VARICOSE VEINS

Varicose veins are dilated, tortuous veins in the legs, just under the skin. They are very common, being more common after pregnancy in women. They are caused by the valves within the veins not working properly, allowing blood within them to leak downwards, rather than being forced upwards, back to the heart. Varicose veins are very rarely dangerous, but can give rise to a number of troublesome symptoms.

Initial consultation.

At your initial consultation, a detailed history regarding the problems you are having with your legs will be taken. Whilst some people do have symptoms in their legs, many people, understandably, are concerned about the appearance of their legs. After discussing your concerns, your legs will be examined, which may include the use of a hand-held doppler. This is small device, which can detect abnormal blood flow in veins. A management plan will then be discussed with you, which may include further tests, such as a duplex ultrasound scan.

One stop clinic.

At Spire Murrayfield Mr Burns is able to offer a 'One-Stop' clinic. This combines a full clinical assessment with a duplex ultrasound assessment of varicose veins in one appointment. This allows the majority of patients to leave with a full management plan, without having to return for a scan on a separate appointment. Occasionally, patients may need to return for a more detailed scan at a separate time.

THORACIC AORTIC ANEURYSM (TAA)
NORMAL VEIN

THORACIC AORTIC ANEURYSM (TAA)
VARICOSE VEIN

Symptoms.

  • The most common symptom that people notice is heaviness, or aching in the leg, particularly towards the end of the day, and especially if they have been on their feet a lot.
  • Pain. Severe pain is uncommon with varicose veins. If accompanied by a hard tender lump it can be due to thrombophlebitis. This is where some blood clots within a varicose vein. This is distinct from a blood clot deep inside the leg (a DVT), and although painful it is not dangerous.
  • Bleeding. This is something that many people with varicose veins worry about, but is actually exceedingly rare.
  • Ulceration. Again, many people are concerned that varicose veins will give them leg ulcers. This is also very unusual. Leg ulcers usually occur in people of who have other problems with their legs rather than just varicose veins.

Diagnosis.

Usually the diagnosis of varicose veins is apparent on examination, and no special tests are required to make the diagnosis. An ultrasound examination (similar to the type of scan used to examine babies before they are born) is often useful when planning treatment. This is painless and requires no x-rays or injections.

Treatments.

A number of treatments are available at Spire Murrayfield Hospital and Shawfair Park. Depending on the problems you have had, surgical treatment may or may not be available on the NHS.

Compression stockings.

The symptoms from varicose veins can usually be treated by well-fitting compression stockings. They can be prescribed by your GP, and are available in a variety of styles.

Open surgery.

This is the traditional method of treating varicose veins surgically, and is done under a general anaesthetic. This usually involves a small cut in the groin, and a smaller cut at the knee. The vein which runs between the two incisions is gently pulled out. The remaining visible varicose veins are removed through tiny incisions (avulsions). This technique is still widely used, and works well, but it can give significant bruising in the thigh which can delay returning to activity.

Radiofrequency ablation. (VNUS™ or Venefit™).

This technique uses a heater probe, inserted into the vein with a needle, which destroys the vein from within. This avoids the cuts in the groin and the knee and the associated thigh bruising. Although the technique can be done under local anaesthetic, Mr Burns finds most patients prefer to be under a general anaesthetic. Typically patients return to normal activity more quickly than with open surgery. A demonstration of the technique can be seen here.

Foam sclerotherapy.

This treatment uses a foam of sclerosant (a liquid irritant to the inside of veins), injected into the prominent veins in the leg. It can be performed under local anaesthetic, although the technique is usually performed in conjunction with one of the techniques above.

Aftercare.

All of the treatments above require the wearing of a tight bandage for 24 hours, which is then swapped for a compression stocking – usually for 1 week. This helps minimise any bruising, and maximises the benefit from treatment. Open surgery requires stitches, but these are dissolvable, and do not require to be removed. All the wounds with radiofrequency ablation, and the avulsion wounds are closed with steristrips (sometimes known as ‘butterfly stitches’). These will peel off on their own after about 7 days.

Pain relief.

You will be discharged from the hospital with some painkillers. Most patients after radiofrequency ablation take find some paracetamol for 3-4 days is sufficient, whilst stronger painkillers may be required after open surgery.

Returning to activity after varicose vein treatment.

Everyone varies, but the following is intended to be a guide to help you plan your recovery. Normal day to day activities around the house can be resumed over the 2-3 days after treatment. Prolonged resting is actively discouraged, as long periods of immobility are a known risk factor for deep venous thrombosis. As a general rule you should take a 5 minute walk around the house every hour while you are awake in the period after varicose vein treatment.

  • Driving. You need to be able to control your vehicle safely, including pressing the brake in an emergency. Most people find they are able to do this 3-4 days after radiofrequency ablation, and 1-2 weeks after open surgery.
  • Bathing / showering. You should let the wounds seal over completely before getting them wet – normally about 7 days. You can shower or bathe during this time by putting your leg in a plastic bag and taping up the top. Obviously swimming with this type of arrangement is difficult, and will need to wait for 1 week after your treatment.
  • Vigorous exercise. If you do vigorous exercise too early, you are likely to increase the amount of bruising you get, and may prolong your recovery. You are advised to take a two week break from anything too strenuous, and then increase it gradually.
  • Work. Returning to work will obviously depend on your individual circumstances, although most people are back at work 1 week after radiofrequency ablation and two weeks after open surgery.

Risks and results of treatment.

The results of varicose vein treatment are usually excellent, and the vast majority of patients are very pleased, but as with any medical treatment, varicose vein surgery is not risk-free.

Cosmetic result.

In general, the cosmetic result with modern techniques is excellent. Usually any scars are no larger than 2mm, and are barely perceptible.

Improvement in symptoms.

The vast majority of people report reduced aching, heaviness and tiredness in their legs. Patients also say they suffer less leg cramps at night, and an improvement in ‘restless legs’, but this is less consistent.

Bruising.

Some bruising is almost inevitable, but is far less with radiofrequency ablation than open surgery. The bruising can be ‘lumpy’, but it will eventually resolve.

Recurrence.

Varicose vein treatment will not remove your tendency for your veins to become dilated. If you wait long enough, you will develop varicose veins again, but this is usually 15-20 years.

Infection.

Very occasionally, the small cuts that are made can become infected. This is no different to any other operation. This is less likely with radiofrequency ablation than with open surgery.

Nerve damage.

There are small nerves which supply sensation to the skin running close to the veins which are removed. This can result in small patches of numbness in the skin. In about 3% of cases this is permanent. If this is the case, it is unlikely to be bothersome, or interfere with your life in any way.

Deep venous thrombosis (DVT) or pulmonary embolus.

This is the formation of a clot in the veins deep inside the leg (DVT), which can break off and travel to the lungs (PE), which in theory can be fatal. The risk of this is extremely low, but is not 0.