Varicose veins

Varicose veins are swollen, dilated, enlarged and twisted veins. This condition may occur in any superficial veins, but most commonly in your legs and feet that appear as bluish purple or red.

What are varicose veins?

  • These are dilated, twisted, enlarged veins.
  • These are a part of the spectrum of chronic venous diseases that includes spider telangiectasias, reticular veins, and true varicosities.
  • Approximately 25% of adults have varicose veins and predominantly women.
  • This is not a serious medical condition, but very common due to abnormality of the venous valve which is present from birth.
  • During this condition, one may feel uncomfortable and can lead to serious problems like mild to moderate pain, blood clots, or skin ulcers.

Why varicose veins form?

  • Arteries distribute blood from the heart to other parts of the body whereas veins collect blood from other parts of the body back to the heart.
  • A varicose vein is a disease of veins.
  • There are two systems of veins: superficial and deep
  • Superficial veins are seen beneath the skin while, deep veins pass through the muscles.
  • Superficial veins are low pressure whereas deep is a high-pressure system.
  • Blood from the high pressure deep venous system is not allowed to reach the superficial veins due to venous valves.
  • Dysfunction of the venous valves leads to the transmission of high pressure from deep veins to superficial veins.
  • Abnormal pressure in the superficial veins leads to dilatation and tortuous veins.
  • Venous valve abnormality could be due to multiple reasons.

When do venous valves become dysfunctional?

  • Older age
  • Females due to hormonal effect
  • Obesity
  • Pregnancy
  • Sitting/Standing for long periods
  • Smoking
  • Deep vein thrombosis
  • Congenital symptoms
  • Family history of varicose veins

What are the causes of varicose veins?

  • Primary varicose veins develop due to the inherent weakness of venous valves.
  • Secondary varicose veins are due to trauma or deep vein thrombosis.
  • Congenital varicose veins are due to disordered development of the venous system.

What are the symptoms of varicose veins?

  • Discomfort or pain in the legs.
  • Sensations such as burning, aching, itching, tightness or tingling of the leg, and swelling of legs.

These symptoms may get worse when you are standing/sitting for a longer period.

In some severe cases of varicose veins:

  • Skin changes such as itchy rash or darkening of the skin of the leg, which may lead to the poor healing process.
  • Burst or bleed dramatically, that can be stopped by keeping pressure on the vein and elevation of the affected leg.
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How are varicose veins diagnosed?

  • Vascular ultrasound in supine and standing position: This is a non-invasive test that uses sound, is done to look for the veins that are not working properly.
  • Physical examination: Physical examination of the varicose veins is done to determine the type, location, extent and possibly the cause of the venous disease. These are often done while one is standing, which causes veins to fill and become visible in bluish-purple or red in colour.

What are the complications of varicose veins?

Infection:

  • Inflammation of the veins – this can be understood as a condition where the veins are dilated, blood gets clotted and wall of vein gets swollen.
  • Also, the blackish discolouration can develop around the ankle and is usually permanent though not a serious issue.

Ulcers:

  • Slow blood flow in veins deprives skin its nourishment leading to thinning and dryness of the skin.
  • Dryness leads to itching and the trauma due to scratching leads to ulcer development.
  • Unless treated well with appropriate strategies they do not heal and can potentially get infected.

Bleeding:

  • Due to high pressure in veins, it is difficult to control, can be controlled by lying flat and applying compression for 10 minutes can arrest the bleeding.

What are lifestyle modifications for varicose veins?

  • Maintain a healthy body weight
  • Routine exercise
  • Avoid sitting/standing for long periods
  • Avoid direct heat exposure
  • Avoid usage of high heel shoe
  • Wear compression stockings
  • Elevate legs

What are the precautions to be taken after RFA procedure with diet, exercise and medications?

  • Use compression elastic leg stocking for at least 3 months
  • Use blood thinner medications for 3 months. This medicine prevents clots formed in the leg veins to travel to the lungs and cause a life-threatening problem. The blood thinner is a very effective medicine to prevent this problem. The new generation of blood thinners is expensive but are very safe agents as the risk of bleeding is very low with these agents compared to old generation medicines.
  • Physical activity and active sports can be resumed in less than a week and the person can walk immediately after the procedure.
  • There are no diet restrictions except to control weight if the person is obese.

