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Varicose Vein

Frequently Asked Questions (FAQs)

 

Is there a prevention or a cure for varicose veins?

The vein may be a normal prominent vein or a small varicose vein. Occasionally other diagnoses occur eg an arteriovrnous malformation. A specialist venous consultation and ultrasound exam will indicate the diagnosis and thus the treatment options.

An small varicose vein may not require treatment except for observation and review. Treating a vein when smaller is somewhat easier. If the vein is small but rubs on your footwear at the ankle, then intervention is advisable.

Complications such as thrombosis and haemorrhage are unlikely given the information that the question supplies but do occur.

In either case, sclerotherapy is likely to be the best treatment. Ambulatory phlebectomy (AP) is another good option if the vein is a bit larger. Avoid extensive vein surgery at your age.

Care should include the ongoing use of compression full leg tights with exercise eg "Skins", approximately 80 Denier, compression knee-hi socks at work eg Holeproof Computer socks, & stronger knee-hi socks for travel eg preferable 20-30mm Hg or Class 2 graduated compression. Support is worn on both legs as varicose vein disease affects both legs even if it presents initially in one leg.

A clinical review and US exam after 2-3 years should detect early recurrence and facilitate easy re-treatment.

There is no cure for varicose veins except for having new parents!

Prolonged standing accelerates varicose vein development.

Medications may relieve aching but are of little value in treatment.

 

Is there any treatment for Varicose Veins for a diabetic person?

Varicose veins can be, and often are, treated in a diabetic patient. Treatment requires vascular surgical assessment before any intervention in a diabetic patient. Ideally the vascular surgeon is involved at every stage, even if not performing each procedure.

Many extra considerations apply and it is wise to let the patient reflect on the available options in most cases. Some basic concepts and examples are:

1. Mildly symptomatic, uncomplicated veins that are an appearance issue may be better left alone. Support stockings or socks can reduce symptoms and stabilise venous dermatitis.

2. A review consultation and repeat vascular venous ultrasound exam should be part of the initial care plan. Varicose veins that worsen or develop complications may then be reconsidered for intervention (largely this means their removal or ablation).

3. A conservative approach with specialist review is preferred because treating varicose veins may involve intervention on the long (greater) or short (lesser) saphenous veins. These long straight superficial veins are important potential autogenous graft options for the patient in the future. They are useful for these purposes even if moderately varicose.

Despite the advent of stents and synthetic grafts for peripheral arterial disease and stents and arterial grafts for cardiac bypass operations, there remain a substantial number of diabetic patients in whom these veins may be life or limb saving grafts later in life.

4. Conversely, varicose veins associated with complications often deserve intervention. Typically one is referred a diabetic patient with a leg ulcer. Assessment and treatment of the arterial circulation comes first. This involves the usual pathways: optimise diabetes control, start or review cholesterol lowering therapy, start or review anti-platelet therapy, an ultrasound exam, likely then an arteriogram, with or without angioplasty and stenting.

Subsequently, one can apply compressive bandages or stocking over the ulcer with less risk of arterial compromise (causes pain, may prevent ulcer healing). In selected cases, it may be decided to treat (sacrifice) potential venous conduits to treat the ulcer.

5. Diabetics have about twice the complication rate at surgery as non- diabetic patients so the move to operate needs to factor in: medical optimisation, operate in a larger hospital with appropriate backup facilities, involve the patient's endocrinologist (or a preferred substitute), consider if a lesser surgical procedure would suffice.

6. Varicose vein surgery (ie operations by incision, generally removing the varicose veins, often called "vein stripping") remains a viable option to treat troublesome varicose veins in many countries, including Australia. It's effective, rapid, fairly safe, and fairly cheap or free to the patient.

7. Newer venous ablative procedures (ultrasound guided sclerotherapy or UGS, phlebectomy under LA, endovenous laser ablation or EVLA) require local expertise and equipment but are generally preferred if accessible. Cost and availability vary widely. The avoidance of a hospital admission, no anaesthesia, and no surgical incisions are major advantages especially for the diabetic patient no matter how well controlled.

