What is varicose veins?
Varicose veins are dilated, twisted veins that are located mostly on lower extremities. They are enlarged veins that are visibly bulging out, above the skin surface. They may be colored red, blue or flesh-colored. A certain type of varicose veins presents like a spider web hence the name spider veins. Varicose or spider veins greatly affects appearance and self-esteem. They can cause discomfort and could put you at risk for a complication such as open sores or blood clot.
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Risk factors for getting varicose veins to include constipation, chronic cough, female sex, history of the venous disease in the family, older age, obesity, prolonged standing, and pregnancy. The cause of varicose vein is still a subject of great debate. Pathophysiology includes weakened vascular walls, incompetent valves, genetic predisposition, and increased venous pressure.
The main symptoms of varicose veins include achy feeling, burning or itching sensation; all that worsens with prolonged standing. These are not the only symptoms. If not treated on time, varicose veins can present with complications which include stasis changes, infection, leg ulcers, and thrombosis. Common conservative management methods of varicose veins include exercise, avoiding standing for prolonged duration, external compression, elevating the affected limb for some time, wearing loose clothing, weight loss among others.
For diagnosis, a doctor must do a physical examination. The most common sign is swelling of the legs. The doctor will do a physical examination on the legs while the patient is standing to check for this. The patient is asked to describe the pain and aching in the legs. An ultrasound determines whether the valves of the veins in the legs are functioning normally. It also shows whether there is any evidence of a clot of blood. A technician runs a transducer against the skin over the region of the leg that is being examined. The transducer then transmits images to a monitor. The images clearly show the structure of the veins in the leg including the valves and any signs of blockage by a blood clot or thrombosis.
Pathogenesis of varicose veins
Spider veins and varicose veins are usually damaged veins. They develop because of the weakening of the small, one-way veins. In a normal vein, the tiny valves help in pushing blood in one direction towards the heart. When valves are weak, blood flows backward thus accumulating in veins. Accumulated blood exerts pressure on vein walls causing them to bulge out as they weaken.
Some individuals have a higher risk of developing varicose veins than others. If your blood relatives develop varicose veins, you also have chances of developing them. However, you can get varicose veins because of standing or sitting for a long time. For instance, people who spend 5 days in a week seated from 8am to 5pm have higher chances of developing varicose veins. Also, varicose veins become more common during pregnancy and as age advances. Spider veins can be caused by hormonal changes, injury or sunlight.
There are many options of treating varicose veins. Treatment ranges from minor surgery to self-care. A dermatologist can apply one or more options to manage varicose veins.
Physical examination before treatment is very important. It helps the dermatologist to decide which treatment option is safe for you. The dermatologist examines the legs physically then take a medical history. As stated before, diagnosis is done using non-invasive methods. Doppler ultrasound shows blood flow in the veins while abnormal blood flow is checked using a method called plethysmography. It involves using a blood pressure cuff to determine changes in the volume of blood in veins.
Physical examination determines the most effective treatment. To get the best results, one or more treatment methods can be used which helps in reducing side effects. In addition to this, the outcome of treatment depends on the experience and skills of the doctor.
1. Conservative treatment
Conservative treatment options for varicose veins include:
• Avoiding prolonged straining and standing
• Putting the affected limb in elevated position.
• External compression
• Keeping restrictive clothing loose
• Medical therapy
• Cardiovascular risk factors modification
• Decreasing peripheral edema
• Weight loss
Different external compression equipment includes support stockings, bandages, and pneumatic compression devices. Although there is little evidence to support their usefulness, they are still used for initial therapy. Another recommended option involves wearing 20 mmHg to 30 mm Hg elastic stockings. These compression stockings have a gradient that decreases pressure from distal to proximal end.
Several medications have been used in the treatment of varicose veins. No medical literature supports the use of diuretics in vein removal. Horse chestnut extract has been successfully used in Europe. According to a randomized placebo-controlled, double-blind study, the seed extracts have been shown to significantly reduce edema.
2. Laser treatment
Varicose veins are treated using different laser machines. They deliver light of various wavelengths into the skin which goes through blood veins. When hemoglobin in blood vessels absorbs this light, thermocoagulation occurs. There are diverse types of lasers including long-pulsed, pulsed dye, variable pulsed, alexandrite lasers, and neodymium-doped aluminum garnet lasers. External laser ablation can amend any tiny, straight vein branch. Laser technique has generally been applied on telangiectasias. It has best been used on smaller veins and not mainly larger veins. For veins with diameters less than 0.5 mm, long pulsed lasers have been applied successfully. They clear the varicose veins completely with significant improvement for veins of diameter between 0.5 mm and 1.0 mm.
small veins disappear immediately after treatment. However, larger veins will first darken then disappear after 1 to 3 months. More than 3 treatments are required for them to disappear completely. During this period, a patient can resume normal working schedule. You may be required to wear compression stockings for some time after each treatment. You also need to protect the area that has been treated from the sun between 3 and 4 weeks of treatment. This prevents the development of dark spots. It is critical to protecting your skin from direct sun rays all year round to prevent the development of new varicose veins. This also prevents skin cancer.
