What are varicose veins

Cause, treatment et prevention

Phlebology and the treatment of VARICOSE VEINS

VO

LUM

E 3

Phlebology is the medical science that involves the diagnosis and treatment of venous diseases. A rather sophisticated term referring to a somewhat common condition: vari-cose veins! Who hasn’t discovered, upon waking in the morning, a very noticeable vein just under the surface of their skin? A long, bluish-bulging vein running down a leg; a network of spider veins threading red web on the ankle or cheek; or a purplish knot of veins showing behind the knee... At times, aches and pains, heaviness in the legs, tin-gling and night cramps signal their presence. But what exactly are varicose veins? Can they and should they be treated?

WHAT ARE VARICOSE VEINS

A varicose vein is a “condition in which the superficial veins, especially of the legs, become knotted and swollen1”. When a vein becomes dilated, it can no longer carry out its normal function, which is to bring blood to the heart. The blood therefore accumulates in the vein, causing it to become engorged, bluish, tortuous and protruding.

There are many types of varicose veins. The most common ones are telangiectasia (spider vein), they appear mostly on the legs and thighs, but can also appear on the face, resem-bling spider webs. Couperose appear on the cheeks, chin and/or nose. Reticular varicose veins appear on the limbs and can enlarge to the size of a little finger. Venous ulcers link the superficial blood network to the deeper one.

The worst cases, although rare, are truncal varicose veins, which develop along the inter-nal or long saphenous vein that runs from the groin to the ankle, and the external or short saphenous vein that runs behind the knee to the back of the ankle. They are generally treated by surgery.

1 Definition from Collins Canadian English Dictionary & Thesaurus

Varicose veins can develop at any age, more often in women (two to three times more than in men2), and anywhere on the body, although they com-monly appear on the limbs. Varicose veins — a progressive disease — are a health condition that affects over half of the population.

Heredity is the number one cause of varicose veins. Individuals with no family history have a 20% chance of developing varicose veins. This chance increases to 44% if one parent suffers from them and to more than 70% if both parents suffer from them3. The risk factor increases according to age, weight, number of pregnancies, frequency of prolonged standing and sitting positions, and lack of exercise, as well as the use of oral contraceptives and exposure to heat.

2 Source : Passeportsante.net 3 According to a study conducted in France and quoted by the Société de chirurgie vasculaire de langue française, Marseille

VARICOSE VEINS CAUSES

TREATMENTSVaricose veins are part of the superficial venous system that accounts for only 10% of blood circulation; therefore, treat-ment is not risky. Beyond cosmetic reasons, varicose veins pose a medical problem: swelling, edema and numbness, which may worsen if not treated. Treatment of varicose veins may correct the unsightliness of the condition, reduce symptoms and slow its progression, but it does not stop it. Depending on the extent or severity of the disease, an annual or semi-annual check up is recommended.

Three effective techniques are used for treating varicose veins:

Surgery is used only for destroying large varicose veins similar to the endovenous laser treatment. The vein is completely removed, therefore eliminating any chance of its reappearance. If surgery is necessary, RAMQ will cover the cost.

Sclerotherapy (with or without ultrasound) is the most common treatment (used 90% of the time). It involves the injection of a sclerosing solution that irritates the wall of the impaired vessel, triggering a blood clot to form and cause a blockage. The vein eventually dies and is reabsorbed naturally. This technique also represents an effective alternative to endovenous laser treatment for large veins, where the injections are performed under ultrasound guidance (echo-sclerotherapy).

Treatment by injections is preferred by most physicians and many medical aesthetics clinics, such as Epiderma, where the injections are done exclusively by a physician. The treatment is effective, safe and affordable (around $150 per treatment). The number of sessions required, as well as the number of injections per session, may vary based on the number and type of varicose veins, age, type of sclerosant used, dosage administered and region to be treated. Larger veins feeding smaller ones must always be treated first, and deeper veins must be treated before superficial ones.

Prior to treating varicose veins, a medical evaluation of blood flow is required. Diagnosis is done through a detailed examination of the venous system using an ultrasound. Afterward, a quicker examination is performed before each session. Temporary side effects may be experienced following treatment, such as inflammation, bruises or depig-mentation, but rarely serious complications (e.g. deep vein thrombosis). Women who are pregnant or breastfeeding, youth under the age of 18, people allergic to injected medication, or those who are sick with infectious and vascular disease, or cancer cannot be treated.

Endovenous laser treatment is used to destroy large vari-cose veins by burning them using an optical fibre that is inserted into the affected vein through a small incision behind the knee. To avoid surgery, this is an effective alter-native treatment, but it is costly (around $2,500 per leg).

Since varicose veins are mainly due to heredity, it is very difficult to avoid getting them. However, steps can be taken to prevent or reduce their appearance, for example, activities improving circulation (such as walking, cycling, yoga or other exercises); wearing comfortable shoes; keeping a healthy weight; elevating the legs when resting; avoiding hot baths and showers, tight pants and belts, hot waxing; and massaging the upper legs. It is highly recommended to wear support stockings for pain relief associated with varicose veins or to delay their development.

Since the treatment of varicose veins involves superficial blood vessels as opposed to deeper ones, patients suffering from blood pressure issues will not be at risk; nor, should one worry about lacking veins for an eventual bypass surgery, because a malfunctioning vein would never be used for a bypass operation.

Nowadays, treatment of varicose veins is modern and safe, with excellent results. Regu-lar follow-up permits better living without discomfort, while maintaining attractive legs.

PREVENTION