Varicose Vein

What are varicose veins?
Varicose veins are dilated tortuous superficial veins occurring usually in the lower limb. They are common and run in families and tend to affect women more than men.

What causes varicose veins?
Varicose veins are causes by the development of faulty valves in the veins of the leg. In health there are two vein systems in the lower limb: deep and superficial.

The deep veins run alongside the arteries between the muscles and bones. Muscular activity compresses the deep veins driving blood up into the heart (the so called muscle pump). Reflux is prevented by competent valves ensuring blood flows upwards towards the heart.

The superficial veins are just beneath the skin.. There are two main superficial veins, the long and short saphenous veins which drain into the deep system through valves in the groin, behind the knee and at various other so-called perforator sites. Valves in the veins and at the junctions ensure that blood flows in the correct direction back towards the heart.

The commonest cause of varicose veins is the development of incompetence of the valves at the groin or behind the knee. These are called the saphenofemoral and popliteal junctions. This allows blood to reflux from the deep system into the superficial system causing dilatation and tortuousity of the veins under the skin, hence the development of varicose veins.

Clinical features of varicose veins
Characteristic discomfort due to varicose veins is an aching sensation exacerbated by standing for long periods and eased by elevating the leg. This may be associated with swelling of the leg. Varicose veins may be painless but cause considerable distress due to their appearance. Chronic high pressure in the veins causes skin changes including thread veins and brown pigmentation (lipodermatosclerosis). If left untreated, the condition may progress to severe skin changes and ulceration of the leg around the ankle.



How are varicose veins assessed?
Varicose veins are usually obvious to the naked eye. However, as described above, the visible veins are a result of faulty valves elsewhere in the leg. Treating the visible veins without addressing the underlying defective valves would produce a bad result; the problem would simply recur in another part of the leg. By contrast, if all the damaged valves are treated, the varicose veins can be very effectively removed with a very low likelihood of recurrence in the future.

The best test to investigate varicose veins is a doppler-ultrasound (duplex) scan. This is a painless test done by passing an ultrasound probe over the surface of the skin lubricated by jelly. The veins under the skin can be visualised and the direction of blood flow through the valves recorded. A detailed picture of the anatomy and function of all the main veins in the leg is established and helps determine which of the methods of vein treatment is best suited to each individual case

Treatment of Varicose Veins
Conventional treatment of varicose veins involved surgical removal of the defective veins under general anaesthetic. Significant post-op pain and bruising were commonly seen and for this reason we do not use this technique.

The underlying damaged veins causing varicose veins can be treated by new endovenous (pin-hole) methods. The main techniques used is endovenous laser therapy (EVLT) which is described in detail in the Treatments, Techniques and Services section of the website.

This method can be performed under local anaesthetic with return to normal activities within 24 hours without the need for lots of pain killers or time off work.

If a patient chooses therapy under local anaesthetic, the treatment is usually spread over two or more sessions spread a week or so apart. If a general anaesthetic is preferred, the whole problem can be treated in one procedure. Please see the Treatments, Techniques and Services section of the website for details of laser treatment of varicose veins, and a video of the vascular procedure.