Varicose veins may look ugly but for a lucky majority who develop them, their appearance will be the only cause of concern. Distended and dilated, these veins appear just below the skin and can create a spider web pattern of blue and purple lines that make sufferers self- conscious. But for a small percentage, varicose veins can cause itching and pain, and even lead to wounds that make some form of treatment necessary.
The good news is that treatment – both surgical and non-surgical – has proven effective time and again, says Dr. Rezni Cassim, Vascular and Transplant Surgeon and lecturer at the Professorial Surgical Unit at the National Hospital.
As you read this, approximately five litres of blood is wending its way through your system. Travelling along an intricate system of veins and arteries, the blood circulates throughout your body. The arteries carry the blood from your heart out to your body, and the veins carry the blood from your body back to your heart. The blood travelling along your arteries is a rich red, an indicator that it is full of oxygen. The blood travelling back along your veins, on the other hand, is much darker because your body has extracted the oxygen in the blood. That’s why veins look purple or blue.
“Going down is easy, high arterial pressure and gravity sends the blood down,” says Dr. Cassim, speaking of the movement along the arteries. Going up, on the other hand, is a fight against gravity and is helped by a system of valves in the veins. “The venous system is designed in such a way that there is a one way flow, with valves stopping the blood from flowing back and defects in the valves are the cause of most problems. " Such defects can appear anywhere, from groin to just above ankle, and cause varicose veins. A malfunctioning valve can create a long column of blood, resulting in what is known as venous hypertension. The venous hypertension may cause varicose veins and its complications.
Dr. Cassim explains that the condition is most often familial, appearing in a member or members of the same family. Aside from the hereditary component, varicose veins can be aggravated by pregnancy. The body has dual systems of veins – one is deep seated and other superficial. If the deep veins are blocked, those just under the skin must cope with a greater load and can develop varicose veins.
An arteriovenous fistula can cause varicose veins in places like your arms. Arteriovenous fistuli represent abnormal connections or passageways between an artery and a vein. In a healthy system, blood flows from arteries, into capillaries and then into veins. An arteriovenous fistula however, can cause the blood to bypass the capillaries and flow directly from artery into vein.
They fall into two categories: congenital fistula which a person may be born with and acquired fistula which develop after birth and may have been caused by trauma/surgery. A big fistula can allow a large volume of blood, under high pressure to flood the vein. The latter, not having been designed to channel so much blood with high pressure, becomes distended. Apart from these there are other rare secondary causes for varicose veins.
 |
Many of Dr. Cassim’s patients are young people. For younger patients, the appearance of the veins is often embarrassing. “The younger they are, the more concerned they tend to be,” says Dr. Cassim, adding that aside from such cosmetic concerns, 90% of his patients will not have any problem. But varicose veins can cause complications. You can have swelling of the legs, because of the pressure, itchiness of the leg, eczema, pain, pigmentation and ulcers (wounds). “When inadvertently traumatised the veins may bleed heavily, and patients should immediately apply pressure to prevent further blood loss,” says Dr. Cassim, emphasising that bleeding should stop in approximately 15 minutes.
“These complications present a reason to treat varicose veins,” he says, “the diagnosis itself is very simple.”
The ulcer is one of the most unpleasant complications, simply because it can take so long to heal. Dr. Cassim has seen patients who have struggled with one for 10 years. “We use a technique called strapping to treat it – it’s a special way of putting pressure on the ulcer to heal it – but that can also take 3 to 6 months to heal,” he says, adding, “All this can be prevented at an early stage.” If you have varicose veins with pigmentation, itching or skin changes, consider it your cue to seek medical advice.
Though varicose veins are simple enough to treat, what doctors are worried about is the possibility of an underlying secondary cause. “If there is a sudden onset of varicose veins, it is better to seek treatment,” cautions Dr. Cassim. However, if you’ve had varicose veins for several years and experienced none of these complications, and do not want treatment for cosmetic concerns, you can choose to leave them untreated.
For those who are interested in non-invasive treatment for complications, Dr. Cassim recommends the wearing of a graduated pressure stocking during the day. The stockings help to force the blood upwards. At night, keeping the legs elevated will encourage healthy circulation. These must become the habits of a lifetime if they are to be effective. Exercising, losing weight, and avoiding long periods of standing can also help. For those who are self- conscious, however, wearing a stocking might not seem like a viable solution.
Doctors seeking to treat varicose veins can choose to do a duplex scan to identify the malfunctioning valves in the vein. There are many invasive methods to treat varicose veins. Dr. Cassim describes the process as akin to getting a haircut – except the time scale differs radically. The varicose veins can recur in 60% of patients in 6 to 8 years. Of course, 40% will be recurrence free. Doctors often employ minimally invasive techniques such as sclerosant injection, foam therapy, or laser ablation to treat these veins.
Other patients, more interested in a long term solution, will opt to have the veins completely removed in an operation. It includes “vein stripping” and the surgery occurs under anaesthesia. Because so much of the blood flows through the deeper veins in the legs, the superficial veins can usually be removed or ablated without serious harm. In the end, it’s the patient who makes the choice, says Dr. Cassim, adding that each approach has its advantages and disadvantages. |
E-mail
