Veins carry blood from the tissues to the heart. In the legs, blood is carried by two systems of veins- a Superficial system which runs just under the skin surface and a Deep system which runs deeper in the muscles. These two systems are connected by Perforator veins.
Varicose veins are abnormally dilated and tortuous veins. They occur in the Superficial veins of the leg.
1. Why do Varicose veins occur?
During sitting or standing, the blood in the veins of the legs has to travel “uphill”. This problem is overcome with the aid of the calf muscles which pump the blood to the heart. Blood is prevented from leaking “downhill” by Valves in the veins. Weakness in the valves / vein wall or inadequate calf muscle action leads to congestion of blood in the leg veins. This congestion causes varicose veins and its associated symptoms.
2. When should varicose veins be treated?
Varicose veins are generally harmless. However, because of congestion of blood in the leg, they can cause chronic leg swelling, pain and heaviness in the legs, discoloration of the skin around the ankle, eczema and leg ulcers which are difficult to treat.
Varicose veins which cause skin complications or ulcers and those which cause significant symptoms should be treated.
Correct management of varicose veins requires accurate identification of the exact site and severity of vein / valve leakage. This is done using a Doppler ultrasound scan, a simple noninvasive test.
3. What are the treatment options?
Compression stockings – these are specially designed garments which prevent congestion of blood in the legs. They need to be worn throughout the day. They are offered as a first step of treatment.
Endovenous LASER/ RADIOFREQUENCY ablation – Most patients with varicose veins are treated with minimally invasive, “scar-less” endovenous ablation. This involves passing a LASER/Radiofrequency fibre through the main culprit vein in the thigh or behind the knee. This is done under ultrasound guidance through a needle puncture. The vein is then sealed from within by the heat energy generated.
Injection Sclerotherapy – This involves treating the superficial veins with special chemical solutions. This is usually done for the superficial visible dilated veins either as an outpatient procedure or in combination with LASER/ Radiofrequency ablation.
Surgery – Surgery for varicose veins is now reserved for those patients whose veins are not suitable for endovenous treatment. This involves a small cut in the groin/behind the knee and removal of the offending vein (stripping).
Endovenous ablation / surgery for varicose veins gives a long-term cure rate of more than 90%.
Article by Dr Sairam Subramanian, MB, DNB(Surg), MCh (Vascular), MRCSEd
Consultant Vascular and Endovascular Surgeon
Kauvery Hospital, Chennai