What are varicose veins?
Varicose veins are dilated, tortuous veins, most common on the legs which arise as a result of dysfunction of the valves in the veins. Once they arise, the veins will only continue to enlarge with time.
Do varicose veins cause pain?
The symptoms associated with varicose veins are variable. Many have no pain at all, but are concerned by the appearance of the unsightly veins.
It is common to experience of feeling of discomfort or heaviness in the legs with prolonged standing. Others describe a feeling of heat, or prickling sensation.
Can complications occur?
Thrombo-phlebitis. Because there are competing flows and through relatively dilated veins, there is a possibility of a thrombosis of clot forming in a varicose vein. This presents as a painful, tender lump, which may take several weeks to settle. Unlike a deep vein thrombosis (DVT), this thrombosis is not life-threatening.
Bleeding. From a varicose vein is rare but can occur.
Venous pigmentation and lipodermatosclerosis. Some patients develop changes in the skin and soft tissues in the lower part of the leg which reflects high pressure in the venous system. The skin may appear more pigmented, most typically on the inside of the calf, and the leg feels firmer than usual. Occasionally this can cause severe pain.
Leg ulceration. When this occurs, there is a risk of ulceration of the skin.
Do I require any special investigations?
Most patients will require a duplex (ultrasound) scan of the veins of the legs, to determine exactly where the valves are faulty, and importantly help determine how to best manage the varicose veins.
Do my veins need treatment?
For most patients with varicose veins, the need for treatment generally depends on the extent to which the veins are worrying the patient. For those with no sign of impending complications and no symptoms, treatment is not necessary.
However, if the veins are unsightly, cause embarrassment or discomfort, it is reasonable to proceed with treatment.
What treatment is available?
There are several treatment options, the choice depends on the scan findings and patient preference.
Surgical treatment still has an important role in managing patients with varicose veins. This involves an admission to hospital for an overnight stay, and is performed almost always under general anaesthesia.
Endovenous Laser treatment (EVLT) is a relatively new modality of treatment and is a suitable option for many patients. This has the advantage that it can be done under local anaesthesia, with less downtime and a quicker recovery. For some patients, it needs to be combined with sclerotherapy (injecting veins), either at the time or several weeks after EVLT.
Sclerotherapy (injecting veins) alone is a suitable option for some patients.
Will my veins come back?
For all modalities of treatment, there is a chance that other varicose veins may re-emerge. Approximately 10-15% will require further treatment in due course.