Varicose veins are very common, affecting up to 15% of the community. They are more common in men (40% of men and 32% of women aged 18 - 64 years). They are usually only a cosmetic problem. However, some patients with severe varicose veins can get symptoms in the leg (swelling, aching, tenderness, itching, heavy legs, fatigue of the legs), changes in the skin near the ankle (eczema or lipodermatosclerosis) or even an ulcer. Risk factors for developing varicose veins include increasing age, family history, obesity and occupation involving lots of standing.
If the varicose veins do not bother you and you do not mind how they look, no treatment is needed. Surgery for varicose veins does not prevent long term complications. Bleeding from varicose veins is very rare (they do not burst spontaneously). The bleeding will stop with direct firm pressure.
Varicose veins are due to an abnormality in the wall or the valves of the veins. Normal functioning vein valves prevent blood from flowing backwards in the veins. When the valves do not work properly, blood flows both forwards and backwards. The backward flow leads to increased pressure in the veins which then become dilated and tortuous (twisted).
If you have got varicose veins there are some things which you can do for yourself which might help:
Elevate your legs whenever possible.
Wear compression stockings.
It is very important to know that if you have varicose veins it is very unlikely that you can be completly cured of the problem. Treatment for varicose veins might prevent them from getting worse or reducing the risk of longer term complications. There are many ways to treat varicose veins including:
1. Compression stocking. These are good a relieving symptoms and preventing further deterioration in the skin. They are very safe but will not remove the varicose veins. Some patients find them too tight and uncomfortable and in the hot weather, they can make your leg very sweaty and itchy. Vascular Surgery of Tasmania recommends PQ Tasmania Healthcare Supplies for stockists of compression stockings. The can be found at 65 Albert Road, Moonah or contacted by telephone on 1300 741 234 or fax 03 6228 9800.
2. Injection sclerotherapy. A fluid or foam is injected into the veins to cause the vein to clot and disappear. This is performed under local anaesthetic and with the aid of ultrasound. If often requires multiple treatments to get a good result.
3. Traditional surgery. Usually under a general anaesthetic, this usually involves tying off the vein at the groin, stripping out the vein between the groin and the knee and then making a few small cuts to pull the rest of the veins out. Most patients go home the same day. This operation has been around for decades and for most patients does the job. However, some patients can have complications including bruising of the leg (which usually settles after a few weeks), infection in the groin wound (which may require antibiotic treatment), injury to a nerve (usually causes numbness on the inside of the calf or foot) and deep venous thrombosis. The most important problem is that the veins might come back again at some time in the future. This happens in up to 15% of patients following varicose veins surgery. Having the surgery done again is much more difficult and dangerous so patients need to be assessed carefully before undergoing redo varicose veins surgery.
4. Endovenous treatment. This involves passing a fine wire up the vein and heating the vein from the inside by either laser heat or microwave heat. This is done under local anaesthetic and is becoming the treatment of choice for varicose veins, especially in Europe and USA. Mr. Stuart Walker offers radiofrequency ablation (VNUS) to his patients as there have been some advantages reported over EVLT. If you are interested in this, ask your GP or medical specialist to refer you to Mr. Stuart Walker for a more detailed discussion.
For those who would like more information see the VV PDF. There is a lot of medical and surgical terminology in this document.