Varicose Veins

Dr Venu Bhamidi | Gold Coast

What are Varicose Veins?

While arteries take oxygen rich blood to various parts of the body, veins are blood vessels that carry the blood back to the heart so it can be re-circulated. Because the veins in the legs have to pump blood back to the heart against gravity, they contain one-way valves, to prevent the blood from being pulled back down to the feet by gravity. There are two sets of veins in the legs; the main ones that lie in the middle of the leg (deep veins that transport ~90% of the venous blood) and ones that run close to the surface (superficial veins that transport ~10% of the blood). Blood is usually pumped from the superficial veins, through communicating veins (known as perforators) into the deep veins to be pumped back to the heart.
Varicose veins are dilated, enlarged veins that are present usually in the subcutaneous (‘fat’) layer and are often tortuous in nature. They are generally greater than 4mm in diameter, with severe cases being 15mm or greater in size. Generally speaking, they are found in around 20-30% of the population, with women often being more affected than men.
Spider Veins are very small-dilated veins that are present within the multiples layers of skin. These are the most common and are present in a large percentage of the population in some degree or the other. These do not necessarily need treatment; in so much as they present more of a cosmetic problem rather than any significant health issues. Treatment is usually in the form of foam sclerotherapy, which is usually done in an office setting.

What causes Varicose Veins?

Varicose veins most often occur when the valves within the veins stop functioning normally. This allows the blood, which should be pumped back to the heart, to pool in the superficial veins in the leg due to the effects of gravity. The subsequent abnormal reverse flow is known as venous reflux. If reflux is left to occur over a significant period of time, it will cause increased blood pressure in the veins, resulting in them becoming distended, swollen and varicose – a process that usually takes many years. There are a number of risk factors for developing the condition. These include:

  • Increasing age
  • Family history/s
  • Obesity
  • Pregnancy
  • Injury to the leg veins
  • Hormonal factors (e.g. puberty)
  • Occupation requiring prolonged standing
  • Gender (usually more common in women)

How are Varicose Veins diagnosed?

The most common problems encountered by those who have varicose veins include:

  • Aching legs (ranging from mild to severe)
  • Swelling of the leg/s
  • Itchiness and dry skin (eczema)
  • Clots and inflammation in the veins (thrombophlebitis)
  • Skin discolouration (lipodematosclerosis)
  • Skin ulcers

How are Varicose Veins diagnosed?

The most common problems encountered by those who have varicose veins include:

  • Aching legs (ranging from mild to severe)
  • Swelling of the leg/s
  • Itchiness and dry skin (eczema)
  • Clots and inflammation in the veins (thrombophlebitis)
  • Skin discolouration (lipodematosclerosis)
  • Skin ulcers

How are varicose veins treated?

In the majority of cases, diagnosing varicose veins is usually relatively straightforward. They are often easily visible and the distribution and direction of the varicose veins will usually suggest which vein in the leg is most affected.

What a physical examination cannot always confidently diagnose is where the highest point of reflux (abnormal functioning valve) occurs. Most of the time, it is located in the groin but occasionally it can be in the thigh or in the pelvis.

As well as the distribution of veins, the leg is examined for signs of other tissue damage that can be cause by the condition, such as skin discolouration, ulceration and eczema.

All varicose veins require an ultrasound to check the deep and superficial veins, get an exact diagnosis of the highest reflux point and provides a ‘map’ showing the surgeon exactly where the problems are in the veins.

The scan also shows whether the veins contain clot or are blocked due to inflammation, both of which help determine the best treatment option.

How are varicose veins treated?

Varicose veins can be treated in a number of ways – conservatively, surgery, endovenous laser or RFA therapy or ultrasound guided sclerotherapy. For minor veins that are symptomatic, a trial of conservative treatment with compressions stockings and lifestyle modification is sometimes helpful. While compression stockings don’t treat the veins, they help with managing the symptoms. As a specialist vascular and endovascular surgeon, Mr. Venu Bhamidi is a Vascular & Vein specialists who can offer the full complement of varicose vein removal techniques – from sclerotherapy through to surgery.

Surgery

Surgery most often involves a small incision in the groin to disconnect the troublesome vein from the main veins and removing the varicose vein.

Endovenous Therapy

Endovenous therapy, such as laser therapy (EVLT) or radiofrequency ablation (RFA), can be done in an office setting under local anaesthesia or under a general anaesthetic in hospital. The procedure involves ablating the vein using heat and often only takes 30-60 minutes depending on the complexity of the procedure.

Sclerotherapy

Sclerotherapy involves using a foam solution into the vein in order to irritate the inside lining of the vein and cause it to seal. The procedure is done under local anaesthetic and often under ultrasound guidance. It is not uncommon to require multiple treatments in order for the procedure to be most effective.

Prevention

While nothing can be done about several of the risk factors (age, gender, genetics), several strategies have been suggested to slow the progression of varicose veins.

These include:

  • Being a healthy weight
  • Wearing compression stockings regularly
  • When not walking, elevate your legs to reduce some of the swelling and discomfort
  • Be as active as possible – keeping the calf muscles active helps pump the blood back to the heart

Prevention

While nothing can be done about several of the risk factors (age, gender, genetics), several strategies have been suggested to slow the progression of varicose veins.

These include:

  • Being a healthy weight
  • Wearing compression stockings regularly
  • When not walking, elevate your legs to reduce some of the swelling and discomfort
  • Be as active as possible – keeping the calf muscles active helps pump the blood back to the heart
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