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Advice to patients about varicose veins

  1. What are Varicose Veins? Varicose veins are abnormally swollen veins visible just below the surface of the skin. Smaller veins in the skin itself are sometimes called ‘thread veins” or “spider veins”. Although these may be unsightly they are not the same as varicose veins.
  2. What causes Varicose Veins? Varicose veins are due to a fault in the one-way valves in the veins which normally only allow blood to flow up the leg towards the heart. If the valves leak, then blood flows back the wrong way towards the feet on standing due to gravity. This reverse flow causes increased pressure on the veins which swell and become varicose. Varicose veins often run in families and are more likely to occur as you get older, they also occur in pregnancy or obesity which increase pressure on the leg veins.
  3. What trouble do they cause? Varicose veins are very common and most often give no symptoms at all though they may look unsightly. However, aching in the leg is common, especially after periods of standing   and ankle swelling or a rash (eczema) may also occur. In some patients, complications due to the varicose veins may occur. Severe varicose veins may damage the skin of the leg above the ankle causing itchiness and discolouration. Without treatment   an ulcer may eventually occur. Sometimes one of the veins can become red and tender ; this inflammation is called “phlebitis”. There is a small risk of a blood clot in the main leg veins , or “deep vein thrombosis”(DVT)
  4. What tests are required? In most cases a simple examination plus a painless test with an ultrasound machine is all that is needed to enable your specialist to decide what needs to be done. Occasionally, a more detailed scan x-ray will be needed before advice about treatment can be given. This is especially likely if your varicose veins have returned following previous treatment, if you have already developed an ulcer or after a previous DVT.
  5. Do I need treatment? Treatment for uncomplicated varicose veins is rarely essential since serious complications are uncommon. Usually the choice   is yours. If your specialist thinks you should have treatment, then you will be informed of this at your consultation. Many patients have varicose veins for the whole of their adult life and never suffer any problems with them.
  6. What treatment is available? Apart from elevating your legs whenever possible, avoiding standing still and using alternative medicines( such as Horse Chestnut extract) there are three types of medical treatment, of which more than one may be needed;
    Support stockings: may be all that is required if aching or swelling are the main problems. Properly fitted medium-weight Class II compression stockings usually work best, either below knee or full leg.
    Injections (Sclerotherapy): a small amount of a special chemical (sclerosant) is injected into each vein and the leg bandaged firmly for a few weeks. The vein becomes inflamed, then shrivels up and eventually becomes less visible. This treatment can also be used for cosmetic treatment of thread veins.
    Operation: more severe varicose veins may require surgery. These veins are removed (avulsed) through a number of small (around 5mm) cuts along their course and the leaky valves are tied off at the groin or knee. The main thigh or calf vein is also removed         ( stripped) to reduce the risk of varicose veins returning. More detailed information about these procedures is available by asking your specialist.
  7. How good is the treatment? No treatment can completely remove every visible varicose vein. Nor is there any such thing as an “invisible mend”- injections may cause some skin staining (small brownish patches) and surgery leaves some small scars. New varicose veins and thread veins often appear even after satisfactory treatment. However, it may be many years before they return.
  8. How can I help myself? Avoid being overweight and wear support stockings if you have to stand up a lot of the time;  elevating  your legs and regular exercise also helps. Dry, itchy skin can often be helped by bland moisturizing (emollient) creams or bath additives available at the chemist or supermarket.
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