Varicose Veins: Cosmetic Flaw or Painful Condition?
What are varicose veins?
Unsightly and potentially painful veins that are enlarged, twisted and bulge at the surface of the skin typically in the legs and feet (but can occur anywhere) are termed “varicose veins”. They are most commonly seen in people who stand for long periods of time at work, such as school teachers. Varicose veins have genetic links and are seen more frequently in women than men.
All veins have tiny valves to help blood move towards the heart. In the lower body, blood returning to the heart requires higher pressure to counteract the effects of gravity, especially when standing. If these valves malfunction or are damaged, forward blood flow will cease and leak back through the valves, and collect in the vein. This stagnant blood has metabolic substances which will eventually damage the vein. This condition, called chronic venous insufficiency, subsequently leads to the potentially painful symptoms of varicose veins.
Signs and symptoms
Mild varicose veins are initially unthreatening cosmetic flaws but severe varicosities compromise blood circulation and can lead to major complications. Patients often feel their legs are heavy or swollen when walking or standing, especially after sitting for long periods of time. In some cases, there is loss of sensation in the affected area, pain, itching, and/or discoloration of the skin. Varicose veins develop a spider web-like pattern that can be seen through the skin and can start to bulge and turn blue or purple. In severe cases, ulcers may develop in the ankle that requires medical attention due to their tendency to bleed easily.
Initial symptoms of varicose veins can be controlled with conservative, non-surgical treatments. To provide temporary relief frequent elevation of the legs, wearing compression stockings, and taking anti-inflammatory medications such as aspirin or ibuprofen may ease discomfort. It is important to note that these treatments will not reverse the varicose process. Eventually, to eliminate pain and swelling and to restore the cosmetic appearance of the affected area, surgical intervention is required. The purpose of surgery is to strip out the superficial varicose veins and drain the stagnant blood from the lower extremities. These superficial veins only return about 10% of the blood from the legs so they can be removed without serious harm; deeper veins will automatically compensate to return blood to the heart.
Traditional open surgery is regarded as invasive since it involves making several cuts on the legs to tie off or strip out any damaged veins, therefore many patients choose to live with the discomfort or rely on non-invasive conservative treatments for their varicose veins. A newer, less invasive technique is Endo Venous Laser Treatment (EVLT). Instead of removing varicose veins, this procedure seals them by inserting a small laser fiber through a tiny incision and pulses of laser light are delivered inside the veins which causes them to collapse. According to the American College of Phlebology, this procedure is highly effective, has no significant complications and is widely accepted by patients since cosmetically the treatment leaves no major scars. It usually takes about an hour, patients are able to walk immediately and most are able to return to work the following day.
In 2008, the Australian Medical Services Advisory Committee reported that EVLT for varicose veins appears to be more effective in the short term and generally at least as effective as traditional surgical treatment. Available literature also suggests that reoccurrence rates are rare and post-operative complications are more likely after invasive surgery than EVLT.
Australian Medical Services Advisory Committee, EVLT Final Report, March 2008.