Varicose veins are enlarged twisted veins that are usually visible under the skin in the legs. Generally, it is not a serious condition but neglecting some types of varicose veins might cause open wounds at the ankle or clot in the enlarged veins (thrombosis).
One-way valves in the leg veins prevent backward flow during flow to the heart. When the valves in the superficial veins do not work, the blood leaks downwards causing enlargement of the side branches appearing as visible varicosities or stagnation leading to skin changes or ulceration in advanced cases.
The cause is unknown but genetic tendency is probably the most important factor. There are no scientifically proven preventive measures but there are various types of successful varicose vein treatment modalities.
VARICOSE VEIN DISEASE
Types of primary varicose veins
Group I- There are visible varicosities and the ultrasound examination reveals a leakage of blood down to the ankle through the enlarged superficial vein called long (from the groin) or short (from the knee) saphenous vein,
Group II- There are visible varicosities without leakage in the superficial venous system. In the first group, if the patient does not have pain ,cosmetic concern or no skin discoloration at the ankle level, there is no clear indication for treatment of varicose veins. If the patient has skin discoloration surgical treatment is indicated even if the patient does not have any symptoms. In the second group the only reason for treatment is the cosmetic concern.
Group II- There are visible varicosities without leakage in the superficial venous system. In the first group, if the patient does not have pain ,cosmetic concern or no skin discoloration at the ankle level, there is no clear indication for treatment of varicose veins. If the patient has skin discoloration surgical treatment is indicated even if the patient does not have any symptoms. In the second group the only reason for treatment is the cosmetic concern.
Symptoms
Varicose veins are typically asymptomatic but may cause mild pain or swelling in the lower leg especially standing for longer periods. Some varicose vein patients develop skin damage or ulcer at the ankle level.
Diagnosis
Vascular ultrasound examination (duplex) is also performed at the time of clinical evaluation by the vascular surgeon. Information obtained from duplex scanning is important to select the type of treatment. The results of duplex scanning are dependent on the experience of the vascular surgeon.
Aim of treatment
Varicose vein treatment for medical reasons (Group I)
There is a leakage in the superficial vein causing skin changes at the ankle.
Varicose vein treatment only due to cosmetic reasons (Group II)
There is no leakage in the superficial vein but small varicosities are visible.
In Group I patients, the treatment is aimed to relieve symptoms, improve the leg's appearance, prevent thrombosis or venous ulcer. Minimal invasive treatment is the only option in these patients. In group II, the choice of treatment depends on the type of varicosities. Sclerotherapy is the best option for those with spider veins or small diameter varicosities. Out-patient phlebectomy (removal of varicosities with tiny incisions under local anesthesia) is the best option for better cosmetic results for larger varicosities (but with normal duplex findings) as sclerotherapy might cause some skin discolorations in larger varicosities.
Various varicose vein treatments
We choose one of the below treatment modality depending on the ultrasound findings, type of varicosities, indication for treatment and the patient’s preference when there is a reflux in the superficial venous system.
1- Radiofrequency ablation.
2- Chemical ablation (Vena seal).
3- Ultrasound guided minimal exploration and invagination stripping.
Phlebectomy and/ or foam sclerotherapy is also used during above mentioned procedures for treatment of visible various types of varicosities.
Local anesthesia is used during radiofrequency ablation and venaseal procedure. Mild general anesthesia is used during ultrasound guided minimal exploration and invagination stripping.
In patients without reflux in ultrasound, we often use foam sclerotherapy (injection of a special chemical into a varicose vein). In rare cases it night be suitable to perform phlebectomy (removal of varicosities ) with 1-2 mm incisions under local anesthesia.
1- Radiofrequency ablation.
2- Chemical ablation (Vena seal).
3- Ultrasound guided minimal exploration and invagination stripping.
Phlebectomy and/ or foam sclerotherapy is also used during above mentioned procedures for treatment of visible various types of varicosities.
Local anesthesia is used during radiofrequency ablation and venaseal procedure. Mild general anesthesia is used during ultrasound guided minimal exploration and invagination stripping.
In patients without reflux in ultrasound, we often use foam sclerotherapy (injection of a special chemical into a varicose vein). In rare cases it night be suitable to perform phlebectomy (removal of varicosities ) with 1-2 mm incisions under local anesthesia.
Varicose vein treatment with radiofrequency
Radiofrequency ablation is a minimally invasive treatment for varicose veins. (Ablation means using heat to damage tissue, which makes scar tissue form. This scar tissue closes the vein.) This technique uses radiofrequency energy to heat up and damage the wall inside a vein. This usually closes off a varicose vein in the leg. Radiofrequency energy is directed through a thin tube (catheter) inserted through a small incision in the vein using local anesthesia. After treatment, compression stockings are used for 1-2 weeks.
Vena seal for varicose vein treatment (Chemical ablation)
The most recent innovation in the treatment of varicose veins is the use of medical glue known as VenaSeal (cyanoacrylate) to physically shut down and seal the main defective vein. VenaSeal Adhesive (Glue), is a safe, medical-grade glue that is used to shut the main saphenous vein in the thigh. Once the vein has been glued shut, it will undergo a process of hardening (sclerosis) and will be gradually absorbed by the body. The procedure is very safe and minimally invasive, performed under local anesthesia. The procedure involves the placement of a very small amount of VenaSeal medical glue into the vein through a small catheter. Unlike other treatments, VenaSeal does not require large volumes of anesthesia. Patients can return to their normal activities right after the treatment.
Foam Sclerotherapy
Sclerotherapy uses an injection of a special chemical (sclerosant) into a varicose vein to damage and scar the inside lining of the vein. This causes the vein to close and become invisible. After the injection of sclerosant is given, the pressure is applied over the veins to prevent blood return when you stand up. Compression stockings are used for one week to maintain the pressure. The results are very satisfactory in about %80 of patients and usually, multiple sessions are required.
Phlebectomy
We prefer phlebectomy when the size and the extent of varicosities are too large for foam sclerotherapy. It is performed under local anesthesia or mild sedation. Mini incisions (1-2 mm) are used to remove varicosities and the patients return to normal activities immediately after the procedure and compressions stocking is used for a week. The results are very satisfactory.