In the human body, blood circulates from the heart to the different parts of the body and back to the heart. This circulation continues throughout life. Blood circulates in special tubes that go to every part of the body. Fresh blood (which is rich in oxygen and nutrients) travels from the heart to the peripheries by tubes called arteries. In the peripheries, tissues such as muscles, skin and bones use up the oxygen and nutrients. The blood becomes poor in oxygen and nutrients. It has more carbon-dioxide and wastes dissolved in it. This so-called “impure” blood returns back to the heart for re- oxygenation. The tubes that carry the “impure” blood back to the heart are called as veins. 

What are varicose veins?

When the veins of the legs are bulged out and tortuous, we call them varicose veins. Varicose veins affect only the lower limbs. Varicose veins are one of the commonest vascular problems. The correct technical term for this problem is “chronic venous insufficiency”. 

Blood in the veins of the leg has to travel back to the heart against the effect of gravity. The veins contain special structures inside them called valves. These valves ensure that the flow of blood in the veins is unidirectional, i.e., only towards the heart. The reverse flow of blood is prevented by these one-way valves. This mechanism ensures that blood does not accumulate in the veins of the lower limb. If the valves fail , they are said to have become “incompetent”. Then the blood will tend to reflux back into the leg veins. These veins get distended whenever the patient stands and the patient develops bulged out, tortuous veins over the leg which we call as varicose veins. 

There are a few known causes for varicose vein disease. Varicose veins are known to run in families. Some patients develop varicose veins at the time of pregnancy , and the veins worsen years later. Varicose veins are known to be more common among professions such as teachers, policemen, shopkeepers and bus conductors who have to stand for a long time daily. A few patients develop varicosities in the legs as a result of deep vein thrombosis (clot in the legs) in the past. This is called secondary varicose veins. Only very rarely is a varicose vein caused by malformations of blood vessels.

What symptoms and signs does a patient with varicose veins have?

Patients may complain of unsightly varicosities on the legs. They also have one or more of the following symptoms: Swelling of the legs; Pain in the legs; Dermatitis or pigmentation around the ankles; Ulcers (wounds) around the ankles which take a long time to heal; Clots in the superficial veins; Bleeding from the superficial veins which can sometimes be profuse.

What tests are done to diagnose varicose veins?

Modern assessment of the varicose veins involves testing with a duplex ultrasound machine. This is a noninvasive test which does not use any chemical injections and does not have any side effects. It involves the use of a special type of ultrasound machine to obtain an image of blood flow through the veins and this image is used to assess the extent of dysfunction of the vein valves. 

In very complex venous disease, the vascular surgeon may use other investigations such as CT scan, MRI scan and venograms. 

What treatments are available for varicose veins? 

There are a variety of treatments available for varicose veins. The vascular surgeon is the best person to advise you regarding the correct treatment in a patient. The available treatments are: 

  1. Conservative therapy. This involves attempts to limit the progression of varicose vein problems. It includes use of stockings (special extra-tight socks), changes in lifestyle and habits (avoid standing for long periods, regular walking, control of obesity). These measures provide symptomatic relief.
  2. Sclerotherapy (injections given to block the varicose veins) This involves use of special medicines called sclerosants. It is generally an outpatient procedure and involves the injection of sclerosant chemicals into the vein to cause occlusion of the varicose vein. 
  3. Surgery for varicose veins involves the removal of veins which are diseased. This usually involves admission into the hospital and administration of anesthesia. A special stripper instrument is used to remove the long veins of the leg which have become varicose.
  4. Endovenous treatments. There are two types of endovenous therapies. These are radiofrequency ablation and laser ablation of varicose veins. Both types of treatments involve the destruction of the diseased vein by passing a special fiber or catheter into the vein and using radiofrequency energy or laser energy to burn the vein from inside. These therapies show great promise.

The various forms of treatment for varicose veins differ in terms of indication as well as efficacy. 

Conservative management is the least effective in the long term.Some scientific trials show that sclerotherapy , while effective in the short term, has poorer results when compared to surgery. The cosmetic results of sclerotherapy are better in short term (<12 months) but the durability and efficacy of surgery in better in the long term. Clinical effectiveness of endovenous therapies (laser and RF ablation) are comparable to surgery.

(Reference: Systematic review of treatments for varicose veins by Leopardi et al in the Annals of Vascular surgery ,Vol 23, Number 2, March 2009).