Varicose veins are the most common problems of veins and any swelling in the leg can be a reflection of varicose veins especially when one is obese in which the visible veins or the varicosities are not very prominent or appreciated. Special investigations are required for all patients with chronic leg swelling to see if there are valve incompetency’s which are leading to varicosities or visible torturous varicose veins. Clinically, in thin or moderately built patients, on physical examination we can see torturous veins that are serpentine in nature. Sometimes small streaks of vessels are also seen as harmless known as telangiectasia. Small to Medium size or serpentine torturous vessels means there can be valve incompetence which can be due to long standing, walking throughout the day and needs to be investigated. Acute leg swelling always needs to be investigated for acute vein problems and chronic patients lying on bed need to be investigated for Deep venous thrombosis formation. Diagnosis is done by the simple use of vascular ultrasound called Colour Doppler of arteries and veins of both the lower limbs to know the architecture and valves that can be depicted through and the site of incompetence can be mapped for further treatment.
Causes of Varicose veins
The limb should be elevated as far as possible so that there is no load on the veins and no pooling of blood in the lying position. During the day one should try and take out time to elevate the limb on a chair or on the bed. At bedtime, limb elevation should be practised by placing pillows underneath the leg so that there is dependant drainage.
COMPRESSION DRESSING AND GARMENT
The compression garment is a tight stocking which is given which helps in pumping the blood upwards and defies gravity. This pressure garment is best tailor made but readymade garments are also available. This should be put as soon as the patient gets up and should be ideally put on the bed. During the day whenever the patient is moving about or sitting the pressure garment should be worn. It should be taken out whenever the person goes back to bed at night or naps in the day Please note no non-surgical treatment can cure varicose veins, it can only be controlled. The moment these non- surgical treatments are discontinued the problem will recur. After the surgery or laser treatment in many cases the limb elevation and pressure garments can be taken off.
Incompetent veins are either surgically ligated or treated with lasers, both which have different advantages and disadvantages, which can be discussed with the doctors. Sometimes Venoplasty can be attempted in very severe cases where the venous valves are repaired and reconstructed. Both options need to be discussed with your plastic surgeon. We recommend surgical options as they are very precise as compared to endovascular lasers which are not very precise and tend to damage the surrounding veins as well which can many a times increase the swelling, unless there is a contraindication to surgery. If only superficial veins are involved and no deep valve incompetence is present, then (injection therapy) sclerotherapy can help. There is also an option of radio frequency treatment that can also help Surgical treatment of ulcer by means of skin grafting or flap plastic surgery may be required in patients with varicose veins
Sclerotherapy is used to treat spider veins which develop in many patients, especially ladies and look ugly. In sclerotherapy we use medicines which are injected in the tiny veins which then collapse and are not visible. Deep Venous Thrombosis when diagnosed has to be treated with urgency. The line of treatment is medical with use of anticoagulants and pressure stockings and monitoring for pulmonary or cardiac embolism. Acute venous thrombosis requires surgical intervention like embolectomy -removal of the thrombus, through open surgery or non-invasive vascular surgery, both options should be discussed with the patient. Many times the venous problems are associated with Lymphedema due to fluid stagnation. We specialize in customized treatment for each patient as each patient is different. The prognosis is quite good if timely intervention is done. Both swelling and ulcers resolve to quite an extent and we encourage you to take good skin care and venous stockings till the problem is resolved.
Frequently Asked Questions
Veins are part of the circulatory system. The deoxygenated blood (blood that has left its oxygen after the exchange) from the different parts of the body to the heart is carried back through the veins. The veins are commonly seen at the back of the hand and in the legs. There are two types of venous systems: Superficial venous system – near to the skin Deep venous system – seated in the deep tissues and in between and around the muscles. Both vary in importance and thus different problems if they turn abnormal.
One very important aspect of veins is that veins have valves which transport the blood only in one direction i.e. towards the heart. Along with the low pressure system which the veins are, they are also subjected to the dependent position of our limbs. Since blood has to flow back to the heart against gravity and the pressure also is not very high, valves are basically a push mechanism. Thus, valves prevent this backflow and allow the blood to flow in only one direction i.e. from distal to proximal. There are multiple channels between the superficial and the deep system, which again have a valve which allows unidirectional flow from superficial to the deep veins. No blood flows from the deep to the superficial. These are the body mechanisms to disallow any pooling of fluid / blood in the superficial system. In the deep veins apart from the valves there are muscles which pump the blood and empty the veins in the proximal direction. Once the vein is empty there is a vacuum created and the blood again gets sucked in. This is the mechanism of how the blood finally reaches from smaller veins to the bigger and larger veins and finally to the heart.
One of the most common symptoms of Venous disorders is swelling, which can be due to abnormality of the vein valves. These are the most common venous disorders in which the veins become incompetent or non-functional which means there is a reflux from the proximal (upper) to the distal (lower) part of the vein, especially if there is long standing, there is a column of blood and there is always a pressure on the valves to hold the column of blood and it finally gives way thus the valve can become incompetent and there is backflow / reflux. There is already a high fluid collection in the lower limb which can cause leakage in the tissues that causes swelling. Similarly, if the valves from the superficial to the deep system become incompetent there is blood regurgitation from the deep system to the superficial system which ultimately gives rise to swelling in the leg. It is not just the fluid collection causing swelling, but the fluid also contains an iron component, which can cause irritation and pigmentation, as well as over a period of time wounds and ulcers can develop in the leg due to high pressure on the veins, which are difficult to heal and resolve only when veins and valve issues are addressed.