"Treating Varicose Veins" from The Star

Whether varicose veins is a cosmetic concern or a painful condition, it can be treated.

VARICOSE veins may not be one of the medical terms that is used by the average person, but its signs – the gnarled, enlarged, and sometimes discoloured veins that line many women’s and some men’s legs – are quite well known in an average household.

Just ask any woman above the age of 50, and she will likely tell you that she knows someone who has it. Nevertheless, as varicose veins are mild in many people, what you would also hear is the misconception that it cannot be cured and people just tend to live with it.

“Most patients simply tolerate the heaviness and discomfort in their legs,” says Tropicana Medical Centre consultant vascular surgeon Dr Lee Soon Khai. “However, if left untreated, varicose veins may lead to complications.”

Genetics and age

Varicose veins are not limited to the legs, although they are most commonly found on the back of the calves and on the inside of the thighs.

 

It happens when our veins (blood vessels that channel deoxygenated blood from various parts of the body back to the heart with the help of surrounding muscles) lose their capacity to return blood to the heart due to the weakening of the valves inside. This can be caused by age, prolonged strain due to long hours of standing, obesity, or hormonal changes in pregnancy.

As the one-way valves are there to make sure that blood only flows towards the heart, weakened valves will allow blood to flow back and fill the veins rapidly, causing them to enlarge and become convoluted to accommodate the extra volume.

“Most of the cases are hereditary in nature,” says Dr Lee. Studies have shown that the risk of one having varicose veins is 80% if both parents are affected, and 50% if only one parent has it.

Even if both parents do not have a history of varicose veins, one could still have a 23% chance of developing it, Dr Lee explains.

While it affects both men and women, mostly when they are 50 to 60 years old, women are four times more likely to have it.

Possible complications and treatment

Although the problem is cosmetic for many people (they feel no pain), varicose veins can cause the legs to ache and feel tired easily.

Pain, heaviness, itching, cramping, and swelling of the leg are also common. When left untreated, a small percentage may develop complications.“Besides increasing pain and swelling, skin changes can occur,” says Dr Lee.

The increased pressure on the veins can cause fluid to leak out into the space in between surrounding tissue and result in slow wound healing. By then, even a small scratch or a minor injury may cause bleeding or the development of a chronic ulcer.

According to Prince Court Medical Centre consultant general and vascular surgeon Dr Tan Kong Hean, of the 10 to 15 patients (with varicose veins) he sees a month, there are some who do not need treatment and some who definitely need treatment due to complications. Others seek treatment for cosmetic reasons.

Varicose veins due to pregnancy generally improves without treatment within three months after delivery.

But for the condition brought about by other causes, treatment choices include surgical and non-surgical ones.

Non-surgical treatments include simple self-care methods to reduce discomfort and the use of compression stockings.

Self-care methods like losing weight, avoiding tight clothes, elevating your legs, and trying not to stand or sit for long periods can reduce the strain we put on our legs.The use of compression stockings – elasticised stockings that cover the toe to the knee, or sometimes up to the thigh – can also help improve the flow of blood back to our heart by squeezing our legs.

As for surgical measures, surgeons can either remove one of the veins in the leg with a procedure called vein stripping and litigation, or close it off by burning (radiofrequency heating) or sealing it shut with chemicals (sclerotherapy).Now, surgeons also have the option of closing off the vein by “burning” it shut with lasers in a procedure called endovenous laser surgery. With endovenous laser surgery, patients are able to walk immediately after the procedure and can be back to their usual activities within one week, says Dr Tan.

While patients may sometimes need a repeat procedure, Dr Tan says that it is very uncommon. The chances a person would need a repeat procedure in three years is less than 10% from the results of long term studies currently available, he notes.

Unfortunately, non-surgical measures can only help reduce the symptoms of varicose veins. However, surgery to remove or close off the affected veins is often considered when non-surgical measures fail.

“Non-surgical treatments (compression stockings) may help those with mild reflux (back flow) and symptoms. If symptoms do not improve, or worsen, they need to consider surgical treatments,” says Dr Lee.