Signs and symptoms of varicose veins

Varicose veins are a cosmetic concern for many people, appearing as visible blue or purple veins under the skin or twisted, swollen veins that are like cords on the legs. Initially, varicose veins are usually painless, but over time they can cause aching pain or heaviness in the legs, especially when standing and walking, cramps in the legs, most often at night, swelling in the feet and ankles, and restless legs.

The veins may lead to sequelae or complications like skin pigmentation or ulcers in ankle/feet and may even get thrombosed.

Diagnosis:

Doctors can often diagnose varicose veins by simply examining the veins in the legs. Your doctor may recommend having an ultrasound doppler scan to look at the veins in your legs and check whether the valves in the veins are functioning properly.

Treatment Options

Many people don’t need any specific treatment for varicose veins other than self-care measures. However, without treatment, varicose veins do tend to get worse with time. The aim of treatment is to ease symptoms, improve appearance and prevent complications such as leg ulcers. Varicose veins can usually be successfully treated, but new varicose veins are still likely to develop over time.

These days there are several non-invasive or minimally-invasive treatment options for varicose veins. These can be done as outpatient or day care procedures and don’t have a long recovery time, so are often recommended instead of surgery.Compression stockings, taking regular exercise and elevating the affected area when resting are sole/ancillary recommended measures advised to the patients in the beginning.

If your varicose veins are still causing pain or discomfort, or they cause sequelae/complications, they can be treated in several ways:

The most common treatment options include

• Surgery- ligation and stripping: the affected veins are surgically removed.
• Minimally invasive percutaneous intervention:-
• Endothermal ablation: here heat is used to seal affected veins using a small fibre (size of a needle).
• Sclerotherapy : this uses special foam agent to occlude the veins that are not amenable to ablation (due to technical reasons).

He latter percutaneous interventions can be used as isolated or combined techniques.

Endovenous thermal ablation

This treatment involves destroying varicose veins using endovenous laser ablation (EVLA) or radiofrequency ablation (RFA).

It involves inserting a catheter (a very thin, hollow tube) into the varicose veins, under ultrasound guidance to make sure it is in the right place. Radiofrequency or laser energy is then applied via the tip of the catheter along the inside of the vein, heating it up and causing the walls to collapse and close together. The vein is replaced by scar tissue and eventually removed by the body.

This treatment can be used for varicose veins with reported success rates of around 95 per cent.

Sclerotherapy is a form of treatment that involves injecting varicose veins with a chemical solution that irritates and scars the vessel walls, making them stick together. This blocks off the veins, which are replaced by scar tissue and then removed by the body’s immune system.Sclerotherapy is usually effective when used to treat spider veins and small tortuous varicose veins where laser or RFA fibres cannot reach.

Surgery

Vein stripping and ligation is where longer veins are tied shut and removed through small cuts in the skin. This type of surgery is usually used to treat more severe cases of varicose veins.

Advantages of laser ablation over surgery

Laser ablation offers many advantages over surgery for most if not all patients. To enlist a few of the advantages-

• Minimally invasive
• No rest/leave from work required
• No cuts /wounds
• Painless
• Higher success/Less recurrence
• Negligible bleeding
• Comfortable recovery
• Easily reproducible for residual varicosities
• Minimal risk of infection