What ARE VARICOSE VEINS
The most common concern of patients with varicose veins are the lumps which appear on the blood vessels in the legs. The disease is not fatal, and generally doesn't affect the overall health of the patient. Varicose veins do not heal spontaneously, and therefore require medical attention for treatment.
As the disease progresses overtime, it's common for patients to feel uncomfortable showing the affected leg in public due to the numerous lumps appearing at the veins. Aside from appearances, the condition causes fatigue and swelling of the legs, and can become a chronic issue for patients.
As varicose veins become more severe, patients may find that darkening or discolouration of the skin occurs alongside the appearance of skin ulcers.
Varicose veins: Disease Mechanisms
A healthy vein has the function of transporting blood which has finished supplying nutrients and oxygen to the lower limbs back to the heart. The valves in the veins are shaped in a way to prevent the blood flowing in the opposite direction (due to gravity). In varicose veins this structure has degraded, which causes dirty blood to flow back into the limbs (vein reflux).
This blood is the main cause for lumps and clumps forming in blood vessels alongside fatigue in the legs due to the lack of oxygen and energy transportation. Without enough nutrients, the skin surrounding the varicose veins also undergo degradation, resulting in darkened skin tones or discolouring.
Causes of varicose veins
< Genetics >
Varicose veins have a strong relationship with the genetics of the patient. An individual with a single parent affected by varicose veins has a 50% chance of being exposed to the disease.
Research has shown that if both parents are affected the child has near 90% chance of having varicose veins in the future. These individuals start to have varicose veins from 30 to 40 years of age.
< Work with long standing hours >
Whilst standing, blood in the veins must flow directly opposite to the force of gravity. This places a large amount of stress on the valves in the blood vessels for a prolonged period of time, accelerating the degradation of the valves.
Individuals who stand for longer than 10 hours a day should be cautious as they are in severe risk of varicose veins. Typical professions include teachers, barbers, chefs and shopping assistants.
< Age >
Collagen and elastin which forms the outer parts of our body weakens as we age. The valves in our blood vessels are also made from these materials, which means they also weaken with age. We therefore see a correlation for the risks of varicose veins and the age of the patient.
< Pregnant women >
During pregnancy, blood vessels become fragile due to the change in hormone balance. Furthermore, the increased weight of the Pregnant women increases the risk of varicose veins indefinitely. Research data in the past has even shown that 50% of women who have experienced child birth has been affected by varicose veins.
To avoid unnecessary health risks our hospital does not treat varicose veins in Pregnant women until 6 months after the end of the pregnancy.
Other causes include obesity, constipation, etc. Varicose veins usually occur by the combination of multiple risk factors.
Variations of varicose veins and its treatments
2 main variations of varicose veins are known to us. One is the "Trunk" type, and the other is the "reticular" type. Trunk type comes in 2 further subgroups of large or small trunk varicose veins. Reticular varicose veins have a network patterned form and a spider shaped form.
The Large saphenous vein is found from the ankle to the inner thigh and is situated very closely to the skin surface. If this blood vessel is affected by the varicose vein condition, we see large lumps forming visibly through the skin. To prevent any damage to the surrounding tissue caused by vein reflux, the patient will need to undergo operation based treatment.
The small Saphenous vein begins from behind the calf to behind the knee. This vein is also located close to the skin surface, causing blood accumulated by vein reflux to surface as visible lumps. To prevent any damage to the surrounding tissue caused by vein reflux, the patient will need to undergo operation based treatment.
This varicose vein can be observed just beneath the skin as a shade of light blue, red or purple. Unlike the "trunk" types, these don't form a lump on the skin surface. Their symptoms are less severe and don't pose any permanent health problems.
If a patient wishes to remove them for aesthetic purposes, we can treat it with sclerotherapy. Regardless of this being a less severe condition, a professional examination should be conducted as there are cases where both trunk and reticular varicose veins occur simultaneously.
Due to an imbalance of hormones and increased body weight during pregnancy, we see varicose veins around the inner thighs.
Common symptoms include fatigue and pain in the lower limbs during menstruation. Several cases show that these symptoms disappear after child birth. We therefore only treat the condition if symptoms continue for longer than 6 months after the end of pregnancy.
Diagnosis of varicose veins
Until recently we used X-ray venography, a technique where we inject a contrast medium into the veins of the leg and observe its circulation. This method places a burden on the patient as the injection to the sole of the foot is extremely painful and the X-ray exposure may lead to health risks.
Currently hospitals prefer the usage of ultrasonic scans which examines the varicose veins directly through the skin surface using a non-toxic jelly medium. This method is completely safe and can be repeated multiple times on the patient. However, unlike X-ray venography, this method requires intense training for the medical practitioner to accurately diagnose the patient.
We have a vascular surgeon who specialises in varicose veins to be responsible for this diagnosis. The examination takes approximately 10 minutes and is absolutely painless.