The following advice is provided by Dr Jocelyn Brookes, MB BS MRCP FRCR, an Interventional Radiologist specialising in endovascular procedures at the London Clinic.
Varicose veins are prominent bulging veins on the legs. They are often accompanied by flares, "thread" or "spider" veins and and may cause skin changes such as darkened patches, scaliness and ulceration.
Veins have one-way valves to keep blood flowing towards the heart. If the valves fail (called “incompetent”), the blood pools in the veins and the rising pressure causes the veins to stretch and bulge. Clearly this is made worse by standing up for long periods. Pregnancy typically makes varicose veins worse or more noticeable.
Chronic venous disease of the legs is one of the most common conditions affecting people. Approximately half of the UK population has venous disease – 50 to 55% of women and 40 to 45% of men. Of these, 20 to 25% of the women and 10 to 15% of men will have visible varicose veins. Varicose veins affect 1 out of 2 people age 50 and older, and 15-25% of all adults.
Symptoms caused by venous insufficiency and varicose veins include aching pain, easy leg fatigue, and leg heaviness, all of which worsen as the day progresses. Many people find they need to sit down in the afternoon and elevate their legs to relieve these symptoms. In more severe cases, venous insufficiency and reflux can cause skin discoloration itching and ulceration, which may be very difficult to treat. One percent of adults over age 60 have chronic ulceration. People without visible varicose veins can still have symptoms. The symptoms can arise from spider veins as well as from varicose veins, because, in both cases, the symptoms are caused by pressure on nerves in the dilated vein walls
Tight fitted stockings support the veins from outside and help to stop the blood pooling and stretching the veins. These are used either after treatment or on their own.
If the problem is very localised, a chemical can be injected directly into the bulging vein causing it to shrink (known as “sclerotherapy”) This procedure may be sufficient on its own or may be necessary after surgery or laser to tidy up remaining varicosities.
If the whole vein system is incompetent, the varicose veins are stripped from the thigh by making a groin incision under general anaesthetic. A short stay in hospital is required. A bandage and pressure stocking are applied and must be worn for a week or two. Full recovery from surgery can take several weeks.
Further visits may be required to eliminate secondary varicosities and superficial unsightly veins (spider veins).
Laser ablation (“ELVeS”,”EVLT”)
A new non-surgical way of treating varicose veins has been developed over the past five years at centres in USA, Spain and Germany. It is performed as an outpatient “walk in, walk out” procedure with no requirement for general anaesthetic or overnight stays in hospital.
The laser treatment involves the insertion of a laser fibre into the varicose vein of the thigh from the knee to the groin using ultrasound imaging to guide the way. The laser fibre is then withdrawn along the vein, heating it from within to close it, using local anaesthetic to minimise discomfort. The treatment session lasts in the region of one hour.
A pressure stocking is applied and must be worn for a week. The majority of patients can return to normal activities including work the next day. Further visits may be required to eliminate secondary varicosities and superficial unsightly veins (spider veins).
The exact choice of treatment depends on the particular nature of your veins, your medical background and most importantly, your wishes. At your initial consultation and assessment , the Doctor will arrange for you to have an ultrasound Duplex scan to map out the condition of your veins, discuss your relevant medical background and explain the options to you, for you to decide.
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