Varicose Veins & Their Treatment

What Are Varicose Veins?

Veins are vessels which drain blood from the peripheral parts of the body and channel it back to the heart. Varicose veins are enlarged, deformed, superficial veins in which blood flow is slowed, or even reversed, as compared to the normal venous circulation. Varicose disease results from stretching of the vein walls and malfunction of the valves that normally direct blood back to the heart. Spider veins or telangiectasia are tiny varicose veins.

How Are They Caused?

Aging and heredity are the largest contributing factors. Women are two to three times more likely to develop varicose veins than men. Hormonal changes produced by puberty, pregnancy, menopause, and sometimes by the use of birth control pills and estrogen, promote the development of varicose disease. Many pregnant women develop varicosities during the first trimester of pregnancy. Fortunately varicose veins due to pregnancy will often improve within a few months following delivery. Other predisposing factors include obesity, excessive heat, disorders of the lower limbs (such as flat feet) and prolonged standing – as in occupations such as sales, nursing, teaching, hairdressing, waitressing, etc… Uncommonly, varicose veins can result from an injury to the leg or a clot in the deep veins (deep vein thrombosis).

What are the Symptoms of Varicose Veins?

Varicose veins can cause pain, heaviness, swelling, aching, burning, tingling and itching. They often produce leg discomfort or restlessness at night. When severe, they can lead to rashes, ankle discolouration, phlebitis, bleeding, and leg ulcers. Varicose veins can also create a general feeling of fatigue. Their appearance may be cosmetically unappealing and result in lifestyle restrictions (like avoidance of shorts or bathing suits).

How Can Varicose Veins be Treated?

There are several methods of treatment:

1. Sclerotherapy

This involves the injection of special medications into varicose veins which cause irritation of their inner walls resulting in collapse and permanent closure of these veins. The majority of varicose veins can be treated by sclerotherapy. Varicosity of the two main superficial veins, called the great and small saphenous veins, can be treated with ultrasound guided sclerotherapy. Sclerotherapy is done in the doctor’s office and does not require loss of time from work or other activities. It does not entail anesthesia and there is no scarring. Modern lasers work well for facial veins but have inconsistent results for small leg veins. Experts agree that sclerotherapy remains the gold standard for leg vein treatment.

2. Endovenous Laser & Radiofrequency Closure

Endovenous laser and radiofrequency closure are relatively new techniques for treating the saphenous veins and large branch veins. Both these techniques involve destruction of the saphenous vein by heating it from the inside with an intravenous catheter. Endovenous laser treatment is available in a number of specialized centres in Canada and is very popular. It is proving to have a higher success rate and fewer complications than any other procedure for treating the saphenous veins. Radiofrequency closure is rarely used in Canada due the high cost of treatment.

3. Surgery
Ligation (tying off a vein) and stripping (removing a vein) can be used to treat varicosity of the two main superficial veins (called the great and small saphenous veins). Modern surgery requires only (two) small incisions on the leg. Extensive surgery resulting in multiple scars is no longer needed because new methods combine surgery with sclerotherapy. Surgery is done in hospital but frequently patients can be discharged the same day. In some cases  local or spinal anesthesia is an option. Follow-up sclerotherapy treatments can be started about four weeks after surgery.
Office outpatient surgery of varicose veins ie. ambulatory phlebectomy” is rarely practiced in most Canadian provinces since it is not well covered by provincial health insurance plans and thus is very expensive for patients.

4. Compression Stockings

Graduated compression stockings help the veins function properly and can significantly relieve pain and swelling, as well as reduce the formation of new varicosities.

Prevention

Exercise, weight control, medical compression stockings and yearly check-ups can retard the development of varicose veins.

 

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