In the body arteries take blood away from the heart under pressure and veins return it to the heart.
In our lower limbs the veins are fighting gravity when we are in the standing position to push the blood back up to the heart. In the legs we have both deep and superficial veins. The larger veins are located deep within the muscles and the superficial or shallow veins are located just under the skin.
Because the veins are fighting gravity, we have one-way valves within the veins which should only allow the blood to flow up or inwards. For multiple reasons in varicose veins these valves don’t work properly and allow the blood to flow backwards. This causes more valves to dilate and as a result varicose veins form.
Varicose veins are bulging veins usually located in the legs that are caused by incompetent valves in the veins allowing blood to flow towards the feet rather than up towards the heart.
Varicose veins are a spectrum of problems that starts with small spider veins and can progress to venous ulceration. It is not possible to tell how far along the spectrum a person will progress too, however treatment can slow or stop a person’s progression and in certain cases can reverse the problems.
Management
There are many reasons for the treatment of varicose veins these range from the desire to have veins removed for appearances, to assist in alleviating swelling aching and discomfort through to the treatment or prevention of a venous ulcer.
There are multiple ways to treat Varicose veins but the aim of the treatment is to remove any of the veins with incompetent valves and only leave behind the ones with normal valves.
The first step in treating varicose veins is to try and identify any underlying correctable causes. These investigations will usually begin with an ultrasound of the legs to identify the problematic areas. Depending on the ultrasound results you may require a follow up abdominal CT scan. This scan looks for issues within the abdomen or pelvis that may be contributing to and exacerbating the varicose veins.
Consultation with Dr McGlade
During your initial consultation Dr McGlade will take a thorough history and examination of both your vein and artery systems. To locate the exact location of the problem and its underlying causes an ultrasound and maybe a CT scan will be ordered. With these scan results a diagnosis can be thoroughly explained as well as a treatment plan. A family member or friend are always welcome to join you for this appointment.
Surgery
Some patients are not suitable for varicose vein surgery due to their underlying problem, in such cases the main line of treatment is medical grade compression stockings.
Varicose vein stripping was previously the most common line of surgical treatment. With technological advancement treatments have become minimally invasive only requiring small needle size punctures to the leg. This removes the need for a groin incision and reduces its associated infection risks.
New technique approaches involve heating the vein from the inside with a radiofrequency probe or laser therapy. Another option which is patient dependent is to use glue to physically stick the veins closed.
All of these above procedures have excellent results that are comparable to vein stripping but with a much shorter recovery time. Most people are able to return to normal activities within one to two days. Smaller veins in the lower leg can also be treated with either injections called sclerotherapy or small cuts to physically remove them as well.
Following surgery, it is best to use compression stockings for at least a month. In the first two weeks following surgery the stockings should be worn full time and only removed for showering. The next two weeks the stockings can be removed at night time when in bed. This regime delivers the best possible results.
