Varicose Veins

Varicose veins are common among the general population. It is defined as tortuous, dilated, abnormal veins of the lower limbs. The other variants of these unsightly veins are reticular veins (superficial, prominent veins) and thread veins (fine, thin cutaneous veins).

Varicose veins are more common in women, caucasians and in those with a family history. The risk factors are:

-obesity

-pregnancy

-prolonged stationary standing

-women taking oral contraceptive pills or hormone replacement therapy

The aetiology of varicose veins can be due to:

-venous valve insufficiency which is either congenital or acquired. Congenital insufficiency occurs in patients who are born with weakness of the venous valves. Acquired insufficiency is secondary to thrombosis (blood clots) occuring around the valves.

-perforator (the connecting veins between the deep venous & superficial venous systems) insufficiency

-disturbance to venous flow such as deep venous thrombosis (DVT), pelvic vein thrombosis and vascular malformations.

Patients who have varicose veins usually present with:

-unsightly dilated veins

-itchiness around the veins

-aching sensation of the lower llimbs

-swelling of the lower limbs

-throbbing pain of the lower limbs

The complications of varicose veins are:

-bleeding (usually due to accidental trauma)

-ulceration of the lower limbs

-thrombophlebitis (obstruction & inflammation of the veins)

-skin changes ie. pigmentation (haemosiderin extravasation), eczema, inverse 'beer bottle deformity' of the lower leg (lipodermatosclerosis)

Investigations for patients with varicose veins include:

-Duplex/Doppler Ultrasound Scans: to assess the site of incompetence and the patency of the deep venous system

-Magnetic Resonance Venography: to assess for pelvic/abdominal vein patency

Patients with varicose veins can be managed medically or surgically.

Medical management for these patients include:

-regular exercise

-elevate lower limbs when resting

-graduated compression stockings

-compression sclerotherapy (injection of sclerosants into the veins under ultrasound guidance)

-pulsed laser therapy (for thread veins only)

Surgical management is indicated for patients with more severe symptoms. These include:

-disconnection of the sapheno-femoral junction or sapheno-popliteal junction

-long saphenous vein stripping

-phlebectomy

Recent advances in surgery include endovascular procedures such as:

-endovascular laser or radiofrequency

-endovascular foam sclerotherapy

All the surgical procedures can be done under local anaesthesia and as day cases. Post surgery, patients will need to be on graduated compression stockings for at least 1 month. Patients are given regular pain-killers, encouraged to walk and advised to elevate their legs when sitting down.