Treatment
Conservative management
- 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.
Surgical Management
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 a 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 an 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)
Content Reviewed by – Dr. Jaisom Chopra