Radiofrequency ablation and Endovenous laser therapy are new laser technologies. They can be applied instead of surgical removal of veins. Both methods destroy the veins from within. Endovenous laser therapy is mainly applied for treating small varicose veins while Radiofrequency ablation is used on larger varicose veins. The two methods almost follow the same procedure:
• Local anesthesia is given to numb the area of treatment and to make it swell.
• The dermatologist makes an incision through which he inserts a laser fiber or catheter into the vein.
• Once the radiofrequency or laser device is activated, it heats up the vein. The vein collapses and seals shut. There is no damaging of the surrounding area by the heat.
• The dermatologist then places a compression stocking after treatment on each leg.
• After a short duration observation, the patient can go home.
• The patient should wear compression stockings and take a walk on daily basis to prevent side effects.
• Note: you can resume most of your activities the day after treatment.
• For veins to disappear completely, you may need more than one treatment schedules.
Sclerotherapy is the most common method applied for management of leg veins by a dermatologist. The method has been reviewed and improved over time to make is safer for patients and to produce better results.
In sclerotherapy, there is an injection of a substance into superficial veins thereby causing the veins to collapse permanently. It is done by inserting a needle into the lumen of the vein. The needle is then used to inject the sclerosing substance into the vein. The sclerosing substance displaces blood and irritates vein walls. It reacts with the endothelium of the veins hence causing sealing and scarring. Various substances are used for sclerosing. A substance such as hyperosmotic solution (hypertonic saline), corrosive agents (glycerine), or detergent solutions (sodium tetradecyl sulfate) works well on small veins of diameter ranging between 1 mm and 3 mm and medium diameter of 3 to 5 mm. sclerotherapy is an effective and very cost-effective method for treating smaller varicose veins. There are however concerns of patients developing visual disturbances and deep venous thrombosis. There are also cases of varicosities recurrence.
After treatment is done, the patient will be required to wear compression stockings on each leg for around 3 weeks and take daily walks to prevent side effects. You can resume your normal activities the following day after treatment. Varicose veins are expected to disappear completely after around 4 months of treatment with sclerotherapy. A patient may require more than one treatments (3 to 4 treatments).
Surgery is currently the most effective treatment method for a varicose vein, especially larger veins. Surgery involves making many small incisions to reduce blood loss, scarring, and complications. This method is particularly good because it significantly reduces the chances of complications of varicose veins.
One of the simplest methods of surgical treatment is called ligation. It involves tying off the bulging vein at the thigh and groin. The most popular methods are phlebectomy and stripping. They are basically collection procedures and not necessarily a single technique. In phlebectomy, the patient is requested to stand to allow marking of varicose veins. Mapping of the vein is done using duplex Doppler ultrasonography or visual skin changes. The patient then stays at a supine position. Consecutive perpendicular incisions are made over the large vein a few centimeters apart, the saphenous vein is brought to the surface at the groin and ligated. This is repeated at the next site of incision and hooked. Dissection is done distally and proximally at each site to sever connection with surrounding materials. The veins are removed as small pieces. A stripper is inserted near the knee into the vein and is moved proximally. It is then pulled distally and removed.
What are the causes of varicose veins?
Varicose veins develop from abnormal inner walls of the veins or abnormal valves of the veins. In the vascular system, blood moves through arteries from the heart to various parts of the body. Blood then returns to the heart from various body parts through the veins (the venous system). Inside the veins are valves acting as one-way flaps which prevent blood from flowing back and pooling. When these valves are weak or are not working in the correct way, blood starts flowing backward causing dilation of veins. The veins dilate and become varicose. This is referred to as venous insufficiency or venous reflux.
Question 2: Does diet affect varicose veins?
Diet affects varicose veins. The food that you eat will either exacerbate or improve your varicose veins. Food such as vegetables, colorful fruits, and foods rich in fiber results in healthier body and subsequent healthier veins. On the other hand, salty foods cause water retention in veins hence increasing pressure within the veins. Red meat and dairy products promote constipation by minimizing consumption of foods. This worsens varicose veins by increasing pressure on veins.
Who is at risk of getting varicose veins
Anyone can suffer from varicose veins. However, women have higher chances of developing them compared to men. Specifically, women are at higher risk during pregnancy. However, a study has shown that men have 42% chances of having venous insufficiency by the age of 60. Regardless of sex and age, people from a family with a history of developing varicose veins are more likely to develop them.
What treatment method can remove my varicose veins
There are procedures that can eliminate varicose veins. Short procedures like vein ablation can greatly diminish or remove veins completely. However, there is always a chance of the condition recurring because one of the cause is a genetic predisposition. Treatment type can also enhance the chances of a future outbreak. For instance, vein stripping is less effective compared to sclerotherapy and ablation.
If you are looking for a doctor who can perform a quality Vein Removal in Camarillo, Dr Zadeh is the best when it comes to treatment of varicose veins. Dr Zadeh is certified by the Board meaning that he has undergone the rigorous training that is required for a skillful dermatologist. He is well versed with sclerotherapy and radiofrequency ablation, two procedures that are very key incomplete removal of varicose veins. You are assured of getting the best care because Dr. Zadeh is keen on applying the evidence-based approach in treating varicose veins. Looking forward to your visit to our clinic in Camarillo.
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