Varicose veins-just a cosmetic concern?

It is not uncommon to find people walking around with varicose veins bulging out of their legs.So are these varicosities just a matter of cosmetic concern or do they have any health implications as well?

Let's find out...


Varicose veins

These are dilated engorged veins that are usually found over the calf region as well as in the pelvic region.Some might be tortuous enough to appear like worms while some might be thread-like resembling spider legs.



What causes varicosities in veins?

Varicose veins occur when the vessel wall becomes thinned out often due to defective valves within them which eventually leads to stasis of blood and secondary skin changes.


What are the risk factors for varicose veins?

There are definite risk factors for the development of varicosities.The most notable ones are mentioned below:

  • Occupational: Varicose veins are frequently noticed in people who have to stand for long periods at a stretch as part of their jobs.These include but not limited to traffic police,surgeons,teachers,beauticians.

  • Positive family history

  • Overweight or obese individuals.

  • Pregnancy

  • Abdominal swellings or any tumours

  • Usage of Oral Contraceptive Pills.

  • Hormonal therapy in post-menopausal period.

  • Wearing tight undergarments

  • History of blood clots.


Why should I be worried about these varicosities?

Often cosmetic concerns are the triggering factors to visit a doctor.However some patients present with non-specific leg symptoms which on evaluation might be traced back to varicose veins.The varied complications are as follows:

  1. Bleeding: by far,the commonest complication which brings the person to the emergency department.

  2. Ulceration: An ulcer usually appears over the ankle region which might start only as a discoloration which is easily ignored.

  3. Discoloration: Pigmentation of the skin occurs due to long-standing blood pooling.

  4. Dermatitis: refers to inflammation of skin and eczema following long standing varicose veins.

  5. Deformities: the most notable deformity is an 'equinus deformity' meaning horse leg resemblance.

  6. Calcification of veins.

  7. Bony involvement (periostitis).



What are the symptoms of varicose veins?

  • Aching or throbbing pain over the legs

  • Swelling of the limb which is more towards the evening

  • Visible venous engorgement

  • Itching

  • Ulceration or simply discoloration of the ankle skin.


What tests should I be undergoing after seeing the doctor?

The most important investigation you have to undergo is a Duplex scan of both the legs-(ultrasound of the veins).This helps in identifying the sites of valve defects or weakness of veins as well as in ruling out blood clots in the veins(Deep Vein Thrombosis) which is even more of an emergency as it can lead to serious complications like sudden onset of breathlessness and death if the clot passes into the lungs(embolism).

Often,it is combined with a sonography of the abdomen so as to rule out any swellings or tumours which might be compromising the return of blood through veins to heart.


So what are my treatment options?

Varicose veins are graded based on the clinical examination and imaging findings and management is accordingly done.

Conservative management

Compression stockings are the most commonly and most acceptable conservative measure for symptomatic varicose veins.It is important to wear the correct size and also the one providing the adequate pressure.These are often prescribed by the treating doctor after taking your limb measurements.



Sclerotherapy

Mild degrees of varicose veins may be treated with a sclerosing agent (which brings about the closure of vein)injected under local anaesthesia to the affected thread veins.Patient compliance is a big advantage of the procedure but might need repeated procedures.


Surgical management

Surgery used to the gold standard of treatment of varicose veins until recently.This involves the ligation and stripping of the affected vein from the thigh region under anaesthesia often combined with connector veins ligation/sclerotherapy.


RadioFrequency Ablation(RFA)

RFA is currently the most sought after treatment method for varicose veins.Here RadioFrequency waves are made use of to heat up and destroy the vessel walls which bring about the same effect of surgery but with less morbidity.This is a minimally invasive method.


EndoVenous Laser Ablation (EVLA)

Here Laser is used instead of RF waves to bring about the ablation of veins.This is considered to be superior to RFA but is only getting popularised slowly as there are only few centres currently practicing it.


Ulcer management: However if a patient with varicose veins has an ulcer,the primary treatment is aimed at healing of the ulcer-either conservatively with dressings or with cleansing and skin grafting of large and infected.The definitive management for varicose veins is later undertaken after the ulcer has healed completely.


However,it must be remembered that all the techniques currently employed for treatment of varicosities are not permanent and usually might require repeated interventions in the persistence of existing risk factors.


Kindly visit a Vascular Surgeon if you have varicose veins!


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