Veins under attack

Varicose veins are abnormally swollen (dilated) veins that are visible just below the surface of the skin. These are visible due to a fault in the one-way flow inside the veins. These valves normally only allow the blood to flow up the leg towards the heart.

If the valves leak, then blood can flow back the wrong way while standing up. This reverse flow causes increased pressure on the veins, which in turn, swell up.

Approximately 20 per cent of men and 35 per cent of women have this condition. Varicose veins can form anywhere in the body, but are most often located in the legs. Varicose veins also tend to be genetic, and become more prominent as the person ages.

They are very common and often give away no symptoms at all, although they look unsightly. Ache in the leg is common, especially after a day of standing, and ankle swelling (oedema) may occur.

Occasionally, severe cases of varicose veins can damage the skin of the leg above the ankle, causing itchiness and discolouration (eczema).Without treatment these skin changes can progress and a varicose leg ulcer may eventually occur. Sometimes one of the veins turn red and tender (phlebitis). Varicose veins are easy to diagnose with an ultrasound (doppler scan). Rarely does one need a CT scan,  MRI scan or venogram.

Conservative treatment options are self care at home, injections (liquid sclerotherapy), ablations (laser or RF) and surgery. Now a simpler technique can effectively treat varicose veins without surgery and this is called ‘ultrasound guided foam sclerotherapy’. It is performed as an outpatient procedure with no hospitalisation.

Sclerotherapy works by injecting a chemical into the veins which causes them to collapse and fibrose. The use of ultrasound enables the vein to be viewed so that the sclerosant can be injected into the vein under direct vision. It also ensures the sclerosant is injected directly into the vein.

Different strengths of sclerosant are used for different-sized veins. Ultrasound guided foam sclerotherapy can treat obvious varicose veins as well as incompetent long and short saphenous veins causing underlying problems.

With this technique, usually one leg is treated per session and if both legs are affected, treatment to the other leg is given a couple of weeks later. Its effectiveness is checked 3-4 weeks later. Some bruising can occur and lump formation can sometimes be felt underneath the skin after the treatment but will settle down over time. Walking is encouraged and one can return to work, but it is best to avoid vigorous exercise for two weeks. As with surgery or any other varicose vein treatment, there is a very small risk of deep vein thrombosis (DVT) occurring, although this is very rare.

Way to prevent varicose veins

Elevate the legs as much as possible. Wear compression stockings. The key is to put them on in the morning before walking around and before the veins become more swollen. If the person is overweight, try to shed the extra kilos.

Avoid alcohol, which can cause the veins in the legs to dilate. See a healthcare professional if the person has problems such as chronic constipation, urinary retention or chronic cough. Avoid wearing tight clothing such as girdles or belts.

Do not cross your legs when sitting. Walking is a good exercise as it can help the muscles to force the blood out of the deeper vein system. If the person is driving on a trip, travelling by air for a long period of time or working at a desk all day, try to get up and walk around every hour or so to allow the muscles to pump the blood out of the vein.

(The writer is a consultant interventional radiologist at BGS Global Hospitals.)