What Are Varicose Veins?
Varicose veins are abnormally swollen, twisted, blue veins that protrude from the surface of the skin usually on the legs. The role of normal veins is to carry blood back from the leg to the heart. Some lie just beneath the skin (‘superficial veins’) and some lie deep in the leg beneath the muscles (‘deep veins’). Varicose veins arise from the superficial veins. The leg muscles squeeze the deep veins during walking, pumping blood out of the leg. All of these veins contain one-way valves to ensure that the blood flows towards the heart. Weakness of the vein wall allows valves in the superficial veins to stretch so that they do not close properly. Blood then flows back down into the leg along these veins. The veins and their tributaries enlarge and can be seen on the surface as varicose veins. Raised pressure in these veins encourages the development of spider veins and discoloured areas which look like bruises. The damaged valves cannot be mended and the best way to cure the problem is to take out the affected veins. All varicose veins are removed leaving only the normal vessels so that venous blood can no longer flow the wrong way, back down into the leg. It is thus perfectly safe and indeed beneficial to remove varicose veins.
The removal of varicose veins does not affect blood flow because other veins and especially the deep veins take over this job. Varicose veins are usually obvious due to their visibility, especially on standing. They are enlarged and tortuous often bulging beneath the skin. Early symptoms include discomfort, aching, heaviness, fatigue, burning, throbbing and cramps. They may be associated with areas of thread veins on the skin. If left untreated, irritation of the skin around the ankles with swelling of the feet (worse at the end of the day) and discolouration may occur. Finally, eczema, phlebitis (inflammation of the vein) and ulceration may occur. Large varicose veins can also be easily damaged by a minor injury resulting in profuse bleeding. Many people, however, only suffer the cosmetic embarrassment of visible veins.
Varicose veins often run in families and may affect up to 30% of the adult population in western countries. Men and women develop varicose veins to an equal extent, but women more frequently seek treatment. The problem may arise at any time of life, but is more common with increasing age. Prolonged standing, excess weight, hormonal medications and pregnancy exacerbate the condition.
Why Treat Varicose Veins?
Varicose Veins do not get better by themselves; indeed they get worse slowly and progressively. Early treatment often prevents the symptoms developing and, of
course, removes the unsightly appearance. In fact, the earlier you receive specialist treatment the better the long term clinical and cosmetic results. Treatment is designed for each patient based on the clinical history, examination and investigation with a Doppler ultrasound scan. When functioning normally, the entire system of superficial veins only return less than 10% of the blood flow from the legs. However, varicose veins are not normal veins. They are diseased vessels that allow venous blood to move back down the leg – in the wrong direction as shown in this drawing. This interferes with normal circulation and forces normal veins to work harder. Eliminating the diseased veins is good for your circulation and reduces the workload for normal veins. When varicose veins are eliminated, patients often notice that their legs feel better and less tired.
Diagnosis & Investigation
Careful clinical exaination of the leg veins is necessary before treatment starts. An ultrasound scan is used to assess the veins
which cannot be seen through the skin. This painless investigation allows accurate diagnosis and mapping of your leg veins so that a bespoke treatment of your veins can be offered and provided. Most patients seen by Mr Tsavellas therefore undergo a Sonosite Doppler ultrasound scan of the leg veins at the time of their initial consultation. Colour duplex ultrasound imaging provides a moving picture of the blood vessels in the leg. A blood flow 'map' is added which shows the direction of blood flow in veins. Knowing where the problem has arisen enables accurate treatment to be planned thus reducing the risk of recurrence. Long term recurrence rates are thus reduced to less than 5% in comparison to a recurrence rate throughout the UK estimated to be as high as 30%.
Endovenous Laser Ablation [EVLA] of Varicose Veins
Most patients who are seen by Mr Tsavellas are offered endovenous laser ablation (EVLA) rather than surgical stripping of their veins. Depending on the extent of veins present and the patients preference, this may be carried out on an outpatient basis under local anaesthetic or daycase basis under general anaesthesia. Under ultrasound guidance, a thin fibre-optic probe is inserted through a tiny entry point, usually near the knee (see animation below). Laser energy is delivered in short pulses to seal the faulty vein so that blood cannot flow through it. The lasering is not painful but there is some discomfort from the local anaesthetic injections. The procedure takes about 50 minutes per leg. You may require some additional treatment for management of any residual smaller varicosities in the lower leg – usually through very small stab incisions called avulsions. This can be undertaken at the same time or later, depending on the pattern of veins and type of anaesthetic used. After treatment, the blood in the faulty veins will be diverted to the many normal veins in the leg. Walking immediately after the procedure is encouraged. EVLA has a very good safety record with significant complications being very rare. It is over 95% successful at obliterating the cause of the varicosities and 90% of patients are happy with the results. Recurrence of varicosities after EVLA is uncommon; this occurs in around 5% of cases. Side-effects from EVLA are minor but do expect bruising, with some discomfort most apparent at 5 days and a tight feeling as the vein contracts. Serious complications are very rare but could include DVT (deep vein thrombosis), skin burns, nerve damage causing patches of skin numbness, leg swelling and arterial damage. You will have to wear compression stockings for two weeks after the treatment and we advise that you do not fly for at least three weeks but otherwise you can get on with your life as normal with minimal time off work.
ELVeS® 'PainLess' Laser System from Biolitec
For treating varicose veins, Mr Tsavellas uses one of the latest laser systems - the side-firing 1470nm ELVeS® system from Biolitec. This has inherent patient safety advantages as well as being very effective. The 1470nm wavelength confers the added advantage of minimizing post-operative inflammatory pain and bruising compared to the more commonly found 810-980nm lasers used in many private clinics.
View an Animation of the ELVeS® 'PainLess' Laser System from Biolitec:
EVLA Aftercare Advice
Following your EVLA procedure, you should take a 15mins walk around before you leave the hospital. You are advised to wear your stockings for 2 weeks night and day. You should keep your stockings on for 3 days and nights and only remove your stockings for the first time 3 days after the procedure. Remove the stocking and bandages, and soak in the bath for 5-10 minutes to remove any paper stitches. However you should not stand up without the stockings on, so for this reason you should not take a shower in the first 2 weeks. You should wear the stockings day and night for the remainder of the 2 weeks, but can take them off during this time to take a bath. Take regular pain relief for at least 5 days after the procedure. You are advised to buy some Paracetamol and Ibuprofen before your operation so you have sufficient at home to take regularly. At home, you are encouraged to take regular exercise, including plenty of walking. We advise you to walk for a minimum of 20 minutes in the morning and the evening. It is important to remain as active as possible with several short walks during the day. The two things to avoid are standing still and sitting for long periods, such as in the car, at the dining table or at your desk. When sitting you are advised to rest your legs on a foot stool. You may experience increased discomfort at about 4-5 days. This is caused by the inflammation of the vein and will be helped by the Ibuprofen. Any bruising will resolve over the next few weeks. In addition you can have some lumpiness under the scars and this will also resolve over time. It is safe for you to drive when you feel confident to do an emergency stop and this is normally within a few days after treatment. You may return to work the following day or within a few days depending on your occupation.