Varicose Veins

Veins carry deoxygenated blood from the tissues back to the heart. The flow in the veins is maintained by a series of valves which allow flow only towards the heart- one way traffic. When the valve gets damaged blood stagnates in the vein leading to varicose veins.

In varicose veins the veins are dilated, become long and coiled like a snake. It is common in those who stand for long hours like policemen, Waiters, salesmen and teachers.

It is more common in women and usually starts during pregnancy In many the varicosities regress after delivery but with recurrent pregnancies the vein remains permanently dilated.

Symptoms: Crampy pain more at night Itching, ulceration and eczema Spontaneous bleeding from the veins Rarely clotting or Deep vein thrombosis Heaviness in the legs more on standing. Pigmentation around the ankle and lower leg Swelling in the leg which reduces on elevating the leg

Investigations

Clinical Examination

Color Doppler study helps to determine which system of veins is affected. It helps to decide on the mode of treatment.

Treatment

Stagnation of blood can be prevented by Medical management

1. Graded compression stockings or Elastocrepe bandage. This should be worn from mid foot upto knee or mid thigh and should be worn during the day.
2. Intermittent elevation of the leg helps to empty the vein. One must lie down and elevate the leg to facilitate flow in the veins by gravity. .
3. Wound care if there is ulcer or eczema Majority of the patients will get good relief with these measures.. But all these can only prevent complication but cannot correct the varicose veins which require some form of intervention.

Injection Sclerotherapy
Some varicose veins can be managed by injecting irritant solution into the vein to block them Surgical Treatment.

1.Open surgery
2.Laser Ablation
3.Radiofrequency Ablation

Surgical treatment is needed if non operative measures fail to control or if there are complications. In open surgery the damaged veins are removed through small incisions. Recently less invasive procedures like Laser and RF ablation have become more popular and have shown good results. In cases of laser and RF Ablation no cuts are made. The laser or RF fibre is passed into the vein through a tiny needle hole and the veins are burnt by the heat generated. All the veins can not be removed or destroyed by surgical means. Even after surgery patient must wear compression stockings to get maximum benefit for 4-5 months.