Varicose veins are enlarged and tortuous veins, most commonly in leg but may be found elsewhere. There are two, superficial and deep, venous systems in our leg. The blood from the superficial veins is drained into the deep veins by network of one way valves. Deep veins are high pressure system being with in muscles, which pump thee blood heart wards. Varicose veins have a strong female preponderance. Due to malfunctioning of these valves, blood from the high pressure deep venous system is being pumped into the superficial system, resulting in dilated and tortuous superficial veins called varicose veins.
Causes of Varicos Veins
- Absence of valves from birth
- Thrombophlebitis – inflammation of the veins
- Occupation that require long hours of standing such as conductors
- Increasing age, menopause, genetic weaknesses in the vein walls or in their valves, excessive pressure within the veins due to a low fiber diet which causes an increase in straining during bowel movements, and damage to the veins or to their valves resulting from inflammation also increase the risk of developing varicose veins.
Common symptoms are fullness, heaviness (often worse at night and after exercise), aching, and sometimes pain in the legs, visible, enlarged spider like veins, mild swelling of ankles, bluish brown shiny discoloration of the skin at the ankles, skin ulcers near the ankle (this is more often seen in severe cases). Whitened, irregular scar-like patches can appear at the ankles.
Clinical examinations and tests are the cornerstone of diagnosis. Investigations aid in the diagnosis and management of varicose veins are Doppler, Duplex scans and at time venography.
How to manage Vericos Veins?
Management of varicose vein involves:
a. Conservative treatment
Elevating the legs often provides temporary symptomatic relief. The wearing of graduated compression stockings has been shown to correct the swelling, and improve the microcirculation in legs affected by varicose veins. They also often provide relief from the discomfort associated with this disease. Anti-inflammatory medication such as aspirin can be used as part of treatment for superficial thrombophlebitis along with graduated compression stockings. In extensive superficial thrombophlebitis, consideration should be given to anti-coagulation, thrombectomy (removal of thrombus) or sclerotherapy of the involved vein.
b. Interventional treatment
1. Surgical Interventional Treatment
- Stripping: consists of removal of all or part the saphenous vein main trunk
- CHIVA: It generally consists in 1 to 4 small incisions under local anesthesia in order to disconnect the varicose veins from the abnormal flow due to valvular incompetence which dilates them. The patient is dismissed the same day. This method leads to an improvement of the venous function
2. Non-Surgical Interventional Treatment
- Ambulatory phlebectomy
- Vein ligation: ligation of the vein with defective valves
- Sclerotherapy: medicine is injected into the veins to make them shrink.
- Endovenous thermal ablation