When should I be concerned about varicose veins? How is varicose veins treated?

Varicose Veins

The presence of varicose veins is obvious to the person who has them. The single most important factor that determines whether or not one gets them is the family background. A tendency toward varicose veins is apparently inherited.

Understand that the veins you see and feel as varicose are normally present; in the diseased state they become more prominent, conspicuous, tortuous and distended because the blood in them flows backward. Varicose veins result from diseased, improperly functioning valves in the large leg veins. Instead of keeping the blood flow from the legs going toward the heart, they allow the blood to pool back into the leg. Thus, normal veins become increasingly prominent by backflow distention.

The process simulates closing off the nozzle of a garden hose while the faucet continues open; the hose becomes distended and wiggly and can even start to leak in weak spots.

What do you mean that these red and blue spidery streaks are not ordinary varicose veins?
What you are seeing are enlarged tortuous little veins within the skin called venous spiders. Varicose veins are different; they occur beneath the skin. These little purple dots and lines in the skin, so common in the thigh areas after pregnancy, are not suitable for surgical treatment. All blue streaks, blue spots and lumps in the leg are not varicose veins. Sometimes a groin hernia or a lymph gland or vascular tumor of the skin can simulate a varicose vein.

Are all prominent veins varicose veins? 

Definitely not. The venous anatomy varies considerably in normal individuals. You have only to look behind the knuckle area of the hand to see the individual variation. Not all distended veins are varicose. A varicose vein is one in which the direction of blood flow is reversed. How can you be sure, then, that these veins are varicose? In the office a series of simple examinations are performed with a tourniquet applied in various positions. This test will demonstrate the direction of blood flow and indicate the procedure that will correct the problem.

Can you prevent varicose veins

Probably not. The disease is often seen in people who do a lot of motionless standing or sitting or who are on their feet a great deal of the time. It is also often seen with the increased abdominal pressure of pregnancy.

What are the preventative measures? 

These include frequent changes in position, calf muscle exercises, supportive bandages, weight control and good foot and shoe hygiene. It is also best to avoid the constricting effect of certain kinds of garters and girdles.

Do varicose veins occur only in the legs and thigh areas? 

The kind of varicose veins we are considering do not occur in the upper extremities. The varicosities in the arm or hand have an entirely different cause, as do the prominent veins that appear anywhere in an area of injury. Although true varicose veins are most obvious in the leg and calf and about the knee, they also can occur in the upper thigh and about the genitalia.

Do all varicose veins need treatment? 

By no means. If there are only a few prominent veins, surgery either is unnecessary or can be delayed to see if they become progressive. Small veins cause no symptoms, and patients consider having them attended to only for cosmetic reasons.

What kinds of varicose veins do require treatment? 

When the veins are so numerous that they create a large pool of blood in the legs, there is the danger of an ulcer developing near the ankle. Since the ulcer can be difficult to treat, it is better to prevent it. If the veins become clotted, there is the danger of phlebitis. In unusual instances these veins can be the source of a blood clot to the lungs. In general, more people have varicose veins than require treatment for it. The operation should not be undertaken for trivial cosmetic reasons.

What is a varicose ulcer? 

This is the result of a long standing vein disorder. The area about the ankle becomes discolored, usually assuming a brownish hue, and the skin in the area becomes tight and thin. If the area is injured, even by a minor blow, the skin will break, there will be bleeding, and a chronic sore will form. These areas tend to enlarge and with time they ooze.

How is the varicose ulcer treated? 

The treatment is adjusted to the size and depth of the ulcer. Minor ulcers often heal completely with surgical ablation of the appropriate varicose veins. In the more difficult problem some aid is offered by the prolonged postoperative use of an appropriately medicated bandage. Large deep ulcers will require removal of the deep tissues and a skin graft covering of the defect. In general, the results are functionally satisfactory.

When can injections be used to treat varicose veins? 

The material injected is an irritating substance that produces an inflammation in the vein in the hope that this will obliterate it. Injections can be expected to be helpful with only minor varicose veins or those that persist after an otherwise adequate operation. This method should be used infrequently, with caution and only in specific instances.

What is a varicose vein ligation operation? 

