About Varicose veins
Varicose veins are enlarged, twisted and distorted vessels which
affect half of people age 50 and older, and 15 to 25% of all adults
in North America. Although any vein may become varicose, leg veins
are most commonly affected. This is because people spend much of
their time sitting or standing which increases the pressure in the
veins in the lower body.
Varicose veins are produced as a result of defective venous
valves within leg that fail to close properly. This causes blood to
flow backwards (reflux) towards the feet and pool in the lower legs
(especially when sitting or standing). This causes the veins to
distend and bulge out and, over time varicose veins may
develop.
Risk factors for varicose veins include: age, family history,
female gender and pregnancy. Other contributing factors include
hormone replacement therapy, birth control pills, obesity or
sedentary lifestyles, and professions that require prolonged
standing or sitting.
Varicose veins are not only of cosmetic concern but can also be
associated with swelling, aching, tenderness as well as a tired or
heavy feeling in the legs which often worsens as the day
progresses. As time goes on, chronic skin thickening, discoloration
and even ulceration may occur.
Varicose Vein Treatment
Options:
Lifestyle Modification Treatment options include lifestyle
changes in which patients are instructed to elevate their legs
whenever possible. In addition, compression stockings are worn
throughout the day. While this approach is cheap and non-invasive,
compression stockings can be uncomfortable and unsightly to wear
for the rest of one's life. In addition, the underlying problem is
not corrected and no cosmetic improvement can be expected.
Surgery:
The mainstay of therapy for varicose veins in the past has been
surgical ligation and stripping of the long saphenous vein (LSV).
This involves making an incision at the groin. The LSV is tied off
and cut. A second incision is then made at the knee and a special
instrument is inserted and advanced up the vein to the groin. The
vein is tied to the instrument and the remainder of the vein is
then averted (pulled inside out), stripped and removed through the
knee incision. Additional incisions may be required up the leg to
tie off branching veins. The advantages of surgery include that it
is covered by provincial health insurance and the fact that the
procedure has been around for years and is reasonably effective.
The disadvantages include that it produces fairly extensive tissue
trauma, multiple scars, may require general anaesthesia and is
associated with higher complication rates and longer recovery times
that minimally invasive therapies.
Minimally Invasive Therapies
Endovenous Laser Therapy (EVLT®):
EVLT® is a new, minimally invasive image-guided technique designed
to replace surgical vein stripping. A catheter bearing a laser
fiber is inserted under ultrasound guidance into the long saphenous
vein through a small puncture at the level of the knee. The
catheter is then advanced (also under ultrasound guidance) up the
leg to the top of the long saphenous vein. The laser is activated
resulting in obliteration of the saphenous vein. The catheter is
then slowly withdrawn and the vein is ablated along its entire
length. Foam sclerosant may be added through the catheter as
required to treat large side branches. Results to date suggest a
cure rate of over 90%
Direct Injection of Liquid
Sclerosants: Useful for spider veins. Not appropriate for
large varicose veins. May be used as an adjuvant therapy to other
forms of varicose vein treatment. Sclerosants (including saline
solution) are injected into clusters of spider veins, causing
obliteration by destruction of the vein wall.
Direct Injection of Foam:
Useful for branch veins but not the large saphenous vein. The foam
replaces the blood in the vessel causing phlebitis or clotting,
thereby destroying the vein. This method is very useful as a
supplemental therapy, often administered along with Endovenous
Laser Therapy (EVLT®).
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