Varicose veins, also called varicoses, are superficial vessels that are enlarged and twisted in appearance. Normally, veins carry the blood from the feet up to the heart but varicoses disturb normal blood flow, causing blood stasis and swelling. That is why varicose veins not only look aesthetically unpleasing but also come with a number of health concerns, including swelling, chronic pain, and soreness in the legs.
There are a few types of varicose veins: spider veins, reticular varicose veins, and saphenous varicose veins. Spider veins are thin strikes of red, green, or purple, that spread in a web-like pattern and can be found anywhere in the body. Reticular varicose veins appear in blue, red, or green tones and spread like a mesh, covering a wide area of the skin. Saphenous varicose veins are the ones that tend to swell and bulge out from the skin. They look extremely unsightly and cause a lot of discomforts.
Varicosities are diagnosed during a physical examination and a Doppler ultrasound test. Doppler ultrasound measures vascular flow and detects abnormal blood flow patterns. The test takes about 20-30 minutes and is completely painless.
Varicose veins present with a number of common symptoms that include aching, heavy legs, swelling of the feet and ankles, burning sensations, muscle cramps, and dry skin over the affected veins. In severe cases of varicose veins, enlarged and twisted veins lead to the formation of extremely painful sores.
First choice treatment options are lifestyle changes, compression stockings, and sclerotherapy. Patients are recommended to quit tobacco, try to lose excess weight, and keep their feet elevated to reduce swelling. Compression stockings encourage circulation by applying pressure to the legs, ankles, and feet. Sclerotherapy involves injecting a special solution that diminishes the appearance and effectively treats spider veins, reticular varicose, and subcutaneous varicose veins.
If conservative measures are ineffective, patients can choose surgical varicose vein treatment. There are two types of varicose vein surgeries: those that close the veins and those that remove them. The former category includes endovenous laser ablation therapy (EVLA) which is one of the most popular procedures for varicoses. Removal of the veins can be performed through ambulatory phlebectomy or vein stripping and ligation. The right procedure is chosen based on several things, like age, the extent of the symptoms, and desired goals.
A good candidate for varicose vein treatment is someone with persistent pain caused by varicose veins despite non-surgical treatment methods, like losing weight, exercising, and wearing compression stockings. Good candidates are between 30 and 60 years of age and have generally good health. However, surgical varicose vein treatment cannot be performed on women who are pregnant or breastfeeding.
Before surgery, patients should follow a healthy diet and maintain an active lifestyle. The first step in the preparation for the surgery is a consultation with a surgeon. The surgeon evaluates the candidate’s health condition and assesses the type of varicose veins, past medical records, and any underlying vascular diseases. The surgeon also reviews any current medications that the patient takes. As part of a physical evaluation, the surgeon performs a Doppler ultrasound imaging test which provides more information on the nature of the vein condition.
On the day of the surgery, a patient should arrive with loose-fitting clothes and without jewellery, piercings, or contact lenses. It is necessary to refrain from food and drinks for at least 8 hours until surgery.
The most popular surgery for varicose veins is endovenous laser ablation (EVLA). The surgery takes about 20-30 min. per leg under local anaesthesia. A surgeon inserts a laser fibre so its tip lies at the highest point (most often in the groin crease). The laser is then turned on and pulled down the vein over about 5 minutes. The laser light causes the vein to contract and close. Previously stagnant venous blood can now flow into normal veins and continue to be carried to the heart. Once the surgery is over, the doctor covers the needle puncture with a small dressing and puts on a compression stocking.
Even though serious complications are very rare, patients should be informed about the possible risks of infection, bleeding, scarring, allergic reaction to medications, temporary numbness of the skin, thermal injury (burn), a clot in a deep vein, and others.
Patients can get back to work and get on with most activities right after the surgery. Varicose vein surgery is a permanent solution, however, it cannot prevent new veins from occurring in the future. This is why patients should take preventative measures, like losing extra weight, taking up exercise, and wearing compression stockings.
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