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Varicose veins are visible, distended and tortuous veins in the legs that arise due to damage to the valves in the veins.

In the leg, the veins bring blood from the feet back to the heart. Valves in the veins prevent the blood from flowing back down the leg due to gravity. When these valves become damaged, blood will flow downwards to the feet. This increases the pressure inside the veins, causing the veins to become distended.

One known risk factor is having a past episode of Deep Venous Thrombosis (DVT). DVT damages the valves in the veins and leads to eventual reflux in the deep veins.

Other risk factors for developing varicose veins include occupations that require prolonged standing, e.g. teachers, salespersons and nurses. Being overweight also may increase the pressure in the veins in the legs, leading to varicose veins.

Varicose veins are usually a cause of concern as they appear unsightly. They may also give rise to symptoms such as:

  1. Calf discomfort after prolonged standing or walking
  2. Foot swelling at the end of the day
  3. Night cramps in the calves

It is also important to exclude other conditions that may give rise to similar complaints, such as peripheral arterial disease, spinal stenosis and prolapsed intervertebral disc.

There are 2 main venous systems in the legs. One set of veins drains the blood along veins near the skin, called the superficial veins. The other set of veins drains the blood from within the muscles of the leg, called the deep veins.

In order to determine which set of veins is damaged and the severity of the reflux, a Duplex scan will be done. This will allow the surgeon to ascertain which veins are damaged and what the best course of treatment is.

  VaricoseVeins

Treatment choices include:
1.    Graded compression stockings

    • Stockings compresses the foot, calf and thigh to prevent distension in the veins. This helps to control the swelling and associated symptoms but does not cure the patient.

2.    Endovenous Therapies

    • Newer and less invasive techniques allow the surgeon to ablate the LSV and treat the reflux without making a skin incision. This includes:
      1.    Endovenous Laser Therapy (EVLT), utilising laser energy
      2.    Radiofrequency Ablation (RFA), utilizing radiofrequency energy
      3.    High ligation and removal of the Long Saphenous Vein
           This is the traditional surgery for varicose veins and involves making two incisions,
           one in the groin and another around the knee to remove the Long Saphenous Vein (LSV).

Dilated veins in the lower thighs and calves can also be treated surgically and removed via small incisions.

Spider veins can be treated with a variety of techniques, including Veingogh.

The most effective method to prevent varicose veins forming is to wear compression stockings to prevent pressure build up in the veins. Other lifestyle modifications may also help, including avoiding prolonged periods of standing and doing regular exercise.

 

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