Veins carry deoxygenated blood from the tissues back to the heart. The flow in the veins is maintained by a series of valves which allow flow only towards the heart, i.e. – one-way traffic. When the valve gets damaged blood stagnates in the vein leading to varicose veins.
Varicose veins are dilated and can be close to the surface or deep within the legs. Those close to the surface can become long and coiled like a snake. It often occurs in those who stand for long hours, like policemen, waiters, salesmen and teachers. It is more common in women and usually starts during pregnancy. In many, the varicosities regress after delivery but with recurrent pregnancies the veins may get permanently dilated.
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- Heaviness in the legs, more on standing.
- Swelling in the leg which reduces upon elevating the leg
- Cramps in legs, more often at night
- Pigmentation around the ankle
- Itching, ulceration and eczema
- Spontaneous bleeding from the veins
- Rarely clotting or Deep-vein thrombosis
- Many women have tiny veins in the skin-spidery veins which occur due to hormone disturbances and do not require any treatment except for cosmetic purposes.
Stagnation of blood can be prevented by Medical management
- Graded compression stockings or Elastocrepe bandage. This should be worn from mid foot upto knee or mid thigh and should be worn during the day.
- Intermittent elevation of the leg helps to empty the vein. One must lie down and elevate the leg to facilitate blood flow in the veins by gravity.
- Wound care if there is ulcer or eczema Majority of the patients will get good relief with these measures. But all these can only prevent complication but cannot correct the varicose veins which require some form of intervention.
Color Doppler study helps to determine which system of vein, deep or superficial, is affected. It helps to decide on the mode of treatment.
Some varicose veins can be managed by injecting sclerosing solution into the vein to help them close.
SURGICAL TREATMENT
- Open surgery
- Laser Ablation
- Radiofrequency Ablation
Surgical treatment is needed if non-surgical measures fail to control or if there are complications. In open surgery the damaged veins are removed through small incisions. Recently less invasive procedures like Laser and RF ablation have become more popular and have shown good results. In cases of laser and RF ablation, no cuts are made. The laser or RF fibre is passed into the vein through a tiny needle hole and the veins are burnt by the heat generated. All veins cannot be removed or destroyed by surgical means. Even after surgery patient must wear compression stockings for 4-5 months to get maximum benefit.
- To wear stockings during pregnancy and after delivery
- Weight reduction
- Intermittent elevation of the leg
- Adequate exercises like pedalling movement of the ankle – It works the calf muscle and helps to empty the veins.