Can you prevent varicose veins?

If you have ever noticed the appearance of large, blue or green coloured, twisted lumps, bulging out from your legs, it is likely that you are part of the significant portion of adults who suffer from varicose veins. These diseased blood vessels are not just a cosmetic issue, but rather one that frequently causes both physical discomfort alongside self-consciousness regarding their appearance, particularly in the season for summer clothes. Similar small, twisted veins, known as spider or thread veins are often associated with varicose veins. These veins are most often blue or purple in colour and can manifest themselves as various unseemly blotches and patterns on the skin, causing comparable physical discomfort and self-consciousness.

Many young adults develop varicose veins, which arise due to a faulty backflow of blood in the veins, however the incidence increases with age and most people are affected to some degree eventually. Women are also disproportionately afflicted, with the development of varicosities accelerated by pregnancies. Varicose veins are hereditary, however, even those with no family history of the disease may also suffer from them. Unfortunately, there are no proven methods by which to prevent the development of these veins, as they ultimately result from a failure of the lower limb veins to overcome gravity. Once they begin to develop, they gradually get worse and the condition will not resolve itself without intervention

Aside from their unsightly appearance, varicose veins can cause a plethora of painful and potentially life-threatening medical complications for the sufferer. This is because the condition arises from a disease of the venous circulatory system. The venous system responsible for returning spent blood from tissues to the heart and lungs, so that it can be replenished with both oxygen and nutrients before being pumped around the body again. In order to do this, the blood travelling up from the legs must overcome gravity, a process in which delicate one-way valves present in the veins are crucial in facilitating. When these flimsy valves fail to direct the used blood to the heart, this blood can spill backwards from the main circulation to pool in stretched-out varicose veins. Here, blood stagnates, allowing for chemicals and cells to form sediments which can irritate the surrounding tissue. This can subsequently result in the characteristic pigmentation and inflammation of skin associated with varicose veins.

The pain experienced by those with varicose veins is commonly described as an ache, although it may also manifest itself as a burning or throbbing sensation. Other physical symptoms include tired legs, restlessness or a general feeling of heaviness in the legs. As such, given both the unpleasant symptoms and their unsightly aspect, varicose veins can have a significant and detrimental impact upon one’s quality of life. Left untreated, varicose veins can also cause far more serious and even life-threatening medical complications. These complications include skin diseases which range from pigmentation through varicose eczema to leg ulcers. Ulcers are difficult, open wounds that can become chronic, allowing bacteria to fester with foul-smelling discharge. Blood clots (known as thrombosis) may also form in the pools of blood inside varicose veins, from which they can spread and travel to the lungs where they can be potentially fatal. Another serious complication which may arise from varicose veins is haemorrhage, in which the varicose veins bleed profusely, requiring immediate treatment.

Old-fashioned stripping operations involving cuts and scars followed by protracted wearing of tight stockings and long walks are now replaced by modern treatment. This new therapy incorporates the latest imaging and laser technology in order to provide a minimally invasive, definitive solution without the need for open surgery. Using magnified ultrasound image guidance, the vascular specialist inserts a microfibre through a miniature needle into the diseased veins. Laser energy is then used to close off the varicose veins, thus restoring the venous circulation to normal. This therapy lasts only a few minutes and, due its minimally invasive nature, avoids any blood-loss, making it so mild that patients are able to return to normal activities immediately afterwards.

This procedure, known as endovenous laser ablation, is remarkably safe, with minimal risks and side effects – as such, there is no age limit to who may undergo it. There is also no scarring produced by this treatment. Bruising is likely to occur, which may take a few days to a few weeks to recover from depending on the severity of the veins. After treatment, although it is recommended to resume normal exercise, there is no need to go on long walks in order to aid recovery. While it is possible to have a recurrence of varicose veins they will generally be less prominent, and they are easily resolved by the same method of laser treatment.

Key Points

• Varicose veins are a common condition affecting men and women of any age
• Skin complications frequently occur with long standing varicose veins
• Thrombosis and bleeding are rare but potentially fatal complications
• Varicose veins predispose to cellulitis and infection of the skin
• Modern treatment is minimally invasive on a walk in walk out basis
• There is no age limit to treatment
• Previous surgery does not preclude endovenous laser treatment
• Early intervention is the best to prevent development and complications

Michael Arthur Murphy is a Vascular Surgeon at Aut Even Hospital Kilkenny