Veins are thin walled vessels through which impure blood is carried back to the heart Varicose veins are a condition in which veins become enlarged, dilated or thickened Affect more than 10% of the population Can occur in any part of the body but the legs are the most affected Varicose veins have an unsighted appearance and can be dangerous if a blood clot forms inside the enlarged vein.

Complaints

1. Twisted cords, and usually appear on the calves, inside of the legs, and ankles.
2. Usually no pain
3. Aching, throbbing, cramping of the calf/leg
4. Fatigue of the leg on long standing
5. Swelling of the leg
6. Sudden pain may indicate clotting of blood in the vein
7. Skin changes- darkening of skin, dry skin, itching, contraction  of skin
8. Sudden bleeding from a long standing vein
9. Wounds in the leg(Venous ulcer) – non healing, recurrent ulcers persisting inspite of long term dressing and surgical treatment

Can affect nearly anyone Underlying cause- valve dysfunctions

RISKS FACTORS OF VARICOSE VEINS

1. Older age
2. Family history of varicose veins
3. Pregnancy
4. Obesity
5. Lack of physical activity
6. Excessive sun exposure
7. Previous DVT
8. Narrowing of veins higher up (Pelvis)

Clinical examination

Confirms the presence of varicosities and its associated skin disorders

Doppler ultrasound

Minimal baseline examination to confirm severity of varicose veins
to assess the deep veins not accessible by clinical examination access functional status of the veins

CT Venogram

Rarely used only for unusual causes or if clinical picture and doppler ultrasound do not match

TREATMENT OF VARICOSE VEINS

Many people seek cosmetic treatment to reduce the appearance of varicose or spider veins.

Several treatment options available

General measures- Losing weight, keeping the legs elevated and wearing appropriately measured medical compression stockings.

Low grade varicose veins- conservative management – stockings and medications

High grade varicose veins with skin changes and ulcers- Options include

-sclerotherapy

-surgery

– Ablation procedure(heat based)  – endovenous laser ablation(EVLA)

-Glue Ablation(non heat based)

– Venaseal

1. Injecting a  solution into the targeted veins
2. Sclerosing solution irritates the vein lining and turns it into scar tissue.
3. Multiple sessions needed
4. Also used as additional treatment after Ablation procedures
5. Also used primarily for recurrent varicose veins.

1. Minimally Invasive Principle- procedure delivers Laser via a catheter to the vein, which shrinks in the heat and eventually closes.
2. Anesthetic and a saline solution are also injected to numb the leg, squeeze blood from the vein and protect surrounding tissue.
3. Ultrasound imaging is used to locate the treatment site, guide the catheter and confirm that the vein has been fully closed.

The VENASEALTM procedure- uses a medical adhesive to seal the vein.

The risks of blood clots, infections and other complications are extremely low as is the probability of recurrence. Recovery is very fast

1. Combination of compression- 4 layer bandage or stockings, medications- to control infection
2. Sclerotherapy- to block the small veins near the ulcer site
3. Ablation procedure- Laser/Glue to block the main culprit vein causing the ulcer

Vein Stripping and Vein Ligation- An incision is made over the varicose vein, the vein is tied off and stripping (surgical removal of the varicosed vessel) is done to remove large varicose veins from the body. Ambulatory phlebectomy- making small pricks and removing smaller damaged veins

Spider veins – small, thin blood vessels prominently visible beneath the skin.

Symptoms

They appear most commonly on the face or legs. Series of lines, tree branches or a spider- or web-like shape, with a red or blue color. Most cases – purely cosmetic concern. Uncomfortable symptoms such as aching, burning, swelling and cramping.

Causes

Valve dysfunction- backup of blood in certain veins, which may occur when the valves in the veins cannot effectively keep blood from flowing backwards as it moves up the legs.

1. Blood vessels expand and becomes visible under the surface of the skin.
2. Common in the legs -blood flow must work against gravity to travel back up to the heart.
3. 30 – 50% of all adults over the age of 50
4. Hormonal changes
5. Pregnancy
6. Obesity and more.

TREATMENT OF SPIDER VEINS

1. Mild cases of spider veins -compression stockings to put pressure on the veins and promote normal blood flow
2. Interventional treatment is mainly for the cosmetic appearance of the leg if other underlying causes are ruled out. Sclerotherapy- injecting a sclerosing solution into the affected veins, causing them to gradually disappear.
3. Fewer side effects, less pain and shorter recovery times than traditional surgical vein removal.
4. Additional treatment -endovenous radio-frequency ablation (EVRFA) or endovenous laser ablation(EVLA) which treats large veins by passing a heating fiber through a catheter directly into the vein.

PREVENTING SPIDER VEINS

Life modifications – losing weight, exercising regularly, wearing support hoses and wearing comfortable, flat shoes. It is important to move the legs frequently, especially if your job requires long periods of sitting or standing in one place.