How to Treat Varicose Veins

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Varicose veins have been around for a long time but why should you be concerned?

Apart from your legs looking like they have green or purple worms on them, there is more about varicose veins that you should worry yourself about. It’s not about just looks after all.

What are varicose veins? 

Varicose veins are caused by venous reflux or chronic venous insufficiency. In the legs, this venous reflux can either be superficial or deep. Varicose veins usually involve the superficial veins of the legs like the saphenous vein. 

When we talk about varicose veins, imagine these veins having valves. These valves when normal have adequate venous pressure which regulates the function of these valves.

When the valves are not functioning or are weak, this is the time when the symptoms start and you may see varicose veins. According to a varicose veins clinic located in Dallas, these symptoms can range from having swelling, visible veins on the surface (which we commonly see), to experiencing pain, heaviness, skin discoloration, and even possible ulcer formation in the area.

Varicose veins are more common in females than in males and early stages of venous reflux are seen in as many as 25% of women and 15% of men. Being a woman is a risk factor for venous insufficiency. Other risk factors include obesity, increased age, multiple pregnancies, history of deep vein thrombosis, and a family history of venous insufficiency.

Evaluation of venous insufficiency is done based on the symptoms that you have experienced and a clinical evaluation by your doctor. Most of the time, a colored duplex venous ultrasound may be done. This is a quick and painless procedure that will help assess your veins and the functions of your valves. Serious problems like a deep vein thrombosis or an obstruction are also evaluated by the colored duplex venous ultrasound.

Having varicose veins is not the end of the world because thanks to the numerous researches and clinical data done on these series of diseases, there are effective ways to manage varicose veins.

The Conservative treatment of varicose veins is done through the use of graduated compression stockings. Now, these are not your ordinary stockings since these stockings are medical grade and compress at a rate of 20- 30 mmHg or 30- 40 mmHg for those with severe cases. These stockings are worn daily and are recommended for patients who do not want to undergo surgery or other procedures to help with the varicosities and pain management. These graduated compression stockings have been proven to work but compliance of patients is usually affected because of the heat and discomfort that may come from wearing them for too long.

Traditional surgery of varicose veins involves the ligation (closing off) or stripping (removal) of the veins involved. This procedure is usually done on an outpatient basis and can be from 60 to 90 minutes. This surgery is usually successful in 80 out of 100 patients. 

In the United States, surgery of varicose veins is less common and has been replaced by catheter-based endovenous thermal ablation (EVTL) or endovenous laser ablation (EVLA). The procedure is done with a laser or a radiofrequency which works as the supply of heat energy. This procedure is less painful than surgery and is done with a local anesthetic. It is frequently performed with an ultrasound to help guide the catheter into the vein that will cauterize the area. With this procedure, the source of the reflux is removed. There’s no need to worry because the veins have a lot of other tributaries or branches where the venous blood can pass through and circulate.

Studies have reported that EVLA is more effective than surgery in preventing the 5-year recurrence of varicose veins in the great saphenous. 

Sclerotherapy is the treatment of choice for smaller varicose veins. Recently, foam sclerotherapy has also been used and is more superior to sclerotherapy using liquid sclerosant alone. Studies report a high immediate success rate for foam sclerotherapy and have low cost with very few complications.  The most common sclerosant used is sodium tetradecyl sulfate, polidocanol, a mixture of glycerine lidocaine and epinephrine, or hypertonic saline.

Transilluminated Powered Phlebectomy uses a transilluminator that is introduced to the skin through an incision. It will then be passed into the area of varicosity and once it is turned on, the vein is sucked in and removed by this suction. This procedure is as effective as the conventional removal of varicosities with less pain and smaller incisions but its use is still not widespread. 

Choosing the perfect treatment plan for your varicose veins will always differ from one person to another since a lot of consideration is made when assessing patients. When setting up an appointment with your doctor, you must prepare the questions that you may want to ask. It is also helpful to have a list of medications that you take as maintenance, a list of previous procedures or operations (be it related or not to your varicosities), and your other health concerns or problems.

Rest assured that there will always be a treatment that will help and fit your needs!