Varicose veins

Varicose veins

Varicose veins is an abnormality conditions of veins. It mainly refers to abnormalities of the blood vessels in the legs which is commonly causes many patients to seek for medical treatment.

In the leg veins, blood is transported back to the heart under a pressure of about 20 mm Hg. The blood in the leg muscles goes into the deep veins. Blood from the skin and surrounding tissues flows through the veins. When there is an abnormality of the combination of veins at this location, it causes Blood flows down the superficial veins, causing the expansion of the peripheral veins called varicose veins.

Cause of varicose veins

•          Aging – this abnormality is found in 70% of elderly (with over 70 years old)

•          Some of your family have been exposed to this abnormality. The chance is as twice as high.

•          Found in female than male

•          During pregnancy, due to high level of hormones

•          The occupation who should stand still for a long time

•          Overwieght people

•          Food intake (12% more of incidents are found for the west country)

The mechanism, underlying the occurrence of varicose veins is unknown, but it is thought to be an abnormality of the venous walls or valves in the veins.

Manifestations of varicose veins

Many patients come to see the doctor as it show unattractive look.the superficial veins is about 3-15 millimeters in size. It usually starts in the calf without any symptoms. In more cases, there may feel pain, fatigue, or tired in the legs after standing for a long time. There are often more symptoms in the afternoon or evening. The patient feels good when lying down and raising their legs high. A very small varicose veins, spider web like is about 0-5 millimeters, with red or purple. For those that are 1-3 millimeters in size with a green line underneath the skin are considered as the early stage of varicose veins.

Some complications may come right after for long-lasting varicose veins e.g. an inflammation of the varicose veins themselves or sometimes clogged ( very rarely), heavy bleeding after an accident with large varicose veins under the thin skin which can cause large amounts of blood loss. This  can be easily cured by having the patient lie down with his legs elevated and covered with elastic cloth, which will help stop the bleeding. Lastly, wounds on the ankle is found to be only 5%.

Diagnosis

Many doctors conduct diagnosis by relying on the patient's physical examination history along with a radiological examination with Doppler Ultrasound or Duplex Ultrasound This can be helpful for the cases with suspected deep vein thrombosis, such as having a history of swollen legs or have a wound on the ankle or suspected congenital varicose veins, such as Klippel-Trenaunay syndrome.

Treatment

There are many ways to treat varicose veins such as using of medical stockings or bandage, intravascular injection or surgery. This  depends on the size of the varicose vein and the patient's symptoms. In most cases, early treatment can be done by instructing the patient to avoid standing or sitting for long period, maintain your body weight, and keep exercising by walking in order to increase the strength of the muscles around the calves, which will reduce the symptoms of varicose veins.

Appying medical stockings

Symptoms of varicose veins may be alleviated by the use of medical stockings or elastic bandages, resulting in an up-size of its length. The suitable type is the type that is worn below the knee at the size of bending about 20-30 mm Hg. The use of medical stockings or elastic bandages may be helpful in early stages of varicose veins but you cannot be prevented from the occurrence of or make varicose veins disappear

The most common problems with medical stockings or elastic bandages are forgetting to use them or being uncomfortable wearing them in hot weather. In addition, complications, especially patients with arterial disease were reports of ischemia of the legs requiring amputation. Therefore, we strongly recommend you to check the pulse at the ankle before use.

Intravascular injection to the artery viens

This method is suitable for varicose veins that are smaller than 3 millimeters, which are branches in the skin without showing abnormality of the valves in the veins. It is applied to the shallow part or use in cases where the surgery was done.  But there are still some small varicose veins left.

Indications for intravascular injection therapy

     • Very small varicose veins, about 0.5 mm.

     • Varicose veins between 1-3 mm.

     • Solitary varicose veins

     • varicose veins below the knee

Contraindications of intravascular injection therapy

     • Patient history with allergic reactions to injectable substances.

     • Varicose veins

     • Large varicose veins associated with deep vein problems.

     • Principle of intravascular injection is an injection of a substance that causes the veins to constrict into the varicose veins, which there are many types of substances that commonly used is called Hydroxpolyethoxidoxecaine (Aethoxysclerol), with a concentration ranging from 1-3%.

Complications from varicose vein injection

An uncommon, yet serious complication is an allergic reaction to the injected substance. In rare cases, it may only cause itching or a rash, but in severe cases it may cause shock to death.

In the case of non-intravascular injection, it may cause the skin to become darken or cause lesions on the skin. In addition, injecting large amounts of it can cause venous inflammation. However, the incidence of deep vein thrombosis (Deep Venous thrombosis) is very rare.

Surgery for varicose veins

         Indications for surgery are

          1. Patients with leg pain and abnormal valves in the veins

          2. Varicose veins that have complications such as bleeding or having inflammation of varicose veins

There are two types of surgical treatment that are currently available: conventional venous stripping and endovenous laser surgery.

Conventional venous stripping is a surgery that is commonly used in all patients with the above indications. This surgery will leave scars on the patients in the groin area and below the knee. However, this type of surgery is still the standard treatment for patients with varicose veins.

Endovenous laser surgery is a new way to treat varicose veins that is gaining popularity nowsaday because the laser is used to treat varicose veins without leaving any visible wounds after surgery. However, this type of surgery cannot be used to treat patients with very large or tortuous varicose veins. Moreover, the equipment used in the treatment is still expensive.