What is the purpose of elastic leg stockings for varicose veins?

  • The veins in the leg need to pump the blood back to the heart but there is no organ to dedicatedly perform this work. The muscles of the leg, termed calf muscles, “milk” the blood back to the heart aided by the valves in the veins which permit a one-way blood flow (only towards the heart).
  • But in patients suffering from varicose veins either the muscles are weak (as in obesity, females) or the valves are not working well (as in congenital valve dysfunction, familial varicose veins) or both (as in old age).

How to choose the right elastic leg stockings?

  • Elastic leg stockings have to be worn all through the day and need to be removed before they retire to bed.
  • The elastic compression leg stockings are different from the commonly used anti-embolism stockings which maintain a pressure of 10-18 mm Hg.
  • These are of three classes:

Class 1 – maintain a pressure of 20-30 mm Hg – used for initial stages of varicose veins

Class 2 – maintain a pressure of >30-40 mm Hg – used for post-operative endovenous ablation of varicose veins using RFA or laser

Class 3 – maintain a pressure > 40 mm Hg – used for advanced stages of varicose veins before surgery.

  • Elastic leg stockings are available in two lengths –
  1. Below-knee length
  2. Thigh-length stockings
  • It is preferred to use the thigh level stockings but they are cumbersome to wear
  • Elastic leg stockings are available in different sizes based on the girth of leg and thigh. So when you buy the stocking please make sure that you are buying the apt size for you.

What is the uniqueness of treatment of varicose veins by Dr C Raghu?

  • Treatment of varicose veins without surgery
  • High success rates
  • Perform three different procedures in the package –
  1. Radiofrequency ablation
  2. Sclerotherapy
  3. Stab venectomy

Combination of procedures ensures a high success

  • Economical packages
  • Successfully treated many patients
  • Many of these patients are elderly and are at high risk for heart problems at the time of varicose veins surgery. This can be best dealt with by a cardiologist led team.

What are the treatment options for varicose veins?

Compression stockings: These stocking will provide a 20 to 30 mm Hg pressure to the affected leg by varicose veins. In case of any blood clots or deep vein involvement in varicose veins, a pressure of 30 to 40 mm Hg is preferred. These are used for symptom relief.

Microphlebectomy: This is a procedure where small incisions are made just below the skin surface by allowing for the removal of varicose veins.

Radiofrequency ablation (RFA) or endovenous laser ablation (EVLT): This procedure is the preferred treatment for saphenous reflux due to less pain and shorter recovery when compared with surgery. This procedure is done by catheter insertion into the vein, and then application of thermal energy for ablating the vein. Both RFA and EVLT use heat energy to ablate the veins.

Vein-stripping surgery: Great saphenous veins are removed by making small incisions in the groin area and below the knee.

Venaseal system: This procedure is done by closure or sealing of the damaged vein by using the glue without any thermal energy. Advantages include no pain, local anaesthesia only, immediate ambulation and no need for use of elastic leg stocking.

Which is the preferred procedure?

  • Surgery, laser and Radiofrequency ablation carry similar success rates of more than 90%.
  • Choice of the procedure is a laser, RF ablation or using glue because these do not entail an open surgery, a patient can be discharged the same day and get back to work immediately. For people averse to use of stockings glue assisted venous closure is an excellent option.

How can we compare surgery with non-surgical treatments?

Surgery – venous stripping Radiofrequency ablation
Surgical incision and scar Yes – long scar along leg and thigh No scar
Pain Usually painful due to scar and damage to nerves Nearly painless
Success Around 70% as perforator veins are small to ligated More than 98%
Recurrence rates 20-30% 5-10%
Mobility Need rest for 7-10 days Immediately can walk
Medications 10-14 days 90 days
Elastic leg stocking Yes Yes

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Copyright © 2019, Dr. Raghu. All rights reserved.
Designed & Developed by Deepak Kambhampati.



Copyright © 2019, Dr. Raghu. All rights reserved.
Designed & Developed by Deepak Kambhampati.