25 May 2018
It’s a myth that you get varicose veins from crossing your legs for long periods – but they are more common in occupations where you are on your feet for long periods of time: retail staff and teachers do suffer more than most, says Mr Duncan Parry, Consultant Vascular Surgeon.
Varicose veins are a common problem affecting at least 20% of the UK’s adult population including both men and women. Blood routinely flows back up the leg and towards the heart with muscular contraction. When the valves inside the veins stop functioning blood can pass back down the leg causing stagnation, high pressure and progressive enlargement of the veins. Family history, obesity, pregnancy and occupations with prolonged standing may all predispose to the development of varicose veins.
Sometimes patches of small blue ‘thread’, ‘spider’ or ‘reticular’ veins may be the earliest signs of a significant underlying venous disorder. In the developing stages these are primarily a cosmetic problem. Thread veins can be an indication of underlying varicose veins, however, and occasionally cause symptoms of discomfort, itching and irritation. Alternatively the appearance of thread veins simply may be a local phenomenon due to the effect of ‘wear and tear’ or hormones (‘oestrogenic’ veins) on delicate skin. Whilst thread veins may be unsightly and embarrassing they aren’t routinely eligible for NHS treatment.
Over time, the abnormal veins may become varicose appearing swollen, blue or purple and tortuous. Varicose veins may cause ‘aching’ discomfort, itching or tiredness usually worse after standing or in bed at night. If ignored, the condition can deteriorate and the high pressure in the veins may cause leg swelling, skin pigmentation and ultimately leg ulcers in 3-5% of individuals. Occasionally, veins can burst causing bleeding, or become inflamed and clot off leading to the painful condition of phlebitis. Deep vein thrombosis is a rare complication from phlebitis that occurs if the clot spreads into the deep veins of the leg.
The treatment of the thread veins will not be successful unless treating any underlying varicose vein problem in the first instant. Therefore, a thorough venous assessment using ultrasound is necessary before initiating any local treatment for thread veins. If the main or ‘truncal’ veins are okay then a series of tiny injections known as micro-sclerotherapy are usually feasible in the outpatient department.
Likewise the modern treatment of varicose veins is dependent upon an accurate ultrasound assessment to highlight the precise source of the problem. Surgery is usually minimally invasive and performed as a day case frequently under local anaesthetic. Common treatments options include Radiofrequency Ablation (RFA) which involves the passage of a fine catheter up the inside of vein, which is then heated causing it to block off and the varicose veins to shrink or disappear. Clinical trials suggest that this is a very effective procedure with less discomfort afterwards when compared to laser treatment (‘EVLA’). Ultrasound guided foam sclerotherapy using Fibrovein® and micro-phlebectomies are other minimally invasive treatment options often used in combination with RFA.
The NHS will fund treating patients suffering skin damage, ulcers, phlebitis or bleeding from varicose veins. For those with whose veins are symptomatic (ie ‘ache’) then NHS referral is variable and frequently a trial of compression hosiery for at least 12 months is recommended in the first instant. It is important to treat varicose veins as early as possible, however, to prevent skin damage and allow for a more rapid recovery following surgery.
Mr Duncan Parry is a Consultant Vascular Surgeon with a special clinical areas of interest include varicose veins, peripheral arterial disease, carotid artery disease, abdominal aortic aneurysm (AAA), thoracic outlet syndrome, the diabetic foot, compartment syndrome, hyperhidrosis and lymphoedema.
The content of this article is provided for general information only, and should not be treated as a substitute for the professional medical advice of your doctor or other healthcare professional.