What are varicose veins and how should they be treated?
Veins are the blood vessels that take the blood from your feet and legs back to the heart, ready for another cycle around the body. This means the blood in your leg veins should flow upwards. When your veins don’t work properly, they let blood flow backwards down the leg. This can cause you to have heavy, achy, tired or swollen legs, which feel worse when standing still. You get relief when you elevate your legs, as the bloods flows up the leg, back to the heart, under the influence of gravity.
If poorly functioning veins go untreated for too long, the skin on the legs can start to suffer. The first signs of this are itching or eczema of the skin, followed by brown pigmentation and eventually a leg ulcer.
People with longstanding varicose veins can develop lipodermatosclerosis. This is a fancy term for hardened woody skin of the lower legs.
Why do veins fail?
There are a few theories as to why your veins ‘fail’.
The main theories are that the valves, which stop the blood running back down the leg, become faulty, and that the vein wall stretches causing the veins to be prominent and bulgy. It’s unclear which comes first, the valves failing, or the walls stretching.
We know that women are more prone to varicose veins. Most people start to have some degree of ‘venous incompetence’ as they get older. Hence the sock marks people notice at the end of the day, and wanting to get home to put your feet up.
Other things that can make you more at risk are:
How do you treat varicose veins?
With any medical treatment, the first place to start is an assessment.
Our doctors take a thorough medical history and examine your legs.
Our doctors have all completed training through the Australasian College of Phlebology. This is the College that maintains high standards and educates Doctors on all things veiny.
Phlebology - the study of veins… not the sexiest area of medicine, but there you are.
How does the treatment work?
The next step is for you to meet our lovely sonographers. They are a skilled and experienced team who will map out the veins in your legs and show us which ones are working properly and which ones are letting the team down. From this map, we plan your treatment.
Large studies have now proven that the ‘gold-standard’ or most effective way of treating varicose veins is with Endovenous Laser Ablation.
This involves closing the faulty vein off with a laser that is gently threaded inside the vein. It sounds horrible, but we perform this procedure under tumescent anesthesia. This means you don’t need to be put to sleep, but also that the procedure itself is pain-free. There is a bit of discomfort involved in giving the tumescent anesthesia, but more in the realms of irritating, rather than painful.
If you are not suitable for laser treatment, the alternative is Ultrasound Guided Sclerothe
Here at Palm Clinic we introduced Ultrasound Guided Sclerotherapy to New Zealand in 1998 as the first non-surgical method of treating varicose veins and in 2003 we added laser treatment (EVLA). During this time we have performed more than 3,000 varicose vein laser treatments and over 10,000 UGS injection treatments. A very small number of people may need varicose vein surgery (we can let you know your best treatment options after your ultrasound mapping).
Whether closing the veins with laser or injection, the end result is diverting the blood to drain through the pathways that are working properly and closing the faulty ones. In almost all cases this leads to a resolution of the aching, itching, swelling or eczema. It is also very effective at healing ulcers caused by varicose veins.
Does the procedure hurt?
Most people report that the legs can feel stingy or inflamed for a month or so afterwards, nothing that stops them getting on with things, but just an awareness.They’re also not too fond of kids or animals bumping in to their tender areas over that time. Usually after a couple of months the tenderness starts to resolve, and their legs start to feel lighter, with a resolution of their aching.
Occasionally, people will say they were in pain, rather than discomfort after treatment. If the veins are rather large, they can require more treatment, which can predispose to more discomfort.
We encourage people to take over the counter pain relief such as panadol and/or nurofen as vein treatment needs to cause inflammation to be effective. In most cases this will be sufficient, but if it’s not cutting the mustard, we want to know about it!
What can I and what can’t I do after treatment?
We do require you to wear some rather ‘attractive’ below the knee compression stockings for two weeks. The first week you keep them on constantly. You sleep and shower with them on. This is for safety reasons, so we tend to be rather strict about it! In the second week, you wear the stockings daily, but can take them off for sleeping and showering.
We ask you to walk for an hour per day. You can split this in to two half hour walks, or even three 20 minute walks. This along with the stockings reduce the small risk of a deep vein clot as a result of treatment.
When can I go back to work?
Most people can return to work straight after they have done their 30 minute walk.
Sometimes we will recommend a week or two off work if you:
- have a strenuous job that requires a lot of heavy lifting/straining
- if you have a job that requires a lot of standing
- if your veins are particularly large and you may require more than the average amount of treatment
What can I expect afterwards?
Varicose veins before treatment feel soft and squishy to the touch. After treatment, they will feel firm, tender and lumpy.
This can sometimes be un-nerving to people, but this is the collapsed down treated veins. Our sonographers are constantly reminding people ‘lumps are good, we like lumps!’
Our scanners are very good at offering reassurance when needed, and checking for anything out of the ordinary.
Over time, the tenderness settles and the body starts to break down the closed vein. When we see you for a follow-up at three months the tenderness has usually settled and the lumps have started to reduce. However they can persist for some months until one day they will just not be there anymore.
What happens if I do nothing?
Unfortunately, if you leave varicose veins untreated they eventually get worse. How long this takes is different for different people.
One can expect the varicose veins to grow larger, have more branches and spread. The skin can worsen in condition, eventually leading to an ulcer.
Varicose veins also have an inherent risk of a clot in the leg due to the fact that they are essentially baggy, loose tubes that are not moving blood very well. Slow moving or stagnant blood poses an increased risk of clotting.
One way to reduce the progression of this process is to wear compression hose, however most people don’t like to wear these in the long term.
If you would like to find out more about varicose vein treatments with a safe and effective non-surgical procedure please contact us or send us a general enquiry for more information. Our trained staff will be happy to answer any questions you may have.