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  • Dr. Henry Ngai

What’s up with those varicose veins?

Varicose veins of the legs, or abnormally dilated veins are commonly seen in a medical practice. They are more commonly seen in women after child birth. However, they can occur in men as well. Varicose vein is one of the most neglected health conditions and many physicians have little knowledge of this condition.

There are 2 venous systems in our legs, the deep and superficial, The varicose veins we see are the veins of the superficial system. These are the ones that a phlebologist treats. The deep veins are deep in the muscle layer and it is not a target of interventional treatment.

There are many factors that lead to varicose veins. The most common reasons are genetic predisposition, pregnancy, prolonged standing, trauma, obesity, occupation and sitting positions especially sitting cross-legged.

Varicose veins may have no symptoms or they can be quite bothersome. Many people with varicose veins of the lower extremities may complain of leg heaviness, swelling, cramps, pain, itchiness, skin discoloration and even skin ulceration. Varicose vein can lead to severe hemorrhage if ruptured. The severity of the symptoms might or might not correlate with the severity of the varicose veins.

Some people seem to be more concerned about the appearance of leg veins. In fact, some people do not want to treat the varicose veins if not for their cosmetic concern. Other than the large ugly looking protruding veins, many also are especially bothered by the smaller thread veins, ie. tiny red and blue small veins (telangiectasiae and venulectasiae respectively ). No matter how these varicose veins may look, people with visible varicose veins should have a medical assessment by a physician who is trained in treating venous disease (phlebology/ vascular surgery).

In the past, surgery is the only option in treating large veins. Fortunately, modern phlebology has eliminated the need of most vein surgery. For veins of all sizes, even the large truncal diseased veins, the preferred treatments is injection, radiofrequency, glue or laser. Frequently combination treatment is appropriate.

Sclerotherapy is a procedure when a solution is injected into a vein to close it. It is very effective in closing almost all non-truncal veins. It is the gold standard for treating tiny thread veins. Surface lasers, such as diode or Nd Yag lasers which were once promoted by laser company to treat leg vein have very limited role in treating veins. Beside the exuberant cost, the side effects of laser far outweigh the benefit. Laser treatment for thread veins is slow, painful and inefficient. The only role for surface laser is to mop up the really fine thread veins after a series of sclerotherapy have cleared the larger diseased veins. Such incidence is exceedingly rare. All laser treatment, if it is needed at all, should be done by a person who have a thorough understanding of vein pathophysiology and should never be conducted by a non-medical personnel, such as a esthetitian. Side effects of laser treatment are ulceration, scarring, dyspigmentation, persistence and even worsening of the treated vein (eg, matting). These side effects are much rarer in injection sclerotherapy.

Laser does have a role in treating truncal veins especially the greater saphenous vein and may be some larger perforator veins. However, this type of laser is called endovenous laser, as it involves a sterile disposable laser fiber inserted into the vein. One can also use radiofrequency energy or glue to achieve similar result. Endovenous procedure is performed under ultrasound guidance to ensure the proper positioning of the fibers and cannulae. It is done by a well-trained phlebologist, surgeon of interventional radiologist.

Compression therapy is still very important for all degree of varicose veins. It is crucial to get a good pair of stockings and to ensure the right pressure stockings are prescribed. Compression therapy is a must after treatment to optimize treatment result and to prevent vein irritation from recannulization of the treated vein. Exercises and proper sitting posture (eg. not crossing legs) are also important to prevent varicose veins.

In summary, we have good and relatively non-invasive non-surgical methods of treating varicose veins. All of these procedures are done in a clinic or vein center as a day procedure. There is no need to stay in hospital and wound care is minimal to nil. It is important to seek good medical care and expert advice to manage this very treatable condition.


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