A guide to varicose veins
Varicose veins are common in the legs, appearing as veins that are swollen and twisted. In this guide, Mr Zola Mzimba, a consultant vascular surgeon, explains why varicose veins occur, how they are treated, and if can they be prevented.
Not all varicose veins need treatment, and not all insurers cover varicose vein procedures
It is important to see someone who understands the condition of varicose veins and who can best explain what is the cause, what are the risks to you and most importantly when to leave well alone.
What are varicose veins and what causes them?
Varicose veins often look like jagged blue or purple lines under the skin, and can have a tactile texture of being bulging or lumpy. They are extremely common in adults, with most studies showing more than 80% of the adult population has some evidence of venous disease.
Varicose veins are caused by a dysfunction of blood flow, where the veins, which transport oxygen-depleted blood to the heart, have a ‘change of direction’, and the blood starts flowing backwards, which causes it to pool and create blockages, accounting for the vascular deformation. This is generally due to failure of the one-way valves in the veins that usually ensure blood flows in one direction only, towards the heart.
What are the symptoms of varicose veins?
In addition to the veins’ physical deformation, there are other possible symptoms of varicose veins, such as:
- Pain, burning sensation, throbbing and aching in the legs
- Dry and itching skin in the area (varicose eczema)
- Cramping and heaviness in the legs
- Swollen ankles and feet
- Rashes in the affected area
The symptoms may become more severe or noticeable after standing for long periods, and complications can occur, such as further swelling of the veins, superficial blood clots (phlebitis) or skin changes that can eventually lead to ulceration, if the varicose veins are left untreated.
Can varicose veins be prevented?
There is not yet a tried-and-true method of avoiding the formation of varicose veins, but it is recommended to maintain good circulation in the body, particularly the legs. This can be achieved with regular physical activity, and a healthy diet.
How are varicose veins diagnosed?
Because of varicose veins’ highly visible characteristics, they can be diagnosed with sight alone, but for further confirmation, an imaging scan called a Doppler ultrasound can be conducted. Doppler ultrasounds are designed to show the flow of blood through the veins, so any obstruction, blockage, or backflow will be highlighted and located.
How are varicose veins treated?
If there is thought to be minimal risk for complications and the patient is not bothered by the cosmetic impact of them, then the patient may choose not to treat their varicose veins. However, most patients may at least want to alleviate their discomfort, which can be done by wearing compression socks, leggings, and stockings, and by occasionally resting their legs at a height above the heart to improve circulation.
More intensive treatment approaches include procedures such as:
- Sclerotherapy to close up the dysfunctional varicose veins to redirect blood flow using injected chemical or saline solutions.
- Thermal ablation to destroy and seal varicose veins with pulses of laser or radiofrequency energy that are passed through a catheter which has been inserted into the veins.
- Micro-phlebectomy to remove the varicose veins surgically, much like vein stripping, but this is conducted through smaller incisions.
- Surgical stripping which is rarely performed as modern techniques have superseded this operation