At a Glance:
2. What are the symptoms of varicose veins?
3. What are the causes and risk factors of varicose veins?
4. How are varicose veins diagnosed?
5. What are the treatment options for varicose veins?
6. How will a person know which procedure is right for him/her?
7. What can a person expect during varicose vein treatment recovery?
8. How should one choose a facility for the treatment of varicose veins?
Subcutaneous veins that become elongated, tortuous and dilate ≥3 mm in diameter are called varicose veins. Even though, superficial veins anywhere in the body can become varicosed those in the legs are most affected. The main reason the veins of the legs get affected is that walking and standing upright for a long duration increases the pressure in the veins of the lower body.
Varicose veins and one of its milder and commoner variation, the spider veins may just be a cosmetic concern for some persons. However, for some, they may be a cause of symptoms, ranging from pain to ulcers, that require prompt treatment and medical intervention.
In most of the cases, varicose veins do not cause any pain. Varicose veins appear:
Symptomatic cases of varicose veins may also report with :
Varicose veins are caused by damage or weakening of the valves in the veins that maintain a unidirectional flow of blood from the legs to the heart against gravity. Damage or weakening of these can lead to a backward flow of blood and its pooling in the vein. As a result, the veins begin to stretch or twist.
Some common factors that increase a person’s risk of developing varicose veins are:
A vascular surgeon can diagnose varicose veins by undertaking a person’s detailed medical history like asking about symptoms of pain and itching and conducting a physical examination. The exam includes a visual inspection of the person’s legs while standing to check for the presence of swelling or venous enlargement.
An ultrasound test is performed to see the functionality of the valves in the veins or evidence of a blood clot.
The treatment for varicose veins usually does not require a hospital stay for long. Recovery is usually fast and uneventful. Due to the availability of lesser invasive procedures, varicose veins can routinely be treated on an outpatient basis, though open surgery may be required for certain persons.
Treatment goals for varicose veins are to:
Some of the treatment options for varicose veins are:
Conservative management options
Interventional treatments for more-severe varicose veins
If a person does not experience improvement in condition with self-care or compression stockings, or if the condition of varicose veins is more severe in the vascular surgeon’s opinion, one of the interventional treatments known as vein ablation may be recommended. Several venous ablation techniques, including minimally invasive and surgical methods, are available and they are of two categories:
When ablation is done, the blood that would normally flow through the affected vein gets diverted through another route back to the heart. Ablation of the veins can be done by the following techniques:
Thermal ablation: Constitutes minimally invasive methods that achieve vein-ablation by generating heat at a temperature at which the proteins within the venous wall get denatured. Radiofrequency energy or laser light is used for generating heat which is introduced into the lumen of the affected vein using specialized catheters. Heat generation within the vessel wall may result in pain. To counter it, an added infiltration of local anesthetic and saline mixture, called as tumescent anesthesia is administered. It also provides a cold buffer from the heat generated by the laser or radiofrequency energy and compresses the vein from outside to help close contact of the catheter with the vessel wall. Both the procedures are percutaneous and ultrasound-guided.
Nonthermal ablation: This is an alternative technique for ablation of varicose veins with a sealing system which includes the endovenous delivery ofa wire, chemical, or glue, or a combination of these into the diseased vein instead of using heat. It can be done in an OPD setting with local anesthesia. As there is no requirement of heat, the discomfort associated with tumescent infiltration is avoided, and there is a lower risk of adjacent nerve injury. Nonthermal techniques like polidocanol endovenous microfoam [PEM], mechanochemical ablation [MOCA], cyanoacrylate glue, etc are suitable minimal invasive options for veins that are not amenable to thermal ablation. Some common types of nonthermal ablation techniques are:
Open surgical techniques: As the minimally invasive techniques of vein ablation evolve to be the standard of care, open surgery options are reserved for the treatment of varicose vein cases that are:
In many cases, surgical treatment is also combined with less invasive treatment options in selected patients for better outcomes. The choice of technique whether ligation and/or removal of veins is dependent on the presence or absence of venous reflux, location, size, and extent of the affected veins.
Before selecting the appropriate procedure, certain factors need to be weighed in making that decision by the person and treating vascular surgeon. Among them, the following are important:
Once a procedure is carried out, the person may feel the procedure-specific side effects. Some of the common effects of most procedures are swelling, bruising, change in color of the skin, and pain.
The side effects of open surgical treatment like vein stripping and ligation may be more severe as compared to the less invasive options. Although they’re rare, complications of open surgery can include blood clots, severe pain, infection, and scarring at the site of the procedure.
In some techniques, the legs may need to be wrapped in elastic bandages after the procedure, and it is advised to wear compression stockings for a certain amount of time.
Postoperative instructions about physical therapy and exercise should be adhered to avoid the formation of blood clots. Recovery after a procedure for varicose vein treatment depends on the type of procedure and individual factors, but in the majority of cases, a person will be able to return to routine life within a week or two.
Treatment outcomes of varicose veins are highly technique-sensitive as each method of endovenous ablation whether thermal or nonthermal, has unique characteristics that must be taken into consideration to meet the expectations of the affected person and treating surgeon. Individualized treatment plan and comprehensive care for persons with the chronic venous disease involves a clear understanding of the technical differences and the advantages and disadvantages of each technique. Every ablation technique requires specific surgical skills that can be achieved only with experience and training. Considering that treatment for varicose veins requires a multidisciplinary approach with advanced infrastructure, treatment should be availed at a high volume center for a holistic care experience.
Nonthermal or thermal vein ablation treatments for varicose veins have emerged to be an ideal option for persons who have symptoms of varicose veins that are not responsive to the conservative options. Even though long-term outcomes for open and endovenous techniques are similar, endovenous ablation is recommended as one of the primary approaches to treat symptomatic vein reflux. This is because of far lesser chances of complications, faster recovery, and cost-effectiveness of endovenous ablation techniques as compared to open surgical ligation and stripping.
The Center for Vascular Surgery at Yashoda Hospitals provides holistic care to persons with varicose veins with the following approach:
Availability of latest treatments: Vascular surgeons at Yashoda hospital have expertise in treating varicose veins with advanced techniques that include endovenous thermal ablation including laser and radiofrequency treatment, all types of sclerotherapy, laser surgery, vein stripping, endoscopic vein surgery, and other procedures.
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