Out of all the elderly women above 50 years in my clinic, about 50 per cent has varicose veins.
It may be due to the standing work that they do or due to multiple pregnancies(Some of them have 9-11 children in the past). The varicose veins can cause intermittent claudication, varicose ulcers and generally leg aches and pain due to poor blood circulation. The advice I always give to those with varicose veins is to wear nylon stockings which can compress their varicose veins. Nowadays stripping of varicose veins can be done by small incisions instead of removing the whole varicose vein by a long incision.
Varicose Veins are swollen veins in the legs which has ballooned up over time.
They are more common in women than in men.
The cause of the Varicose Vein is due to the accumulation and stagnation of blood in the veins over time. From the heart blood flows easily downwards to the legs into the capillaries to supply nutrient and oxygen to the foot. From the foot the blood is then pushed up though the veins right up to the heart.Movement of the blood in the veins is assisted by the contraction of muscles pushing the blood upwards.When the muscle relaxes, the blood in the veins gravitates downwards but is prevented from going down by valves in the veins.
If the valve in the vein fails, blood begins to accumulates and stagnate in the veins causing ballooning and dilation of the veins. The distended veins are then called Varicose Veins.
Causes for the failure of the valves in the veins are:
1.Hereditary - some people are born with inherent weakness of the valve of the veins.
2.Prolonged standing -causes gravitation of the blood down the veins
3.Pregnancy - the veins may be partially blocked by weight of the fetus causing stagnation of blood
4.Obesity - the weight of the body causes the blood to slow down and gravitates down wards in the veins.
5.pelvic tumors like pregnancy can partially block the blood flow up the veins.
6.Tight stockings- constricts the blood vessels mechanically
7.Smoking- constricts the blood vessel through its chemicals
Varicose Veins reduces the blood flow in the legs and can give rise to complications:
1.Phlebitis-
inflammation of the varicose vein is due to a blood clot stucked in the vein forming a thrombosis. The skin over the inflammed vein becomes hot, red, swollen and tender. A thrombosis in the superficial veins are usually not dangerous but a deep vein thrombosis can become detached and lodged in the lungs causing pulmonary embolism.
2.Haemorrhage
bleeding may occur when a swollen varicose vein with thinned walls burst. Blood will then flow out. Trauma or injury of the swollen varicose vein can also cause bleeding.
3.Varicose ulcers
may occur when the swollen venous wall gradually stretched and breaks without bleeding. The break may slowly develop into a ulcer becoming larger unless treated.
4.Varicose pigmentation results from skin discoloration from an iron containing pigment called hemosiderin from broken down red blood cells stuck in the varicose veins.
The type, size, location and depth of the varicose vein problem can be determined by various non-invasive diagnostic tests:
1. venous doppler,
2.PPG, and
3.color duplex ultrasound.
1. No treatment if condition is mild
2. Elastic stocking- support stockings and pressure bandaging compress the valves of the veins together to prevent back flow and prevent dilation of the veins. Once the stockings are in place, you should exercise by walking as much as possible. When sitting raise the legs. While sleeping do not use the stockings.Raise the bottom of bed or put legs on pillows to elevate the legs. While stockings can slow down the natural course of the disease and reduce the painful symptoms. they WILL NOT CURE the disease.
3. Medical treatment:
Injection of veins-
a.Traditional Sclerotherapy
Here the veins are injected with a small amount of a solution causing them to collapse and disappear.
b.Ultrasound Guided Sclerotheraphy
By using a Doppler/Duplex Ultrasound system the doctor can get a x-ray-like picture of the deeper vein and inject at strategic locations of the vein.
c.Foam Sclerotherapy
Similar to traditional sclerotherapy, but using a foaming agent, making it more suitable for larger veins.
d.IPL Laser Therapy used mostly for the smallest spider veins. In this method a light beam is pulsed onto the veins to seal them.
4. Surgical treatment:
a.tying of veins-
The simplest treatment consist of tying the superficial vein in the upper thigh preventing the flow of blood in the superficial vein and deflecting it into the deeper vein.
b.stripping of veins
this consist of removal of the long superficial vein using a instrument called the stripper. After the removal of the vein, firm pressure is applied to the leg.
c.Ambulatory Phlebectomy
Parts of the vein is removed through tiny incisions leaving only small puncture marks and requires no stitches.
d.Closure(Radiofrequency Occlusion)
A super-thin catheter is inserted in the vein and when removed it closes the vein behind it by the use of radio frequency waves.
e.Endovenous Laser Treatment -same as the Closure Procedure, except the catheter emits laser rays instead of radio frequency waves
Prevention of varicose veins are by:
1.Reducing weight
2.Exercising
3.Avoiding prolonged standing
4.Putting your feet up
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