What are varicose veins?
Varicose veins are twisted, enlarged veins commonly affecting the lower limbs but any vein may become varicose.
How do they present?
- Patients normally present with pain in the leg/legs which is more of a dull ache occurring towards the end of the day after prolonged standing. This pain is relieved by elevation.
- They also develop swelling around the ankles and the legs feel very heavy.
- They complain of discolouration around the ankle area.
- Ulcers may form around the ankles.
- They may complain of itching and night cramps.
- Some obese people may have pain, swelling and heaviness for years with no visible varicose veins because of the obesity. They too have huge veins proven on color doppler.
Why do they occur?
It is because the valves within the veins become incompetent or spoilt and allow the blood to ferlux down the vein when standing and causing to dilate.
How is the diagnosis of varicose veins made?
- First the patients present with a history of leg pain, swelling and heaviness in the legs. They may also complain of night cramps and itching.
- On examination we may find dilated veins along with color changes of the skin around the ankles. Some unfortunate patients may have ulcers around the ankles.
- A provisional diagnosis of varicose veins is made.
- The final diagnosis is on color doppler study which confirms reflux at the saphenofemoral junction in the groin or the saphenopopliteal junction behind the knee. The veins are dilated and may be tortuous. The perforators (connecting veins between the deep and superficial veins) are located and marked.
What is the treatment?
- Leg elevation – this is done at night with two pillows under your ankles to elevate your legs. At night one does not have to wear stockings.
- Compression stockings – This is generally below the knees and should be worn from the time one gets out of bed in the morning to the time one enters the bed at night. The only time they are removed is during bathing and of course at night.
Today this is done using Radio-Frequency Ablation (RFA) or Lazer.
- Both the methods give equally good results thought most feel that RFA is less painful in the post-operative period.
- One day hospital stay is needed.
- It is performed under Local Anesthesia or spinal anesthesia but most feel that pain during local anesthesia is unbearable.
- There are no scars and cuts.
- The patient is recommended to walk and lead a normal life from the next day.
- There is over 95% acceptability for the procedure and most feel they would recommend the procedure to a friend.
Who are the people more prone to varicose veins?
It is a universal disease affecting all ages and both sex equally. People with standing jobs are more prone – teachers, sales men and women, house wives, army and police personnel. It is also commoner in obese people and many have a family history of disease.
People say recurrence is common?
How could a burnt vein recur? If recurrence takes place it is due to perforators which have not blocked completely or have recurred. There is never a second surgery. Only we inject the vein which has recurred and occlude the perforator. It needs no admission and is done as an out-patient procedure and the patient continues has normal activity.
Is it possible to avoid varicose veins from occurring?
It is not possible. You can delay it by leg elevation and stockings but come it will. It is because of the valves going bad in the groin and behind the knee and there is no way known that you can prevent that. Once this occurs then it is worsened by the pull of gravity.
How can we help ourselves?
Self care involves regular exercise, weight loss, wearing loose clothes, avoiding prolonged standing and elevating the legs when convenient.
Word of caution
- Have you been told varicose veins surgery is painless? There will be an ache along the medial aspect of the thigh where the vein has been burnt. This could present as burning or pulling sensation and may be quite irritating though you are doing all your activities.
- Ulcers and dermatoliposclerosis (darkening of the skin) may take time to heal. One could get infection in these areas even after surgery which would go away slowly over time. This time varies in different patients. The doctor is only going to remove the source which caused these complications. Frankly you have no option – leave it alone and let it worsen or treat it and allow it time to heal.
- Recurrence of varicose veins – This is not a myth. Varicose veins do recur even after the most successful surgery but return as isolated veins which would probably need injection therapy (sclerotherapy) as an outpatient. Overall you should be much better.
- There could always be a double cause for the problem – Many people get leg pain due to varicose veins and knee joint arthritis. After varicose veins treatment the arthritic pain will still persist because it is unrelated to the varicose veins. A diabetic with varicose veins may have an ulcer which could persist even after proper treatment of the veins.
- Recurrent Cellulitis even after surgery – Many times patients present with cellulitis and on colour doppler study they have varicose veins. The cellulitis is due to dermatoliposclerosis (poor skin texture due to years of venous pressure secondary to long standing varicose veins).
Life style and home remedies
There are some self care measures you could take to reduce the discomfort the veins can cause. These measures also will prevent or slow the development of varicose veins. These measures include:
- Exercise – Walking is the ideal way to improve the circulation in the legs.
- Watch your weight and your diet – Weight reduction by shedding off extra Kg. takes unnecessary pressure off your veins. Have a low-salt diet to prevent swelling caused from water retention.
- Watch what you wear – Avoid high heels. Flat shoes work calf muscles more which is better for your varicose veins. Avoid wearing tight clothes around your waist, legs or groin. They could compress the veins and up the leg and worsen your varicose veins.
- Elevate your legs – Take several short breaks daily to elevate your legs above the level of your heart. This improves the circulation in your legs. Lie down and elevate your legs on 3-4 pillows.
- Avoid long periods of sitting or standing – Change your position frequently to encourage the blood flow. Try to walk every 30 minutes or so.
- Do not sit with your legs crossed – This position could increase circulation problems.
Prevention of Varicose Veins
There is no way to completely prevent varicose veins but you could delay their occurrence or reduce the risk by improving the circulation of your legs. These are the same measures you take to reduce the discomfort from varicose veins. The measures include:
- Watch your weight
- Eating high fibre, low salt diet
- Avoiding high heels and tight hosiery
- Leg elevation
- Changing your sitting or standing position regularly
1. Many obese patients with severe pain in the legs but no obvious visible veins due to the obese legs go repeatedly to the orthopaedic surgeon or the neurologist with no relief and ultimately land up in psychiatric care. A simple Colour Doppler study may reveal severe reflux at the SF junction and large varicose veins. On treating these their pain settles completely.
2. Occasionally patients present with unusual problems not documented in the literature like one patient presented with black spots on the sole of the feet which were painless but present for years and only progressively increasing. He had added severe varicose veins. On our treating his veins the spots progressively disappeared over the following couple of months.