Varicose Veins – busting the myths

08 March 2019

Varicose veins – busting the myths

Varicose veins are seen as an ‘old age’ issue, with many associating the problem with leg ulcers and a sedentary lifestyle. However, by the age of 30, 44% of women and 19% of men in the UK have leg vein problems. By the time people reach their late fifties, 54% of women and 42% of men have some degree of varicose vein problem, with 28 million people in the UK affected by leg vein issues before reaching their fifties.[1]

Here at Spire Dunedin, varicose veins are treated by specialist consultant Professor Timothy Magee, who has been treating the condition for over 20 years. We asked him to discuss some of the myths around the condition:

Why do I have varicose veins?

People normally become aware of varicose veins when they experience discomfort or heavy legs, or as the weather changes and the temperatures rise, they start to think of uncovering their legs. Varicose veins are superficial veins which have become enlarged as a result of the blood flow being slowed and sometimes stopped as a result of valves becoming defective or damaged. The valves allow blood to flow in one direction, as part of the venous system, delivering blood back to the heart and lungs. If the valves fail, the veins swell and bulge because the blood remains static and under pressure. As these are surface veins they become obvious through the skin with a green or blue tinge and/or a raised lumpy appearance. Deeper veins in the core of the leg are less likely to suffer from valve failure.

The condition, unfortunately, can be hereditary but some jobs can also aggravate varicose veins, particularly those which involve standing for a long time.

The majority of people with moderate varicose or spider veins do not suffer from constant pain. However, for those who regularly encounter issues with their legs feeling itchy, tired, heavy, cramped or restless, vein treatment is ideal.

Removing veins doesn’t seem healthy – is it necessary?

About 10% of people with varicose veins go on to develop skin changes such as pigmentation or eczema, while about 3% may develop venous ulcers. [2] The tension caused by the blood entrapment can cause dry and flaking skin in some, while others experience hard, leathery and red skin. If the skin is severely damaged it can lead to a breakdown in the surface of the skin, resulting in an ulcer - which are slow to heal. If the varicose veins had been treated beforehand, it is unlikely that an ulcer would have occurred.

Varicose vein treatment is for people in their 80s – why do I need it?

Unfortunately, varicose veins do not go away or get better on their own. There is a risk of permanent changes to the skin and ulcers in the future, if they’re left untreated - particularly if you have a genetic predisposition to them.

You should get your veins treated for what you have, rather than what might develop. Some people have very marked varicose veins that do not cause them pain, but do not like the look of their legs and undergo treatment for cosmetic reasons. For whatever reason you decide to investigate treatment, the length of time you have had varicose veins for does not mean that they have become untreatable. Some people have extensive varicose veins but their skin is largely unaffected and they do not have ulcers. Others may have minor varicose veins but their skin is damaged with ulcers. It’s unclear why damage to the skin happens more to some people and not to others.

How long will it take to heal?

After treatment to remove varicose veins, the procedures Professor Magee performs allow you to be able to leave hospital on the same day. When you're ready to be discharged, you will leave with your leg bandaged. Over the next 48 hours the local anaesthetic used during the procedure will wear off. You may feel achy and bruising may appear, with small lumps and bumps caused by deeper bruising - seen and felt as well. This bruising will be visible for about a week.

When the bandages are removed after 24 hours, it is important that the long support stocking (thigh length) is worn for the next week to 10 days. This helps to give support to the bruised leg and gently compresses it, easing any tenderness and bruising over time.

As you feel more comfortable, you can start to do more active activities. There may be some swelling or aching as a result of reintroducing activity but this will not damage the results of the operation.

As you feel more comfortable, you can start to do more active activities. If you overdo it, the worst that will happen is your leg will ache, hurt or swell, but you will not do any damage to the operation. Over time the bruising and any visible incisions in the skin will disappear.

Within one to two weeks you can expect to be back to most normal activities. You do not have to stay in bed following the procedure and you will be encouraged to get out and about when you feel up to it. Note that if your job is physical you will need to set aside two to three weeks for recovery.

