due to ovarian vein reflux.

Endovenous Laser Treatment

Endovenous laser therapy is a technique that uses a laser to destroy the vein. The procedure is usually performed in a doctor's office and takes about 30-45 minutes. The small laser is passed into the vein with guidance from the ultrasound machine. The laser is then fired up and the entire vein is fibrosed. The laser is fired at multiple locations and the entire procedure is performed with some local anesthesia.

Advantages of Endovenous Laser Treatment

• Sealing of veins by inserting a small catherer.
• No anaesthesia required.
• No infection & minimal side effects.
• Minimal to no scarring.
• No hospital stay.
• Early recovery.