All about Varicose Veins

Those discomforting blue and purple bulges under your skin look awful when you look at them. They are varicose veins. It may not be a very serious condition but it may lead to other critical conditions. Dr. Ami Dodiya pens down everything you need to know about varicose veins.

Varicose veins are abnormally dilated, elongated, tortuous veins occurring due to damaged venous valves under the skin. They appear blue or purple bulges under your skin normally on your legs, ankle or feet.

Varicose veins are not considered to be critical but in severe conditions it may lead to other critical conditions.

Causes of varicose veins

1. Hormonal factors: Imbalance in estrogen and progesterone levels can cause dilatation of the blood vessels and which may lead to varicose veins.
2. Pregnancy: When a woman carries a baby, the weight of the baby may compress the major blood vessels in the pelvic region causing varicose veins.
3. Other causes: obesity, sedentary lifestyle, standing for long hours (athletes and models).

Symptoms

• Bulging over the affected area with pain.
• Pigmentation
• Itching
• Bleeding
• Blackish discolouration
• Ulceration (last stage)

Diagnosis

• Gender: Very common in females.
• Medical history: Any previous medical history of varicose veins can cause varicose veins as it has genetic predisposition.
• Height and weight of the patient: Varicose veins being common in obese patients.
• Physical examination of the prevalent condition.
• Colour doppler ultrasound: This is the most important investigation to check the size, severity, intensity or any blood flow destruction by the possible presence of blood clots.

Management

• The management of varicose veins is based on size, symptoms, severity and location over the body parts. The management of varicose veins can be done through medications as well as surgical intervention.
• It is important for one to manage the varicose veins depending upon its severity. If a patient doesn’t follow any management then there are possibilities of varicose veins getting more severe and the patient might end up having bleeding, ulceration, deep vein thrombosis (clot gets dislodged into major vessels) and chronic venous insufficiency (damaged vessels are incapable to push the blood towards the heart).

Conservative way of management

1. For obese patients: The primary advice for obese patients is weight reduction by diet control and ample amount of exercise.
2. Lifestyle issue: The primary advice is lifestyle changes like addition of some kind of physical exercise to the routine. For people who have long standing hours can practice postural change every few minutes.
3. cosmetic concern: Varicose veins can look ugly on the skin and hence certain people’s major concern is the same. There are primarily two options for the same - one is a conservative treatment by applying stockings regularly for 3 months. The other one is an intervention by Foam Sclerotherapy in which a solution is injected into the blood vessel that will shrink the diameter of the vessels and works like magic.

Operative way of management

1. Open: It is the high ligation and vein stripping method.This procedure involves tying off a vein before it joins a deep vein and removing the vein through small cuts. It is rarely practised nowadays.
2. Endovascular: These are daycare procedures done under local anaesthesia and the patient can resume work from the very next day.
   1. Endovenous Thermal Ablation: In this method the affected area is exposed to the laser energy, the heat of which will be carried by a fibre catheter in order to destroy the walls of the vessels.
   2. Mechanochemical Venous Ablation (MOCA): In this method, a thin-fibre like catheter is introduced in the varicose veins but instead of thermal energy, a chemical is injected that destroys the walls of the vessels.