To get back to sport, recovery may take between three to four weeks. Sport and exercise is in general a good thing, as it gets the blood pumping much faster. However, you should not fly for four weeks after the operation as there is a slight increased risk of deep vein thrombosis.

Will they come back?

There is a misconception that varicose veins return, which is probably due to historical methods used in treatments. Modern procedures to remove varicose veins are extremely effective resulting in recurrence being low.

This is why Professor Magee recommends an ultrasound as part of the preliminary examination as this will pick up the underlying causes of the swollen veins. If the feeding veins can be found and treated, this reduces the risk of recurrence. It would require new vein issues and new valve failures for the problem to occur again.

What are the treatment options?

There are several treatment options available at Spire Dunedin Hospital for varicose veins:

Option one: Endovenous Laser and removal of varicose veins

The operation is usually a day case procedure, meaning you leave hospital on the same day as your treatment, though this is dependent on whether one or both legs are operated on at the same time. It involves a laser catheter and small 3 mm incisions in the skin, which allow Professor Magee to remove the varicose veins entirely and seal the underlying feeding veins. The latter prevents recurrence in the future.

The procedure involves passing a catheter into the feeding vein to heat and seal the vein. Known as Endovenous Laser Ablation (EVLA) it involves a tiny laser inside a catheter inserted into the affected vein emitting energy to heat and seal the vein. Hook phlebectomy or microphlebectomy is also carried out at the same time and involves a hook-shaped instrument which is used to remove the affected veins through 3 mm incisions.

This type of surgery has an extremely high success rate. While the risk of recurrence is not zero, it is minimal and while all surgery carries an element of risk, varicose veins removal surgery is considered to be a safe procedure. It will be completed under local or general anaesthetic. Prospective patients should be aware of a 0.5% risk rate of infection, bleeding, or thrombosis.

Option two: Endovenous Laser only

A second type of treatment is where the feeding veins are sealed but the actual varicose veins themselves are not removed, remaining in the leg after treatment. This takes the pressure off the affected veins, but they're still visible afterwards.

Option three: Foam Sclerotherapy

Ultrasound-guided foam sclerotherapy (USGFS) is a third treatment option and involves the injection of a special foam into the affected vein, which blocks it. The varicose veins are not removed, meaning there is a higher risk of recurrence in the future. The drawback with this procedure is that it can cause staining of the skin which can be permanent.

Will I need follow-up appointments after treatment?

You will have a follow-up appointment a few weeks after surgery, to make sure your recovery is progressing and to answer any questions you may have.

Book a private consultation with Professor Magee

Would you like to find out more? Professor Magee offers 10-minute mini consultations completely free of charge.

This is a chance to ask any questions you have and decide if you would like a full consultation, where your past medical history and previous treatments will be discussed, while a detailed assessment of your varicose veins will be carried out.

A full private consultation will last for around 20 minutes and if you are using your private health insurance a GP referral letter will be required. For self-funding patients a letter from your GP is not required.

It is recommended patients have an ultrasound scan before treatment. This can be carried out at Spire Dunedin Hospital after the first full consultation and is used to accurately assess the underlying causes of varicose veins. After the scan you will leave with a diagnosis, a treatment plan and recovery times. All costs will be confirmed with you in advance.

Note that surgery is only one potential outcome from the consultation. The best treatment options will be discussed with no pressure to book immediately. If you do decide to proceed with your treatment privately you will be passed to the appointments team to find a time convenient to you.

 

[1] Evans CJ, Fowkes FGR, Ruckley CV, Lee AJ. Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study. J Epidemiol Community Health 1999;53:149-53.

[2] Bergan JJ, Schmid-Schönbein GW, Coleridge Smith PD, Nicolaides AN, Boisseau MR, Eklof B. Chronic venous disease. N Engl J Med 2006;355:488-98.

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