Varicose veins

Varicose veins Varicose veins

Varicose veins are common and usually not a medically serious condition. They are much more frequent in females as a result of the demands of pregnancy. They are usually a result of valves not working properly, thus allowing blood to flow DOWN the leg instead of only upwards towards the heart. This occurs in the superficial veins and the important deep veins in the leg are usually normal. Commonly there are no symptoms, but veins can cause a heavy ache, itching, night cramps and a feeling of heat. The cosmetic appearance is the major cause of concern to patients.

Investigations

The main test is an ultrasound, which will prove whether the valves are working or not. The usual valves are in the groin or behind the knee, and the deep veins of the leg are also examined.

Treatment

In many cases no treatment is required as the veins are not harmful unless they have an associated complication such as bleeding, thrombosis(clot), eczema(rash) or ulceration. In the absence of these, the only indication for treatment is if the veins cause symptoms sufficient to warrant it, or if the cosmetic appearance is unacceptable. The treatment can take the form of support stockings, injection sclerotherapy or surgery. Newer techniques of treatment not requiring surgery are currently under investigation.

Surgery is performed as a day stay procedure in the majority of cases, and involves a groin incision, stripping of the main superficial leaking vein in the thigh or calf, and removing the visible varicose veins through tiny cuts. The operation takes about 1 hour and bandages are worn for 4 days. The groin incision is closed with an absorbable suture which does not need to be removed.

Complications of surgery are uncommon. The most serious one is deep vein thrombosis which can very rarely result in death if this clot travels to the lungs. This risk can be reduced to a minimum by early exercise (from day one), and a blood thinning injection (Heparin) is given prior to surgery. Other complications are
a) Nerve damage from removing the visible veins through tiny incisions, and areas of numbness around these cuts can occur. This is the most symptomatic complication that patients can suffer. Most of these areas recover feeling within a few months. Occasionally a major skin nerve is damaged by the stripping procedure, and this can produce numbness along the inner shin and foot with a groin procedure, or numbness on the outside of the foot with a stripping of the vein behind the knee.
b) Infection of the groin incision. This is not usually serious and may require opening a portion of the wound to allow drainage. It is also uncommon. Some people react to the dissolving stitch placed in the groin incision, and this can result in a red wound with a small amount of discharge. This can take up to 6 weeks to settle but is an inflammation and not an infection.
c) Swelling of the ankle can occur in a few people after stripping. This will usually subside after a few weeks, but in patients who have previously unsuspected lymphoedema, it can be permanent.
d) Bruising is invariable after surgery but settles in a fortnight.
e) Spider veins can occur around areas of vein removal. This is uncommon and unexplained.
f) Occasionally a clear fluid (lymph) can leak out of one of the tiny leg incisions. This is due to damage to a tiny lymphatic vessel which runs next to a vein, and settles down after some days.

It should be realized that recurrence of varicose veins after surgery has been reported in about 20% of patients. This can occur years later and is due to regrowth of connections to the deep vein in the groin in most instances. However most patients are satisfied with the results of surgery.

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