To ligate a blood vessel means to tie it off. In this exact sense the term is loosely used in all referring to this operation, because the diseased veins are cut and then ligated. An adequate operation for varicose veins requires that the principal varicose vein in the groin and all its tributaries be ligated and divided at the junction with the normal deep vein of the leg. Ligation and division are also required whenever there is superficial venous incompetence above and below the knee, in the calf, about the ankle and in the back of the knee.

What is a varicose vein stripping operation? 

This procedure strips out, that is, it actually removes, the large superficial varicose veins and some of their branches from the thigh to the ankle area. Almost the entire length of the main vein is removed.

Which operation is more likely to be effective? 

The operation has to be modified for each individual. Today most surgeons map the part that requires treatment by marking out the varicose veins on the skin with an indelible pencil just before the operation. The usual procedure is a stripping (removal) of the vein with multiple ligations.

Does that mean that there will be several incisions? Can both sides be done at the same time? Will I be asleep? 

There will be an incision in the groin, another at the ankle, and several about the knee and calf area. They are necessary to gain access to all the "blowout" areas that require ligation, stripping and excision. Both sides can be operated on at the same time, each side by a team of two surgeons working simultaneously. The operation can be done with you asleep or awake, as you prefer. You will feel nothing. In certain patients the procedure can be done under local anesthesia.

What kind of a result can I expect? Is the operation risky? 

Ordinarily this is among the least risky operations, and major complications are uncommon. Satisfactory results of this operation can be anticipated. Frequently, however, they do not always conform to the patient's expectations. The incisions often heal somewhat slowly, but they do heal firmly. Most of the varicosities will be gone, but areas of discoloration, prominent capillaries, and scars will remain. You should not require special stockings after this procedure, and the function of the limb should become more satisfactory. A few prominent veins may remain. These can then be treated by injection. If the operation is not delayed until the disease is far advanced, the results can be exquisite.

What are Varicose Veins?

Why can't my grandmother's varicose veins be fixed?

In this case the superficial veins that you see as varicose are associated with an obstruction, a phlebitis, of the deeper veins, and the primary disease is in the deeper veins. This requires a nonoperative treatment, at least in the beginning, including supportive bandages, intermittent leg elevation to 45° at bedtime and when sitting. Calf and toe exercises and the avoidance of injury are advised. A poorly timed or planned operation in such an instance may make the leg much worse. About eight out of ten such cases can be managed without surgery.

My varicose veins came on with the pregnancy. Shall I have them fixed during the next pregnancy if they get worse, or shall I have it done before? Varicose veins can appear or become worse in the first three or four months of pregnancy, and then they tend to improve. These operations should not be done during the pregnancy except in very special instances. The veins often get somewhat better after the delivery. However, if significant varicose veins are present six months after delivery, the operation should be done then because they get worse with each pregnancy. It is sometimes amazing how prominent veins caused by pregnancy can disappear by the third month after delivery. Consideration for surgery should be deferred for at least that long. I've been operated on and still have varicose veins about the vulva and behind the knee.

This is not an uncommon problem. It means that the veins feeding the area have not been tied off. Another properly planned procedure is required to correct this.

What happens if you don't treat varicose veins?

In unusual instances the disease remains stationary. Usually the veins become increasingly prominent, the cosmetic disfiguration more marked, and the danger of a varicose ulcer, phlebitis and bleeding through the skin is increased. However, you can try a regime of properly fitted supportive bandages and leg elevation exercise as a way of possibly preventing rapidly aggravation of the process.

I hear of so many dissatisfied people who still have the prominent veins.

There are several possible explanations. The disease may have been far advanced. The operation may have been incomplete. This is not minor surgery. It has to be planned carefully and completely and carefully carried out. It is a hospital procedure and cannot be done with less than full facilities. If the treatment is below standard, the results will be the same. In addition a detailed regime of supervised postoperative care is required. Patients compare the obvious results, for this is an area where the surgeon's proficiency can be really inspected. However the results must be considered in terms of the initial problem.

Varicose Vein Exercises

What period of hospitalization is required for an ordinary varicose vein operation? How long does varicose vein surgery take?

The average stay can be short, in one day before and out the day after the operation. Bandages are often required for two or three weeks. You are ambulatory during the entire period.


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