Varicose veins are a very prevalent condition that no one really talks about as an illness. People who have not experienced them may think they are purely a cosmetic eyesore, but they are, in fact, a component of a condition called venous disease. Patients who have it know the pain and discomfort varicose veins cause in their legs.
Our legs contain a relatively complicated system of veins which rely on little valves to circulate blood back up to the heart after it has been brought down by the arteries. These valves are fairly fragile and deteriorate over time. Once that happens, the blood doesn’t go up effectively and hydrostatic pressure starts to build, causing veins near the skin’s surface to bulge and discolor. As the condition progresses, symptoms such as pain, aching, heaviness, and itching may occur. In later stages skin ulceration can develop.
Around 40 percent of the general population will develop varicose veins at some point in their life. For most patients, they typically start to manifest by middle age, but I have also seen teenagers with varicose veins. In some patients, family history and heredity are significant risk factors. Some people who have to stand for long periods of time at their jobs are also at risk. Obesity and pregnancy can also increase the likelihood of varicose veins. Making healthy lifestyle choices, such as not smoking and exercising, can help prevent them.
Compression hose or stockings can be used to treat varicose veins in a non-invasive manner. Some patients can manage their discomfort quite well when combining their use with regular leg elevation and exercise. Unfortunately, many patients don’t wear them as directed because they can be difficult to put on and can be warm, especially in hot weather. More definitive treatment options are available and depend on the size and extent of the veins. We can administer injections for smaller veins, commonly known as spider veins. For larger veins, a surgical procedure becomes the best option to alleviate the pain and swelling.
Up until about 10 years ago, varicose veins were traditionally removed via a surgical procedure known as stripping which, although effective, involved multiple incisions and resulted in significant bruising, swelling, and pain following the operation. Recovery and time out of work were also substantial. A newer, less invasive technique involves passing a small catheter inside the vein, and then using either a laser or a radio frequency electrode. The inside of the vein is heated until the collagen fibers contract and the vein shuts down. This procedure can be done as an outpatient using only a local anesthetic. Many patients drive themselves or even walk home following the procedure. The swelling, bruising, pain and recovery are significantly reduced compared to the stripping operation.
It should be emphasized that no surgery or other treatment can promise a complete and permanent cure of varicose veins. Treated patients can develop recurrent varicose veins, but most can expect good long term control of symptoms, especially when combined with exercise, weight control and healthy lifestyle choices. A physical exam and ultrasound test is all that’s needed to check for venous disease, and treatment is covered by most insurance plans. Talk to your primary care provider or call Brattleboro General Surgery if you would like a consultation about varicose veins.