Varicose Veins A Guide for Patients What are varicose veins? Varicose veins are abnormal, dilated blood vessels caused by a weakening in the vessel wall. There are many causes of varicose veins - the common are hereditary, pregnancy, obesity, previous blood clots, even excessive standing or sitting at work. Your veins carry blood back to the heart. In your leg, this means the blood has to flow upward, against gravity. Consequently, these veins have one-way valves to prevent the blood from back flowing. Over time these valves can fail to close tightly allowing blood to pool and causing the bulging and twisting characteristic of varicose veins. What causes varicose veins? High blood pressure inside your superficial leg veins causes varicose veins. Factors that can increase your risk for varicose veins include having a family history of varicose veins, being overweight, not exercising enough, smoking, standing or sitting for long periods of time, and having DVT. Women are more likely than men to develop varicose veins. Varicose veins usually affect people between the ages of 30 and 70. Pregnant women have an increased risk of developing varicose veins, but the veins often return to normal within 1 year after childbirth. Women who have multiple pregnancies may develop permanent varicose veins. What are the symptoms of varicose veins? Some people do not have symptoms but may be concerned about the appearance of the veins. If symptoms occur, they may include: • • • • • • Swollen legs Muscle cramps, soreness or aching in the legs Tiredness, burning, throbbing, tingling or heaviness in the legs Soreness behind the knee Itching around the vein Brown discoloration of the skin, especially around the ankles Symptoms often worsen after prolonged standing or sitting. In women, symptoms may be worse during menstruation or pregnancy. Occasionally varicose veins can Sometimes the condition leads to more serious problems, such as, a painful blood clot, referred to as superficial phlebitis (inflammation of a vein), or skin ulcers. How are varicose veins diagnosed? During a physical exam, the doctor will check your legs while you are standing. Your doctor also may request that you have an ultrasound scan to check the blood flow in the superficial veins (near the skin’s surface) and deep veins. Treatment Compression Stockings Your doctor may prescribe compression stockings, which are elastic stockings that squeeze your veins and stop excess blood from flowing backward. Compression stockings also can help heal skin sores and prevent them from returning. You may be required to wear compression stockings daily for the rest of your life. Photoderm This procedure is done in the surgical day ward. A small probe, which emits intense, pulsed light, is placed on the affected area. This is used to selectively damage or destroy abnormal small veins including small spider veins, certain sizes of varicose veins and vascular birthmarks. Laser Treatment Your doctor inserts a tiny fibre into a varicose vein through a catheter. The fibre sends out laser energy that kills the diseased portion of your varicose vein. The vein closes and your body eventually absorbs it. This procedure is performed under local anaesthetic and takes about 45minutes. You will be up and walking as soon as it is over and you can go home straight away! Vein Stripping To perform vein stripping, your surgeon disconnects and ties off all varicose veins associated with the saphenous vein, the main superficial vein in your leg. This vein is then removed from your leg. A procedure, called ‘small incision avulsion’ can be done alone or together with vein stripping. Needle avulsions allow your surgeon to remove additional varicose veins branches from your leg using hooks passed through small incisions. The skin is closed using steristrips (sticky paper strips) and if possible no stitches are used. You are usually let home on the same day. Post-operative instructions You are encouraged to walk as soon as possible. You can return to work within a day post-laser treatment, or within one week post vein stripping. You may have some bruising and soreness for 7-10 days after the treatment, and you will be given a prescription for some antiinflammatory pain medication. Day 2: Remove the first (Class II) elastic stockings from leg, leaving 2nd elastic compression stocking in place for one week Day 7: Remove elastic stocking from leg and soak in warm bath, with Savalon or salt. This will remove the steristrips. Reapply elastic stocking and continue to wear for at least two more weeks. Week 6: You will have a check-up appointment. Options for treating rare small persistent veins or spider veins, e.g. photoderm therapy, can be discussed at this point. Complications: Complications following Laser therapy are rare. However, a few complications are associated with vein stripping. • Bruising or tender lumps may occur along the course of the removed vein. These resolve within 6-8 weeks. • Swelling of the foot and ankle may occur but usually disappears within a few weeks. A few simple measures help alleviate this, such as, wearing compression stockings, avoiding long periods of standing, sitting with you feet elevated, taking short walks and keeping mobile. • Rarely, the procedure can damage superficial nerves that lie near the stripped vein, causing a patchy area of numbness in the leg. The nerves usually recover, however, and sensation returns within 6 to 12 months. Department of Vascular and Endovascular Surgery University College Hospital Galway Phone: +353 91 542346 Fax: +353 91 542360 E-mail: wvi@mailn.hse.ie www.vascular.ie