Varicose Veins

Image of varicose veins in legs behind the knee.

What are Varicose Veins?

Varicose Veins are bulging veins in the legs that produce many different types of symptoms. They are often confused with smaller veins (thread veins or spider veins) which are situated much closer to or within the overlying skin. Varicose Veins can be small (2-3mm across) to very large (2-3cms across) and tend to produce marked bulging of the skin.

Anyone can develop Varicose Veins, but your parent may pass on an increased tendency to develop them. Women who have had multiple pregnancies or people who are obese also have a higher risk of developing Varicose Veins.

What causes Varicose Veins?

Veins are responsible for bringing blood back to the heart. When you walk, muscles in your leg squeeze the veins and help the blood flow (sometimes against gravity). When veins are working normally, a series of valves helps this process. In people with Varicose Veins, and a related condition called Chronic Venous Insufficiency (CVI), the valves don’t work well enough to help. The blood tends to pool in the lower leg and cause symptoms associated with both conditions.

 

What are the symptoms of Varicose Veins?

Many people with Varicose Veins have no symptoms, other than visible veins in the leg, while others may have more painful symptoms including:  

  • Pain, itching, swelling, burning, leg heaviness or tiredness

  • Skin discoloration

  • Symptoms that typically worsen throughout the day and are partially relieved by elevation or wearing compression socks or stockings

  • Temporary clots in the surface veins (phlebitis)

  • Bleeding after a hot shower or minor trauma

  • Skin tears or ulceration in very severe cases

Sometimes, Varicose Veins clot and become painful, hot, hard and discoloured. This uncomfortable but temporary condition is called phlebitis. Clots associated with phlebitis are limited to surface veins. They are not dangerous (like deep clots associated with deep vein thrombosis or DVT) and usually get better on their own in a few months.

 

How are Varicose Veins diagnosed?  

A vascular surgeon will ask questions about your symptoms, medical and family history before performing a physical exam to gently probe for problem areas on your legs while you are standing. We also look for signs of tissue damage secondary to the Varicose Veins.

More detailed ultrasound mapping is often required to plan the most effective treatment for you. This is particularly important following any previous surgery, if you have a history of clots, valve abnormalities or leg ulceration. The scan is called a Colour Flow Duplex scan.

 

How are Varicose Veins treated?

There are a range of treatments available, depending on the location of your value problems (the underlying cause of Varicose Veins); and the location, severity and tortuosity (the degree of twists) of your veins. Common treatments include:

Compression Stockings

Wearing compression stockings may be all you need if aching and swelling are the main problems. The stockings compress the veins and prevent blood from pooling in the legs. You’ll need a proper fitting to make sure the correct grade of stocking is used.  

RFA (Radio Frequency Ablation)

If compression stockings don’t provide enough relief, and the affected veins are straight (determined by the ultrasound), some form of ablation therapy is an option.

Radio Frequency Ablation is a minimally invasive procedure used in the treatment of varicose veins. It is an alternative to the traditional stripping operation. Under ultrasound guidance, a radiofrequency catheter is inserted into the abnormal vein and the vessel treated with radio-energy, resulting in closure of the involved vein.

Your vascular surgeon will use numbing medication before inserting a catheter (thin tube) into the vein to numb all the surrounding skin. The vein is then treated. This part of the procedure is painless and typically takes 20 minutes. After the procedure, you will wear a compression bandage as part of your recovery. You may need other treatments for more visible veins.

EVLT Laser Vascular Procedure

EVLT (Endovenous Laser Therapy)

Endovenous Laser Therapy (EVLT) is a quick, minimally invasive laser procedure that can be performed in your doctor’s office. There is no post-operative scarring, as it is only a probe and a slim sheath that enters the vein via a tiny skin nick.

The probe is guided into place using ultrasound and the procedure is performed strictly under local anaesthetic – similar to that used by dentist – to numb the treatment area. The treatment takes less than an hour.

Key Benefits of EVLT (Endovenous Laser Therapy)

  • immediate relief from symptoms

  • no scars

  • only a local anaesthetic is needed

  • can be performed in the doctor’s office (no hospitalization needed)

  • treatment in less than an hour

  • normal activities can be resumed immediately – with little or no pain

These newer treatments are replacing the ‘stripping’ part of the operation previously used to remove Varicose Veins.

Injection sclerotherapy

If your veins are twisted, sclerotherapy may be recommended. Guided by ultrasound, a small needle is advanced through the vein to inject a chemical (sclerosant) that causes the vein to spasm and clot. The clot is then broken down naturally by the body and the vein disappears. This method is may also be used for thread veins but may not be as effective as other techniques for larger Varicose Veins.

The principle is to inject a substance which irritates the inside lining of the vein causing it to become sticky. A compression bandage then pushes the walls of the vein together so that it is sealed off with scar tissue. This treatment is also called injection sclerotherapy.

Compression is required after the injection to stop blood clots forming inside the vein. Compression lasts for about three to six days for small veins and from three to six weeks for larger veins. Bandages and stockings are used in various ways. Injection treatment is suitable for Spider Veins and Varicose Veins.

Surgical Treatment

Surgery to remove the varicose veins may be needed for some people. Usually the results of surgery are more attractive than the appearance of large varicose veins. Most scars or stains resulting from surgery are faint. Sometimes they are permanent and unsightly. Not all surgeons use the same technique. Ask how the surgery is to be done.

Non Invasive Techniques

Our non invasive Laboratory is one of the key components of Vascular Associates Camperdown. Non invasive testing, as the name implies, allows patients to be examined using Doppler ultrasound techniques free of the risks and discomforts of injections and/or other invasive maneuvers. These tests allow diagnosis of almost all known or suspected vascular disorders and testing can often determine the severity of the problems and its need for treatment.

 

How do I prevent Varicose Veins?

While you may not be able to prevent Varicose Veins, you can do a lot to prevent them from coming back after treatment. 

Follow all the instructions from your vascular surgeon and wear your compression stockings to help prevent new Varicose Veins from forming. Your stockings will also help to speed up the recovery process.

 

Talk to your doctor about Varicose Veins

If you have any questions about the various treatments for Varicose Veins, speak to the team at Vascular Associates.