What are they?
Veins are blood vessels that function to return blood to the heart. Veins contain one way valves and when there is obstruction of veins, or when prolonged pressure is placed on the veins, the valves stretch and no longer close properly. The veins in the legs that are close to the surface of the skin enlarge and result in what is commonly called varicose veins.
Pain in the legs is frequently related to varicose veins. Symptoms include feelings of fatigue, heaviness, aching, burning, throbbing, itching and cramps. These symptoms may be accompanied by swelling, which often appears after long hours of standing.
How are they caused?
Heredity is important in the development of varicose and spider veins. Women are approximately twice as likely to suffer from varicose veins than men. Up to 20% of the adult population have varicose veins and experience discomfort as a result.
Environmental factors also play a large part in the development of varicosities, for example, prolonged standing – especially for workers such as nurses, sales assistants, flight attendants, waitresses and teachers, for example. Varicose veins may also become more frequent with advancing age, but may appear at any time of life and small varices are sometimes seen in school children.
Although all factors such as puberty, pregnancy and the menopause also influence the course of the disease. As many as 70 – 80% of pregnant women develop varicose veins during the first trimester. Pregnancy causes an increase in hormone levels and blood volume which in turn causes veins to enlarge. Later in pregnancy, the enlarge uterus causes increased pressure on the veins in the pelvis. Approximately 60 – 70% of varicose veins due to pregnancy will disappear within a few months of delivery.
How are varicose veins investigated?
A physical examination is useful in showing the extent of the varicose veins, but it is not always clear from where varicosities arise. This is especially true when varicose veins have recurred after a previous operation. Even experienced vascular surgeons find it difficult to decide exactly where the problem lies without the use of special investigations.
Colour duplex ultrasound imaging allows us to obtain pictures of the veins in the leg and find out at which point varices arise. The machine used is related to those used for scanning during pregnancy, but also can measure blood flow in the blood vessels. This allows the deep veins to be assessed as well as the varicose veins, allowing us to establish in which veins valves have become leaky.
Photoplethysmography and strain gauge plethysmography, blood flow measuring techniques, are also to measure the function of the veins in the leg. Using these tests doctors can find out whether the overall function of all veins in the leg is normal, or if there is a problem with the deep veins, or obstruction in any major vein.
All of these tests are called “non-invasive”, that is none of them involves any needles or injections and, in fact, none of these tests is painful!
Surgical treatment of varicose veins
The results of the tests tell us exactly where the varicose veins are comming from. If this affects large veins on the surface of the leg then the most effective treatment is surgical removal of varicose veins. If the problem is simply spider veins or small varicose veins close to the surface of the skin, then the best treatment is injections (or “sclerotherapy”).
Surgery is usually performed under general anaesthesia and involves tying off the source of any veins in which the valves have failed through incisions 3-4cm in length. Where a large vein on the surface of the leg is affected, that vessel is removed by a technique known as “stripping”. To do this a special metal instrument is passed along the vein and then the entire length of the diseased vessel is pulled out.