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What is Venous Disease?

Varicose Veins - an unrecognized and poorly understood common problem

Varicose veins are a very common problem affecting millions of people around the world. It is twice more common in women than in men, sometimes affecting children as young as 14 yrs.

Normal function of leg veins

The function of the veins in the legs is to transport blood from the feet to the heart. This is aided by walking, movement of the ankle and the calf muscles. Once the blood is pushed up from the feet into the abdomen and then to the heart, reverse flow back to the legs is prevented by special valves, which work like check dams. These valves are present only in the legs and not in the abdomen.

Causes of varicose veins

At times these valves become weak and this leads to backward flow of blood into the calf and foot on standing or in activities that involve maintaining erect posture. Another very common reason for its development in women is pregnancy. The hormonal changes in pregnancy lead to a weakening of these vein valves, but often this returns to normal on completion of pregnancy and delivery. Due to the weakening of these valves at multiple levels, it leads to the development of unsightly veins at various places in the legs, eg. behind the knee, in the calf, around the ankle etc.

Problems with varicose veins

As a result of the backward flow of blood on standing for prolonged periods in individuals with weakened/ damaged valves, symptoms like pain, heaviness, tiredness, restlessness, swelling and visible veins of various sizes begin to appear. These symptoms often lead to irritability as these are not understood and expressed properly by the sufferer. The visible veins tend to be very tortuous and bulge out looking unsightly. These are all as a result of pooling of blood in the veins and in the calf on standing, and almost always decrease on lying down and keeping the legs at a higher level than the level of the heart. But of course this is not possible always, and can be done only at night by majority of the people. Occasionally in severe situations, it leads to dark brown discoloration around the ankle with ulcerations. Other complications like clotting in these abnormal veins occur which is very painful. Sometimes this clot can embolize to the lungs and become life threatening. Spontaneous bleeding can occur which is often profuse but painless.

Diagnosis

Diagnosing an individual with varicose veins is very simple and can be done with simple physical examination and an ultrasound examination known as Venous Duplex test. This will tell us the reason for the varicose veins and is essential for treatment planning, intra-operative assessment of completion of the treatment and also for post- operative follow up.

Treatment options

Treatment for these problems has evolved greatly over the last decade. Earlier, various surgical treatment methods of these veins used to be carried out, which involved making incisions in various places to surgically tie or remove the visible veins. This procedure involved a lot of blood loss, prolonged hospital stay and was painful, preventing early return to work and recreational activity. Recurrence rates were also high. As a result of this, patient dissatisfaction with the problem and its treatment was very high.

Today, treatment of varicose veins is carried out by special lasers and radiofrequency devices in a nonsurgical manner. This procedure is carried out under ultrasound guidance (which is mandatory) through a small needle prick in the legs near the ankle or calf, and the entire vein is treated from inside. As a result of this, the vein is removed from the circulation system but left in the body. Of course there are various other veins in the legs to carry out the function of the treated vein. The body in turn slowly dissolves the treated vein and this disappears over a period of time leaving no trace of the vein with the refluxing valves. The advantages of this day care procedure are shorter operative time, minimal blood loss, painless, faster return to normal physical and recreational activities and no scarring as no incisions are placed. Ultrasound guidance is mandatory as it ensures intraoperative completeness of the procedure, and post operative follow up can be maintained. Recovery is rapid and regular walking, climbing stairs, etc. without the help of any aid is resumed and encouraged in the immediate post- procedure period. Special compression stockings are to be worn in the post- procedure period for a short time. Early return to work and recreational activities is encouraged. The stockings are used as post operative dressings and worn from morning to night. These are normally used for a period of 3-4 months and then gradually discontinued.

The few precautions to be observed are to avoid squatting on the floor for any reason, not to carry or lift heavy weights for 3-4 weeks. Whatever activity that is to be done is done with stockings on. The stockings can be taken off at night and leg kept at a slightly higher level while sleeping.

Dr. Aadarsh Kabra

MBBS, DNB (General Surgery), DNB (Peripheral Vascular Surgery), FVES
Sr. Consultant - Vascular & Endovascular Surgery

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