Varicose Veins Your legs contain a system of deep veins and superficial veins. The deep veins are very important as they provide the ‘motorway’ for the blood to return to your body. It is these veins that are affected if you have a DVT (deep vein thrombosis – or a blood clot).
The superficial veins in your legs lie closer to the skin. These veins can develop weaknesses in the wall causing them to enlarge and the valves to fail to close. This allows the blood to travel ‘backwards, away from the heart and downwards under the influence of gravity, so pooling in your legs when you are upright. This increases the pressure in the veins and causes them to bulge out from the skin, this is called venous hypertension. A test which you can do may show this situation, you will notice the veins decrease in size if you lie down and lift your leg as gravity is then draining the blood ‘forwards’, towards the heart; however, it is important to note that not all patients with varicose veins will have visible bulging veins in their legs. The affected veins may be deeper beneath the surface and their first experience of problems may be the symptoms or skin damage listed below.
This increased pressure can cause several problems:
Cosmetic concerns of the bulging veins appearing unsightlySymptoms – these can include: aching, heaviness, pain, swelling, itching, restless legs. Damage to the skin – skin staining, inflammation of the thin layer of fat under the skin resulting in a characteristic shape of the lower leg, eczema (itching). Bleeding. Thrombophlebitis – where the veins close to the skin clot off and become inflamed and tender. Leg ulcers which are wounds around the ankles that even with appropriate treatment take time to heal; 3-6% of people with varicose veins will develop an ulcer in their lifetime! It is recommended that if you have an ulcer, you should be referred to a vascular surgeon within 2 weeks. Over time a small but significant number of patients progress from just cosmetic varicose veins to develop symptoms, including damage to the skin (which may be permanent) and then further to the most feared complication of varicose veins, leg ulceration.
Treating your varicose veins will help improve the look of your leg/s and improve the symptoms that you may be suffering. Given time, if you have any skin damage this may sometimes slowly improve over many months, although sometimes this damage may be permanent. If you have any thread veins or spider veins then these should only be treated after you have had your varicose veins treated, otherwise these will recur very quickly.
Thread Veins Thread veins, telangiectasia or spider veins are tiny veins within your skin. These may appear blue, red or purple. They are harmless but can affect the cosmetic appearance of your legs. The cause for these is unknown but there is possibly an inherited risk. It is important to ensure that you do not have varicose veins feeding them as treating the thread veins without addressing the underlying issue will result in rapid failure of the treatment and recurrence of the veins.
Endothermal Ablation Endothermal ablation is a percutaneous technique (using small needles not scalpels) where energy is used to ‘ablate’ the vein. At MD veins we use radiofrequency ablation, however there are other forms of doing this treatment using for example laser or steam – essentially, they perform the same task by delivering a certain amount of energy to the lining of the vein to close the vein.
Your surgeon will numb an area with local anaesthetic and insert a small tube (sheath) into the vein (either in the inside of the leg or on the back of your calf). Using ultrasound, they will pass a catheter (the radiofrequency ablation device) through the vein. The surgeon will then inject a special mix of fluid to numb the leg around the catheter. The energy created through the catheter closes the vein as it is withdrawn.
Ultrasound Guided Foam Sclerotherapy Your surgeon will numb small areas with local anaesthetic and then insert one or more cannulas (like a drip that you have in the back of your hand) into the veins in your leg/s. This technique requires the surgeon to have a good understanding of the veins as the foam is injected and the surgeon will use the ultrasound machine to track the passage of the foam and direct it along the veins to be treated. Your bed will be tilted to empty the veins of blood as the foam is deactivated by blood. The foam chemically damages the walls of the vein causing it to block off and shrink. If you are very slim or the veins are very close to the surface, you may notice that the veins become hard and occasionally there may be some mild discolouration over the skin. If this occurs, it is usually temporary and will settle down over the weeks following the procedure.
Micro-Phlebectomies If you have very large varicose vein branches, the best option may be micro- phlebectomies. The area is numbed with local anaesthetic. A tiny incision is made, and the vein hooked out through this. The skin is then closed with either ‘steri-strips’ or tiny sutures, the sutures are absorbable and will fall out in a week to 10 days. If they are still, there in 2 weeks, then please book an appointment to see the nurse at the hospital to have these removed or see your GP practice nurse. Your leg may be a bit more bruised after this treatment, but this will settle down given time. If there are any small veins left over then these can usually be treated by a further session of ultrasound-guided foam sclerotherapy.
Micro-Sclerotherapy To treat small threat veins your surgeon will carefully inject them with a tiny needle and syringe using a chemical sclerosant (similar to foam sclerotherapy but in liquid form) which will treat the veins. A typical session lasts around 30 minutes. If you have extensive thread veins then you may require more than one treatment session to get good results – most patients can be treated in 2-5 sessions though some may require more.
