Varicose veins are abnormally dilated, blue-green coloured veins on the thighs and legs. They are easily visible on the skin. This condition is a manifestation of the disease known as Chronic Venous Insufficiency.
Varicose veins on the leg
The normal function of veins is to carry blood from the leg towards the heart (One-way flow). In normal standing/sitting position, this one-way flow is maintained by certain VALVES which are present at different levels of the veins.
When these valves become defective due to various reasons, there function is lost and the flow of blood in the veins is reversed. As a result, the leg veins do not empty completely and more blood keeps on collecting in the veins, causing VENOUS HYPERTENSION. This is the cause for heaviness of legs and stretching or bursting type of pain which is felt by the patient.
This disease is common in patients having jobs involving long periods of standing or sitting with legs down (School teachers, Shopkeepers, Field workers, IT Professionals). Ladies may develop Varicose veins during pregnancy, which is noticed only when it becomes troublesome after few years of childbirth. People who are overweight may also suffer from varicose veins. It may also be hereditary, and more than one members of a family may be affected.
Difference between normal veins and varicose veins
This condition leads to swelling and discomfort of the legs, which is more during late evening and night. Patient may also complain of night cramps, which is due to stretching of veins.
A diagnosis of Varicose veins is suspected by the typical complains of the patients and clinical examination of the leg, which may show visible veins, swelling or discolouration of the skin. The diagnosis of Varicose veins is confirmed by a DOPPLER ULTRASOUND of the legs.
A good doppler ultrasound tells about the flow of blood in the veins, the condition of valves and helps in staging of the disease. Terms such as "Reflux" or "Incompetence" in the Doppler report confirm Varicose veins and necessitate early treatment.
A Doppler Ultrasound of the Legs
Treatment of varicose veins depends on the stage of the disease. In early stage (Stage 1), wearing GCS (Graded Compression Stockings), some medicines and lifestyle modifications are sufficient to relieve symptoms. But advanced stages of the disease (Stage 2 and above) do need urgent treatment to prevent progression to complications.
GCS (Graded Compression Stockings)
If treatment is not done within good time, advanced stages of the disease can lead to severe leg pain, swelling and complications such as uncontrollable bleeding from the veins, skin darkening and ugly looking, non healing ulcers. Late stages of the disease may lead to permanent damage and disfigurement of the leg.
Venous Ulcers in the advanced stages of the disease
Few years ago, Surgery (SFJ ligation with Stripping) was the only treatment available for varicose veins, which involved multiple cuts on the legs, was painful and resulted in ugly looking scars on the legs.
With the invent of new technologies in recent years, Surgical treatment for Varicose veins has been replaced completely with non-surgical (Endovenous Ablation) methods.
EVLT, RFA and VENASEAL treatment are done by passing special catheters inside the leg veins through small needle holes, and do not involve any major cuts/incisions on the legs.
A RadioFrequency Ablation machine with attached RFA catheter
A Radio Frequency Ablation (RFA) catheter is placed through a small hole (Port) in the vein
The latest technology developed for treatment of Varicose veins is the Glue Ablation technique (Commercially known as the VENASEAL treatment, which involves treating the abnormal refluxing veins with a medically specialised GLUE which is used to seal these abnormal veins.
Mechanism of VENASEAL (GLUE Ablation) treatment
All these techniques (Laser Ablation / Radio-Frequency Ablation / Glue Ablation) are equally effective techniques for treatment, however the post-operative comfort level and patient acceptability has been more for Glue Ablation followed by Radio-Frequency Ablation and least for Laser Ablation
All above techniques of Ablation are compounded by addition of Injection Sclerotherapy and Stab Phlebectomies to improve the treatment outcomes.
Injection Sclerotherapy involves injection of a liquid known as Sclerosant into the veins, which result in permanent closure of the abnormal veins.
Injection Sclerotherapy (IS) for small Varicose veins
Stab Phlebectomies (Avulsions) involve removing the abnormal bunches of veins in the legs through very small (2-3 mm) incisions. Since these small veins are completely removed, there are no chances of recurrence. The mini-scars heal within 4-5 days, and are barely visible after a week following treatment.
Stab Phlebectomies (Avulsions): Abnormal varicose veins removed through small cuts on the skin.
A Vascular and Endovascular Surgeon has expertise in all these latest modalities of treatment. These are absolutely painless, scarless and quick procedures.
Benefits of treatment with one of the latest modalities are numerous. They are Daycare procedures (Discharge on same day), less time consuming and have a rapid recovery.
There are no big scars, post operative pain or need for bed rest. The biggest advantage of this treatment is that patient can start walking and other routine activities can be resumed within few hours following the procedure.
No prolonged hospitalisation or bedrest/ leave from work is required after the treatment, and results of these treatments have proved to be excellent in patients with Varicose veins all over the world.
Results of treatment with Radiofrequency Ablation + Injection Sclerotherapy + Stab Avulsions
Results of treatment with VENASEAL Ablation + Injecton Sclerotherapy + Stab Avulsions