What Are Varicose Veins?
Varicose veins are enlarged, bulging, twisted/knotted and distorted veins that lie just beneath the skin. They may be blue or purple in colour and can appear like ropes under the skin.
They are more prominent in hot weather, and after long periods of standing or exercise, varicose veins tend to reduce in size with rest and leg elevation.
The good news is that minimally invasive treatments are now the preferred alternative to traditional vein stripping surgery. Endovenous laser is the current “Gold standard” to treat the underlying cause of varicose veins in most cases with medical superglue another great option.
Causes of Varicose Veins
In most cases, varicose veins represent the distended tributaries or “branches” coming off larger malfunctioning veins (“trunks”). They are most common in the calves, but can be seen anywhere in the lower leg, depending on what “feeder vein” is malfunctioning. Varicose veins are always a sign of venous reflux, or venous insufficiency.
Each vein has small unidirectional valves that regulate the blood flow towards your heart. When your calf muscle contracts, the valves in your veins open. This is what allows the blood to flow upwards, towards the heart. Each time the muscles relax, blood “falls” back toward the feet (helped by gravity). The valves quickly close, to stop blood from flowing away from the heart.
When the valves don’t close properly, we call it venous reflux (also venous insufficiency or venous incompetence). Blood flows in the wrong direction, and this may cause the blood to pool in the leg, as it is not effectively returned to the heart. This then causes progressive dilatation of the veins, leading to the formation of varicose veins.
The best varicose vein treatment is not to simply remove them surgically (as some clinics do), but to eliminate the underlying source of reflux first.
Do Your Legs Look Like This?
Our Approach to Treatment
Treatment of large malfunctioning veins (trunk)
Endovenous Laser Treatment (EVLA) to great, small, and/or anterior accessory saphenous veins. 60 minutes
Treatment of large varicose veins (branches)
Phlebectomy removal of larger bulging varicose veins 90-120 minutescombined with
Ultrasound-Guided Foam Sclerotherapy (UGFS) on smaller veins. 30 minutes
Treatment of small varicose veins (branches) if required
Extra sessions of UGFS to close smaller veins if identified as required at post-treatment follow-up scan 30 minutes
You may not require this stage.
Optional treatment surface veins (leaves)
Usually done by Microsclerotherapy 30 minutes
Most patients require multiple treatment sessions to remove spider veins.
Follow up and maintenance to ensure best results
Frequently Asked Questions
Why do I have varicose veins?
Most varicose vein issues are hereditary. If you have one parent with varicose veins your risk of having them is around 65%. If both parents are affected the risk rises to approximately 90%. Another main risk factor for women is pregnancy, with the risk increasing with each additional pregnancy. Standing occupations such as hairdressers, nurses, and chefs also have a high risk of varicose veins as gravity puts pressure on the veins and weakens them.
How do I prevent varicose veins?
Once varicose veins are present, they will not resolve of their own accord. Measures to reduce the rate of progression include maintaining a normal healthy weight and going for regular walks of 20-30 minutes per day. Reducing the length of time spent on the feet in a stationary position may help and alternating between standing and sitting positions during the day will also reduce the pressure on the veins.
What will happen if I don’t treat these veins?
Generally, without treatment, varicose veins will get progressively worse over time. Symptoms may occur such as heaviness, ache, pain, and tiredness in the legs towards the end of the day. Further progression may result in leg swelling, itch, skin discolouration, and eventual skin ulceration. Blood clots related to superficial venous thrombosis may also occur in severe cases and can lead to the more serious condition of Deep Vein Thrombosis.
What treatment options exist?
Outdated, old-fashioned options such as surgical stripping are rapidly becoming obsolete due to poor long-term success, with recurrence rates of up to 50%. Modern treatment options include endovenous laser ablation, sclerotherapy injections, and ultrasound-guided ambulatory phlebectomy. In many cases a combination of different treatments will give the best long-term results.
Will the veins come back after treatment?
Many people are concerned that the treatment will be of limited value because the veins will just come back. This was certainly the case in the days of surgical stripping with a 50% recurrence rate at 5 years; however, using the latest minimally invasive techniques, we can reduce the risk of recurrent varicose veins to the baseline risk of approximately 3% per year.
What is the downtime following treatment?
This depends on the type of procedure performed and the severity of the veins being treated. Modern treatment with laser can involve no time off work and approximately two weeks off heavy gym work and four weeks off international travel.
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