Normal Circulation & Varicose Veins
Blood is carried away from the heart by arteries and is returned to the heart by veins (which have one-way valves). There are many networks of veins in the legs which return blood to the heart. The deep veins in the legs carry 90% of the blood to the heart. These veins do not become varicose because the muscle layers, which surround them, protect the walls of these veins.
The surface or superficial veins carry 10% of the blood returning to the heart. If the valves in these veins do not function well, blood doesn't flow efficiently and the veins become enlarged because they are congested with blood. These enlarged veins are commonly called spider veins or varicose veins, depending on their size.
Spider veins are small red, blue or purple veins on the surface of the skin. Varicose veins are larger, distended veins that are located somewhat deeper than spider veins. Varicose veins are no longer able to function properly and other normal veins have taken over for them. Because varicose veins are a hindrance to the circulation, treatment of varicose veins aims at improving the circulation.
Vein disorders are not always visible; diagnostic techniques are important tools in determining the cause and severity of the problem. In addition to a physical examination, a non-invasive ultrasound is often used.
Leg Pain and Varicose Veins
Varicose veins are the leading cause of leg pain in an otherwise healthy adult population and are more painful while they are forming because the walls of these veins are stretching. The pain, often a burning sensation, can subside for several years once the walls of the veins have stretched beyond their elasticity. At this time, heaviness, rather than pain, can be felt.
Female hormones have an effect on varicose veins, resulting in some women experiencing greater pain before and during menstruation and during pregnancy. Other forms of discomfort experienced with varicose veins can be night cramps or “restless legs,” which cause the individual to shift leg positions frequently, and pain while standing or walking. Symptoms, often made worse by prolonged standing, include feelings of fatigue, heaviness, aching, burning, throbbing, itching and cramping - leg swelling can also occur. Severe varicose veins can compromise the nutrition of the skin and lead to eczema, inflammation, or even ulceration of the lower leg.
Spider Veins (Telangiectasias)
Spider veins are tiny, thread-like, purplish-blue or red veins seen close to the surface of the skin. Spider veins are usually the result of larger underlying veins, are generally painless and do not lead to medical complications.
Reticular veins are turquoise-blue veins seen through the skin in areas of stretch (knees, etc.). When they become varicose, they can cause sharp pains which can be pinpointed on the legs. Reticular veins cannot lead to medical complications.
Collateral veins are large veins. When they become varicose, they can pool a large volume of blood. They are often the cause of heaviness in the legs. Collateral (or truncular) varices lead, in time, to medical complications.
Causes of Varicose Veins
Ninety percent of varices are inherited from direct relatives; 10% of varicose veins are caused by an injury, an inflammation or from a deep venous thrombosis (blood clot). Women are more likely to suffer from abnormal leg veins. Hormonal factors including puberty, pregnancy, menopause, the use of birth control pills, estrogen and progesterone affect the disease. It is very common for pregnant women to develop varicose veins during the first trimester, because pregnancy causes increases in hormone levels and blood volume, which in turn cause veins to enlarge. In addition, the enlarged uterus causes increased pressure on the veins.
Varicose veins due to pregnancy often improve within 3 months after delivery. However, with successive pregnancies, abnormal veins are more likely to remain. Other factors which can indirectly induce the formation of varicose veins are obesity, old age, excessive heat, including prolonged exposure to the sun, prolonged standing, constricting clothing and girdles, and disorders of the lower limbs and feet. These factors should be controlled to prevent varicose formation.
Will veins return?
Unfortunately, vein disease (both varicose and spider/cosmetic) is a dynamic disease. By this we mean that there is a perpetual change over time. For some people, there are very few recurrences of vein problems over time. For others, it simply means that they need more treatments on a regular basis. Our experience has demonstrated that regular follow up is very important for vein disease, regardless of the type of treatment given.
Since 1850 or so, there has not been a new way found to “repair” varicose veins. By this we mean that the faulty valves in the veins cannot be replaced. We, therefore, have learned to remove or eliminate the diseased section of the vein involved. This is why, in my opinion, we should do the least invasive treatment to satisfy the patient in eliminating the problematic veins. More importantly, regardless of the treatment given for the “diseased vein,” treating the diseased vein should not bother the rest of the other veins in the leg, or cause possible future disease of other veins. Proper follow up and timely treatments have been shown to be the best care in the long term.
Recommendations for best results after sclerotherapy:
What is echosclerotherapy?
Echosclerotherapy is an ultrasound-guided injection technique for the treatment of varicose veins. The purpose of echosclerotherapy is to sclerose (close) the veins near their site of origin. The goal of the treatment is to drastically reduce or eliminate the need for vein surgeries.
Although the percentage rate of success is high, in some cases patients may require surgical intervention despite this treatment. As a rule, we inject a vessel twice, on separate occasions at least 6 weeks apart. If the outcome is unsuccessful, then surgery may be the last option.
Echosclerotherapy is not a benefit of the Medical Service Plan (MSP).
All of our vein surgeries are done under local anaesthesia. Minor incisions are done after ultrasound guidance over key areas to access the veins. Dr. Malo will go over this procedure in detail with you if you prefer. Varicose vein surgery is a benefit of MSP in BC.
If you have further questions or would like to schedule an appointment, contact our office today.
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