The varicose vein consists of: - A. Venous insufficiency or venous reflux at groin B. Prominent and dilated perforators. C. Dilated tortuous side branches.

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The most common presenting with symptoms: -

• Pain (some time on & off).
• Swelling more prominent in end of day.
• Heaviness in leg.
• Fatigue.
• Prominent & dilated veins in leg veins.
• Pigmentation.
• Venous ulcer. 

The causes

The important causative factors are obesity, lack of exercise, abnormal pressure on veins during pregnancy, abnormal life-style, prolonged standing and prolonged sitting with legs down. Due to advanced age, overweight and lack of exercise veins of legs become very weak and, therefore, develop into varicose veins.
Today a lot of occupations and professions have sprung up where a person is required to either constantly stand up for a long time or made to sit with legs hanging down for a considerable time. Computer professionals, receptionists, security guards, traffic policemen, salesmen working at counters in shops and departmental stores and persons doing desk jobs day in and day out are the worst sufferers of varicose veins.

Women are more susceptible to varicose veins?

Among females, due to some hormones, the walls of veins become enlarged and dilated. Besides, during pregnancy because of a lot of pressure on leg veins, these become weak and varicosed. Fashion is playing havoc among women. High-heeled sandals and tight belts and panties are significant contributors to the development of varicose veins, as these items obstruct the normal flow of blood in the veins.

Diagnosis of varicose veins

This is done by general examination and ultrasound Doppler study which can show the exact site of disease in the form of damaged valves & dilatation of veins.

Picture shows venous incompetence on Doppler & leg shows swelling & marked pigmentation.

Effects on leg & complications

Bleeding from Superficial Veins - long-standing high pressure in the veins may develop an area that bleeds through small sites, no larger than pinholes. Most of these occur around the ankle, but spontaneous bleeding can also occur anywhere there is high venous pressure

Venous pigmentation, also known as Hemosiderin staining of the skin is a relatively common late complication of untreated superficial venous insufficiency or venous reflux resulting in chronic venous hypertension.

Venous stasis dermatitis, also known as venous eczema, is a common inflammatory skin disease that occurs on the lower extremities in patients with severe chronic venous congestion. It can arise as discrete patches or affect the leg all the way around the ankle. Symptoms of this condition include swelling (typically concentrated around the legs or ankles), changes in skin color and texture, and pain. The affected skin is itchy, and assumes red, purple, or brown colors.

venous stasis ulcers, is the most serious complication of untreated superficial venous insufficiency and chronic venous congestion.

Superficial venous thrombosis is a blood clot, or thrombus, which develops in a vein close to the surface of the skin. The blood clot commonly appears as a red streak along the course of an affected vein, which may feel warm and tender or swollen due to inflammation (phlebitis).
Deep vein thrombosis (DVT) - occurs when a blood clot forms in the deep veins of the body, usually in the leg. Total occlusion of one or more of the major leg veins and the impaired blood return to the heart results in massive leg swelling. 
Pulmonary embolism - blood clot forms in the deep veins of the body some time migrate to lungs vein it may lead to death also if undiagnosed.

 

Treatment options for varicose veins

• Non-surgical treatment by RFA (radiofrequency ablation or laser)

• Conservative Treatment: - Elevating and flexing your legs can help reduce leg swelling and relieve other symptoms. Compression Stockings: - Compression stockings are elastic stockings that squeeze your veins and stop excess blood from flowing backward. You may be required to wear compression stockings daily for the rest of your life.

• Sclerotherapy: - This is only for short segment disease.

• Vein Stripping Surgery

  It is a major surgery. Physician disconnects and ties off all major varicose vein branches associated with the saphenous vein, he then removes the saphenous vein and varicose veins from your leg surgically. The recurrence rate is too high and it leaves ugly scars. It needs 2-3 weeks for recovery.

 

Non-Surgical treatment for Varicose Veins - Radio-frequency Ablation

Radiofrequency ablation (RFA) is the latest and most effective, patient friendly and non-surgical treatment for varicose vein using Multipolar RFA machine.Under color-doppler ultrasound vision, a radiofrequency catheter is inserted into the abnormal vein and the vessel treated with radio-energy, resulting is closure of the involved vein.
The interventional radiologist (are uniquely skilled in using the vascular system to deliver targeted treatments throughout the body without surgery) accesses the abnormal saphenous vein just above ankle or below the knee percutaneously through a small cannula in abnormal vein. Ablation uses a thin, flexible tube called a catheter with tiny electrodes at the tip of the catheter, which heat the walls of the varicose vein, and collapses the thick veins.

Advantages of Treatment with RFA

• It is less risky as compared to surgery.
• No surgical scar on skin.
• Procedure done under short / local anesthesia.
• It is done as day care or 24 hrs hospital stay.
• Patients can resume normal activities within a day.
• The recurrence rate is very low as compared to surgery.

Non surgical treatment vs. surgical treatment

	Best Option
FREQUENTLY ASKED QUESTIONS	Non-surgical treatment , Radiofrequency Ablation	Surgical treatment , Stripping Surgery	Non-surgical Laser
1. Success rate	More than 98%	About 60%	About 70-75%
2. Anesthesia	Local or mild	General	Moderate
3. Hospitalization	Day care	1-2 days	Day Care
4. Scar in leg	Nil	Yes more than two or three	Nil
5. Blood loss	Nil	Yes	Nil
6. Major advantage	Treats Incompetence at groin, perforators, and side branches also.	Removal of main vein. Need another surgery for perforators	Treat only main vein. Need another surgery for perforators
7. Recovery	Few hrs	1-2 days	24 hrs
8. Full recovery	Few hrs	3 weeks	1-2 days
9. Recurrence	One %	More than 20-40 %	More than 30%
10. Cost	Less expensive	expensive	expensive
11. Treating associated abnormal vein	Yes in same sitting	No	No