Varicose veins are lumpy twisted veins that stick out when you are standing up but shrink when you lie down. They affect about 3 in 10 people in Europe but are much less common in Africa. The reason behind this is largely hereditary. Varicose veins are common in pregnancy but in most people, they disappear after delivery of the baby and therefore treatment in pregnancy is not advised.
Thread veins or spider veins are very small visible veins in the skin which are not sticking out. As we get older, we all eventually develop these but they cause no trouble apart from being unsightly. Cosmetic treatment for these is generally effective with tiny injections of sclerotherapy, however we continue to develop these as we get older.
What causes varicose veins?
The normal way that blood goes upwards to your heart from your foot, is that the muscles of the calf pump the blood upwards when you walk. As the muscle contracts, the blood is forced up and then is held up by valves. Varicose veins develop when these valves break and therefore the blood just yoyos up and down. This increases the pressure in the veins and they start to bulge.
What happens if varicose veins are not treated?
Over a long period of having varicose veins, they can cause discomfort and leg swelling. If symptomatic varicose veins are left untreated, this eventually leads to complications. These complications include developing a very itchy rash near the vein which is called venous eczema; some people develop a very tender vein which is called thrombophlebitis. After a long period the skin can become damaged and turn dark, brown and shiny. If left, this can turn into a break in the skin called an ulcer which is slow and difficult to heal. If a very large vein near the surface gets knocked you may suffer very severe bleeding which only stops by putting the leg up in the air.
What are the benefits of treatment?
The aim of treatment is to reduce symptoms and prevent the long term complications developing. The visible appearance will be also greatly improved but it is possible to develop new veins later in life. Up to 95% have no recurrence at 5 years with new techniques.
What treatments are available?
In order to choose the right treatment for you, your surgeon will need to scan the veins in your legs to determine where the valves have broken and how extensive the varicose veins are. The aim of treatment is to destroy or remove the damaged veins and force the blood to go away from the skin and into the calf where it belongs.
ClariVein ultrasound guided ablation. This is now the commonest treatment. It is done under a small amount of local anaesthetic. A small catheter is passed into the damaged vein and it spins round inside the vein while a sealant is injected to seal the damaged vein and make the body reabsorb it. You walk in and then walk out with a bandage on, but with very little restriction while you recover.
Foam sclerotherapy is suitable for smaller veins or recurrent veins which are very twisty and which a catheter will not go up. This is again a type of sclerosant (sealant) which blocks the damaged vein and makes the body reabsorb it.
Surgery under a general anaesthetic is rarely needed apart from advanced or large veins. This is done as a day case and will involve a cut about one inch long either in the groin or behind the knee. In addition there will be very small incisions to remove the biggest bulging veins and this gives a good cosmetic result. The leg will be bandaged, which restricts movement and prevents you driving for a week. You should be able to potter around without any problem. Most people who have active jobs, take two weeks off work.