Veins in the legs can be superficial or deep. The superficial veins are close to the surface of the skin and drain blood from the skin and underlying tissue while the deep veins are close to the arteries deep in the muscles.
In the superficial system, the great saphenous vein (GSV), is the one most commonly diseased and associated with varicose veins. It begins at the inside of the ankle and
extends up to the groin. Another superficial vein that commonly malfunctions is the short saphenous vein (behind the calf).
Varicose veins can appear as blue, bulging, rope-like blood vessels that protrude beneath the skin (sometimes they can even look like a cluster of grapes). They are often found on the inside of the thigh, calf or on the back of the leg, but can form anywhere from ankle to groin.
Spider veins are similar to varicose veins, but they are smaller and closer to the surface of the skin. They can be red, purple or blue vessels that appear in a spidery or sunburst pattern. They can occur anywhere on the legs, and can cover either a very small or very large area. They don’t bulge as prominently as varicose veins, but may be more noticeable to you. There are some medical conditions that can predispose you to having these spider veins.
Symptoms
Not all patients with varicose and spider veins develop symptoms. The some or all of the following leg symptoms can occur:
- pain (aching, throbbing, or cramping feeling)
- heaviness/tiredness
- burning or tingling sensation
- swelling (usually worse at the end of the day)
- tender areas around the veins
- bleeding or blood clots
- episodes where the veins become red/hot/tender (superficial thrombophlebitis)
Often symptoms are worse at the end of the day after prolonged sitting or standing, and with warm weather. Symptoms may also worsen for women around the time of menses. Relief of symptoms can be achieved ambulation, leg elevation and the use of compression stockings.
Long standing venous disease may result in a condition known as chronic venous insufficiency (CVI). This can cause potentially irreversible skin damage, such as:
- swelling or tightness of the skin (lipodermatosclerosis)
- itchiness / rash in the lower leg (venous eczema)
- darkened skin / brown discolouration (haemocidirin deposition)
- ulcers (wounds) that usually occur around the ankle/shin region and are slow to heal
Diagnosis:
Although varicose veins are visible on the skin, ultrasound is used to definitively diagnose the extent of the vein structure affected, and to assess which treatment options may be available for your individual pattern of disease.
Treatment:
Dr Morrisroe uses a range of techniques to treat varicose veins and she will tailor a treatment for you based on the location of the veins, the severity of disease, and of course, your treatment goals. There are multiple options, summarized below.
Open Surgery – including:
- Ligation – tying the vein off
- Stripping – physically removing the vein by extracting it completely
- Phlebectomy – the removal of the affected vein through small incisions
These “open” surgical techniques have been around for a long time, and they are safe and effective. However, more modern minimally invasive techniques are preferred by Dr Morrisroe for most of her patients. These techniques include radiofrequency ablation and laser ablation for truncal disease. These techniques also have excellent long-term outcomes, whilst allowing for potentially faster recovery and return to work.
Endovenous Radio Frequency Ablation (RFA) / Laser Ablation (EVLA)
This technique is generally used on the larger saphenous veins. Both approaches utilise keyhole techniques with ultrasound technology to collapse the diseased vein(s).
- A tiny incision is made around the lower inner knee area so that a catheter can be passed through the diseased vein under ultrasound guidance.
- The catheter powered by radiofrequency or laser energy purposely damages the vein wall
- The vein wall shrinks and is sealed closed, allowing blood to be rerouted to healthy veins
- Relief of symptoms should occur over the coming days
- Rapid recovery – the average patient resumes normal activities within a few days
Further information available: https://www.medtronic.com/us-en/patients/treatments-therapies/varicose-vein-therapies/our-treatments/closurefast-procedure.html
Sclerotherapy
This is a procedure where a ‘sclerosing agent’ is injected into the affected vein, often under ultrasound guidance. The sclerosing agent allows the vein to close off.
This is the treatment of choice for spider veins when there is no underlying incompetence of the great or short saphenous veins.
*Why closing or sealing off the veins that are not working correctly works well*
When varicose veins are effectively treated, they can no longer carry blood. This helps your circulation because the varicose veins were not working anyway. Sealing or removing the veins that are not working means that the blood can no longer “pool” in the varicose veins, and instead is re-directed into the veins which work so that the blood is returned to the heart in a reliable way. When blood “pools” in the varicosed veins it leads to high venous pressures and can lead to the complications listed above.
After treatment, the venous blood makes its way back to the heart through the remaining vein structures. Prior to treatment (using an ultrasound); Dr Morrisroe will check that your deep veins are working well, and that your varicose veins are suitable for intervention.
