VARICOSE VEINS EXPLAINED

WHAT ARE VARICOSE VEINS?

Veins are blood vessels that take blood from the body back to the heart. When veins become enlarged, abnormally twisted
or become thickened, they are called “varicose veins”. These veins can form anywhere in the body, but the legs are the
commonest place where they develop.

The VEIN SYSTEMS

Veins are either superficial (run under the skin) or deep (surrounded by muscle inside the leg). The superficial veins are those
that typically become varicosed. Inside the veins there are one way valves that open to allow blood flow to the heart and
close to prevent blood reflux back to the legs

The long saphenous vein (LSV) and its tributaries are the most likely superficial veins to become varicose.
The short saphenous vein on the back of the leg may also become varicose.

It is thought that varicose veins are caused by the turbulent reversed flow beneath inadequate valves. According to the
most prevalent theory, veins with inherently weak walls expand in width and length so that valve cusps separate and
allow reverse flow to occur. According to another theory, the valves of the veins become incompetent first and this is
followed by expansion of the wall of the veins.

Varicose veins are the result of valve failure causing reverse blood flow.

Some people are born with defective valves, other people's valves become damaged as a result of a deep vein thrombosis,
pregnancy, obesity and prolonged standing.

What are the symptoms of varicose veins?

Patients are frequently disturbed by the poor cosmetic appearance of their legs. They also report a constant ache, especially
after standing and also of itching. Varicose veins can also cause pigmentation and thickening of the skin (lipodermatosclerosis),
ulcers and venous eczema.

VARICOSE VEIN TREATMENTS

Compression Stockings do not make the varicose veins go away but will assist the leg in pumping the blood back to the
heart. This will improve symptoms such as pain and ankle swelling.

Injection Sclerotherapy is useful for small veins below the knee and causes fibrosis (shrinking) of the varicosities.

Ultrasound guided foam Sclerotherapy involves injection of chemical foam under ultrasound control into the diseased veins.
It acts on the lining of the veins to seal it and eventually the varicose veins disappear. No anaesthesia is required. Pigmentation
may remain at the sites of injection in 2% of the patients for more than 1 year. There is also a 1% risk of deep vein thrombosis.

Vein Junction Tie – the veins of the superficial system are disconnected from the veins of the deep system so that varicosities
are unlikely to occur.

Vein Stripping – this procedure involves removing the main thigh leg vein by passing a wire tipped with a stripping head.
During the recovery the patient may often feel hard lumps under the skin. This is reversible and resolves within few weeks.

Multiple Avulsions – performed via small stab incisions over varices which are carefully marked before surgery.

Endovenous LASER treatment- A very thin laser fibre is inserted in the long saphenous vein. The heat that is delivered by
the laser destroys the vein. This is often performed with the patient awake under local anaesthesia. No vein junction tie is needed.

RISKS OF VARICOSE VEIN SURGERY

I have read and understand the following risks of varicose vein surgery:

•  Scar – as part of the healing process, scar tissue formation is inevitable. The scar will be as small as possible for cosmetic
considerations but large as necessary to perform the surgery safely.

•  Bleeding / Bruising - surgery performed on blood vessels predisposes to bleeding and subsequent bruising to the skin.

•  Infection – any surgery which creates wounds involves an element of infection, although sterile technique and practice helps
reduce the risks.

•  Sensory loss – nerve fibres that run in the skin can be damaged as part of the stripping process resulting in a loss of
sensation over the affected part of the skin.

•  Recurrence – there is a 15-20% chance that varicose veins, once removed, may grow back over a number of months to years.
These are usually amenable to injection therapy

•  Deep vein thrombosis – All surgery carries a risk of a blood clot forming within the blood vessels. Varicose vein surgery carries
a risk of approximately 1%. All precautions to minimise the risks are taken before and after the operation.