7. There are still a group of patients for whom hospitalisation and surgery are advised in varicose vein treatment. Another small group may also require surgery for ulcer biopsy, debridement, or skin grafting.

8. Smaller varicose veins may often be injected (sclerotherapy) in diabetic patients after the issues described above have been addressed by the doctor and canvassed with the patient (informed consent vs signing a consent form). Many diabetic patient have enough burdens in life without aching or unsightly varicose veins on their legs.

9. The topic of varicose vein management in the diabetic patient is vast. This answer highlights some major considerations.

10. Diabetic patients with any but the mildest of varicose veins require specialist surgical management, even if that amounts only to a review consultation every year or two. The diabetic patient might also need specialist input for arterial disease, a topic largely not addressed here.

 

How is varicose veins treated?

I had varicose veins on my left leg for over 3 years. I neglected it and only when i started wearing compression stockings, i felt a little comfort. I realized that i neglected it too long and consulted a Vascular Surgeon. With in a month i underwent "Endovenous Laser Therapy (EVLT)" & "Ambulatory Phlebectomy". EVLT was performed for the section above the knee to groin and Ambulatory phlebectomy was done below knee by making small incisions to cut the veins.

It was a day surgery and was performed under General Anesthesia. Operation typically lasts around an hour and i could walk slowly the same day. I had to wear compression stockings continuously even after surgery and first 4-6 weeks are very important time in recovery.

Below image was taken few minutes before my surgery. Doctor marked the bulgy vein areas below the knee.

 

Obstetrics and Gynecology: Is it normal to have varicose veins after pregnancy?

The simple answer is "yes" in the sense that it is not uncommon. However, varicose veins during pregnancy can be treated with the adverse effects reduced to an absolute minimum.

The two best methods for treating varicose veins during pregnancy are compression stockings, thigh-highs and pantyhose for treatment of varicose veins affecting the legs, and compressive undergarments for varicose veins affecting the vulvar region, a condition known as vulvar varicosities.

Sclerotherapy is not considered to be advisable as a treatment option during pregnancy.

 

Should Varicose vein patients be suggested to join the gym for weight reduction/varicose veins?

Varicose veins can be caused by several reasons. Being overweight/obese is only one of them. The major factor would be standing for long hours. Do remember that losing weight will not automatically 'cure' varicose veins, only prevent its recurrence after it has been operated on. That being said, so long as your varicose veins have not been operated on, exercising, especially high impact ones, really should be avoided. Best to get your varicose veins operated on before you get seriously involved in your mission to lose weight.

 

How can a woman minimize varicose veins during pregnancy?

Compression garments for wear during pregnancy are very useful for at risk women.

Early in pregnancy, standard Class 1, 15-20 mm HG, 140 Denier pantyhose or stay ups can be worn at work to good effect and appearance.

Later in pregnancy, similar items with an abdominal panel are available from hosiery suppliers. They need to be fitted to each person.

Throughout pregnancy, exercise tights are available. These also need fitting.

All such items are harder to wear after 37-38 weeks but by then, the women will be at home and can try to put her feet up more!

Garments to be worn for 6-8 weeks after delivery, then pack away for next time! Patients rarely require firmer Class 2 garments.

Resume wearing usual commercially available support hose or tights at work. Use compression tights (Skins, 2XU) when exercising.

Consider having sclerotherapy as a young women to control your varicose veins before pregnancy. On occasion, sclerotherapy between pregnancies is helpful.

 

Will riding a cycle be beneficial for one having varicose veins?

Cycling can help prevent varicose veins and also relieve pain from pressure of current varicosities. While it may decrease their large appearance, it will not totally get rid of varicosities already formed. But really, any exercise or massage of the calf muscles will help improve or prevent varicose veins and cycling is definitely a wonderful way to keep your calves moving.