About Your Veins

Flow of blood through the vein

The visible varicose veins in the legs, both large and small, are most often a result of problems elsewhere in the leg.

Veins carry blood from the tissues back eventually to the heart. They are thin walled tubes which get squeezed by the surrounding muscles as they contract. This squeezing forces blood along the veins and a series of non-return valves ensure the flow is only in one direction.

If these valves become faulty and fail to close the flood can run backwards (or reflux) and will father or pool in the legs.

Where this extra blood is sitting in veins close to the surface of the skin, the veins will swell up and become visible and 'varicosed'.

There is one major vein (the greater saphenous vein), which connects to many of the surface superficial veins. Failure of the valves in this vein is quite common and is therefore a major cause of surface varicose veins. This vein runs down from the groin to the lower leg and the faulty valves are often up near the top. Hence varicose veins in the lower thigh, around the knee and in the calf are often caused by a problem much higher up.

Varicose veins are a very common problem - Up to 25% of all women and 18% of all men will suffer from varicose veins to some degree. There are a number of factors which lead to varicose veins:

• Heredity - This is the most important factor, so if your parents and grandparents have the problem you are at increased risk.
• Gender - Women have a higher incidence of varicose veins due in part to the female hormones affecting the vein walls.
• Pregnancy - This causes a risk in blood pressure and volume and also adds to the hormonal effect mentioned above.
• Age - As we ago so our tissues loose elasticity and this is true of vein walls causing the valve system to work less well.

There are additional factors which do not cause varicose veins, but will speed up their development and make them worse:

• Obesity - Increases in weight often go hand in hand with increased blood pressure which will add to vein problems.
• Prolonged Standing - The volume and pressure of blood in the lower limbs is affected by gravity, so the longer you stand the greater the effect.
• Physical Trauma - Sometimes trauma to the lower limbs can damage the underlying blood vessels and add to the problem of varicose veins.
• Changes in lifestyle - These may slow down the development of varicose veins, but in most cases if you are going to develop the problem, there is little which can be done to avoid it.

The symptoms associated with varicose veins fall into three categories:

A badly vericosed leg

Physical symptoms

• Tiredness
• Heaviness in the leg
• Pain - aching or burning sensations

Visual symptoms

• The tortuous blue varicosities seen running down the leg
• Areas of small red/blue blood vessels in the skin known as spider veins
• Swelling in the lower leg

Long term consequences

• eczema
• pigmentation
• ulceration
• bleeding

It is important to note that not all patients will not suffer all the symptoms listed above and similar symptoms may have other causes than varicose veins.

Conservative Management

• This requires the patient to sit with their legs up whenever possible, and to wear compression stockings throughout the day.

Surgical Treatment

• This is called Ligation and Stripping. It involves an opening at the groin so the top of the greater saphenous vein can be tied off and cut.
• The redundant vein is now stripped out of the leg via an incision at the knee.
• Performed under general anesthetic this will cure the problem as the faulty vein is removed. The current treatment of choice.
• Traumatizes the tissues and may damage small nerves along the course of the vein.
• Long recovery period (up to 2 weeks) with immobility and pain.

Alternative Minimally Invasive Treatments

Ultrasound Guided Sclerotherapy - Where an irritant chemical is injected into the vein following by tight compression.

• Excellent for small veins as a cosmetic procedure but less good for the greater saphenous vein to treat the underlying problem.
• Limited in the size of vein which can be treated so many patients will not be suitable candidates for this technique.

Radio Frequency Thermal Treatment - Using heat generated from a radio frequency electric current to close the greater saphenous vein in situ.

• Limited in the size of vein which can be treated so many patients will not be suitable candidates for this technique.

EndoVenous Laser Treatment or EVLT™ - EVLT™ deals with the most common underlying cause of varicose veins; incompetence of the greater saphenous veins. Unlike surgical stripping, EVLT permanently closes off the vein while leaving it in place. to learn more about this very advantageous procedure see page on this website, About Laser Surgery.