Varicose veins at Ashtead
Hospital
What are varicose veins?
Varicose veins are dilated, tortuous, visible superficial veins
in the legs, nearly always caused by poorly functioning valves,
which normally control the direction of flow in leg veins. If these
flap type valves fail then blood which should be travelling back
towards the heart flows in the wrong direction, causing distension
of the surface veins which gradually become more and more
prominent.
The most common sites for such problems to start are where the
main surface veins connect to deeper veins at the groin (long
saphenous vein), or behind the knee (short saphenous vein).
Why do they occur?
In many cases varicose veins run in the family, where there is
likely to be an inherited weakness either in the vein wall or
valves. Other factors which exacerbate the development of varicose
veins include pregnancy and being overweight. Although occupations
involving long hours of standing may aggravate the symptoms from
varicose veins, this is probably not the cause in the first
place.
What problems can they cause?
Varicose veins are usually easily visible and cause some people
concern purely because of their unsightly appearance. They may also
cause considerable aching, heaviness or cramps in the legs. The
veins may become very tender and inflamed (phlebitis). Skin changes
can occur, especially around the ankle, with brown discoloration or
staining of the skin and sometimes flaking and itching (varicose
eczema). In later stages the skin changes can progress to breakdown
of the skin and the development of venous ulcers.
Reasons for treatment?
Not all patients with varicose veins need treatment. Simple
measures, such as weight reduction, wearing support tights or
elastic stockings and trying to avoid long spells of standing, may
be sufficient to alleviate aching symptoms, although these will not
cure the underlying problem. Various reasons for more definitive
treatment may be considered – to improve the appearance, to
alleviate symptoms, to treat developing skin changes and ultimately
to prevent or aid in the management of venous ulcers.
Varicose vein treatments in the 21st century
Treatment of varicose veins is undergoing a major change in the
21st century. During the 20th century varicose veins have been
treated by either conventional surgery or sclerotherapy. The types
of surgery, involving saphenofemoral ligation or short saphenous
ligation, with or without stripping and phlebectomies, has changed
little for the best part of 100 years. Sclerotherapy was introduced
about 50 years ago and although there was some early enthusiasm it
was found to be associated with a high recurrence rate. It remains
the best treatment for thread veins.
Recently, the widespread use of duplex ultrasound to thoroughly
assess both the deep and superficial venous systems has provided a
more focused approach to treatment, as well as the possibility of
less traumatic and less invasive ways of treating varicose
veins.
Investigations
If varicose veins are causing worry or troublesome symptoms then
assessment by a vascular specialist is recommended. A careful
medical history and direct examination of the legs is necessary.
Duplex ultrasound is now used to more accurately define the source
and details of the varicose veins.
Duplex ultrasound
This is a large complex machine which combines the ability to
assess the direction and speed of blood flow, with a direct
ultrasound picture of the enlarged veins. This clearly maps the
distribution of veins and hence enables the best treatment to be
planned.