Varicose Veins

What are varicose veins?

Varicose veins are a common problem.  They are abnormally prominent veins visible in some people on the thighs and legs.  Some patients have fine superficial spider veins.  Others have larger enlarged varicose veins.  Varicose veins can be associated with symptoms such as aching and itchy legs.  Some patients will develop swelling, abnormal skin pigmentation or eczema and in advanced cases the skin may break down producing a non-healing wound or ulcer.

What causes varicose veins?

Varicose veins and the associated problems relate to the veins not working properly.  Healthy veins normally take blood from the feet back up to the heart.  They have valves in them to ensure that the blood only flows in one direction.  In some people the valves do not function properly, and the blood refluxes back down the leg.  The pressure increases causing the veins to become distended. Fluid can leak out of the veins causing swelling. After a prolonged period of elevated pressures skin changes and ulcers can develop.

If I have varicose veins am I at risk of blood clots?

Patients have both deep and superficial veins that can have problems.  Varicose veins are mostly associated with problems related to the superficial veins.  Varicose veins can develop painful blood clots. These are however typically superficial and do not have the same risks associated with deep blood clots (deep vein thrombosis).

What should I do if I am concerned about my varicose veins?

If you have concerns about your veins you should get a referral from your General Practitioner (GP) for a vascular assessment.  This will include you describing the problems you are having and whether you have had any previous treatments for varicose veins.  It is important to disclose if you have a history of blood clots, whether you have any other medical conditions and your current medications, as some medications can cause bleeding or increase the risk of blood clots.  Your assessment will also include an examination of your legs including your veins and it would be helpful to dress appropriately for this.

What tests will I need?

Most patients will need to go on to have an ultrasound scan.  This is a non-invasive test used to examine the circulation in the blood vessels of the body and in this case your legs. It  is not painful and does not require any injection or radiation.  This is usually performed by an experienced vascular sonographer who understands the assessment of patients with venous disease.  This test identifies exactly what the problem is, and which veins are involved. Often patients have damaged valves in either the great saphenous vein on the inside of the thigh or leg or the short saphenous vein on the back of the calf.

What treatments are available to treat varicose veins?

After your assessment and detailed ultrasound examination advice can be provided in relation to the most suitable treatment.  Some patients are best managed with firm compression stockings.  Other treatments include injection sclerotherapy, minimally invasive endovenous laser treatment, gluing of veins or an open surgical procedure known as stripping the veins. Patients with problems related to varicose veins typically can be treated with minimally invasive procedures in order to assist them with their symptoms and the appearance of their legs.

What is compression therapy?

Some patients will get relief from their symptoms and their veins can be controlled by wearing firm compression stockings.  Compression stockings promote normal blood flow up the leg.  Typically Class II stocking are used, however some patients will only tolerate a less firm Class I stocking.  Patients should be specially measured for these stockings. Stockings need to be worn during the day and can be taken off at night.  After a period the elastic becomes less effective and new stockings will need to be bought.

What is injection sclerotherapy?

Injection sclerotherapy involves injecting the vein with an irritant solution called a sclerosant in order to shrink the vein and shut it down. The body then gets rid of the vein over time. Injection sclerotherapy is performed in the clinic rooms.  Sometimes it is done under ultrasound guidance.  Patients will need to have compression stocking on their leg for a period after the procedure but can immediately walk, drive and essentially return to normal activity. The risks are soreness and lumps at the injection sites that usually settle over time. Some patients develop skin discolouration and in some cases multiple treatments may be required.

What is endovenous laser treatment?

As an alternative to surgical stripping most patients with diseased long or short saphenous veins can be managed these days with a procedure called endovenous laser treatment. Endovenous laser treatment uses heat in the form of a thin beam of light which closes and shrinks the varicose vein causing scar tissue to seal off the vein.   The laser is placed into the vein under ultrasound guidance and activated to shut the vein down. The vein is effectively destroyed and as it heals the vein disappears and blood then flows through alternative healthy veins. This has the advantage over surgical stripping of being less invasive.  This procedure is less painful than surgery and patients return to normal activity after a shorter period.

A patient’s varicose veins may also need to be directly treated either with surgical removal through a small incision or alternatively injection sclerotherapy performed either at the same time as the laser treatment or later.

Can my varicose veins be treated with glue?

A more recent treatment for varicose veins that has become available is medical grade glue called VenaSeal™ (cyanoacrylate).  This involves the placement of a very small amount of VenaSeal vein glue into the vein through a small catheter. Once the glue enters the vein it seals the affected vein shut, blood is immediately re-routed through other surrounding healthy veins in the leg. This is performed in the clinic rooms under local anaesthetic.  Similar to laser and injection treatment it is minimally invasive and patients can return to normal activity almost immediately.  However not all patients are suitable for this type of procedure. This is dependent on a patient’s ultrasound findings as to whether this is an appropriate treatment. Like laser treatment some patients may require additional injection sclerotherapy later.

What is open surgical stripping?

While open surgery has largely been replaced by minimally invasive procedures, it remains appropriate for selected patients with varicose veins. Surgery involves directly removing diseased veins from the thigh and leg through incisions. Often an incision is placed in the groin where the vein is tied off before being stripped from the leg.  Patients can have bleeding, pain related to the incisions and there is a risk of wound infection. Patients normally require a period off work and need to avoid any heavy or strenuous activity.

What happens to the blood flow after my veins have been treated?

Varicose veins typically involve the superficial veins. Treating them does not compromise the circulation in the leg. Blood is directed to healthy deep veins and then returned to the heart.

Where are the procedures carried out?

Depending on the severity of the problem patients can be treated in both public and private hospitals.  Some patients are suitable for treatment in the clinic rooms.  Patients need to be assessed and have an ultrasound performed by an experienced vascular sonographer to determine the best option.

What are the risks of treatment?

All treatments do carry with them some risk.  In patients with surgical incisions they can have problems with bleeding, wound infection and they will also have small scars that typically fade over time. There is a risk of inflammation after the procedure which settles with anti-inflammatories.  Some patients do develop skin discolouration that may not completely fade.  Rarely patients develop blood clots which can be prevented with medication. There is also a small risk of nerve damage and associated numbness.  Every precaution is taken to avoid these problems.  A proportion of patients will need more than one treatment in order to completely manage their veins.  Some patients are left with some residual veins.

What if I’m planning on becoming pregnant?

Prior to pregnancy or between pregnancies patients can have their varicose veins treated. Varicose veins do become worse during pregnancy and this is managed with compression stockings.

What if I’ve been treated before?

Patients who have had previous treatment for veins including surgery in the past may be suitable for further treatment should their varicose veins return.

Do varicose veins only affect the legs?

Some patients have more complex problems related to their veins.  These include problems with the pelvic veins and the veins related to the ovaries.  In these patients a more comprehensive assessment is required with ultrasound and sometimes computerised tomography (CT). Treatments are individualised for each patient to address these more complex problems. Dr Freeman has extensive experience in the treatment of varicose veins and the treatment of patients with more complex venous problems.

Sydney Vascular Ultrasound provides specialised vascular and venous diagnostic imaging in Burwood, Bankstown and Liverpool.