Varicose Veins

Which Varicose Veins are Harmful? Which ones cause aesthetic concerns? Should all of them be treated?

The clinical picture we encounter with the dilation of veins, also known as varicose veins, is so common that we can say it is seen in about one in every two people. According to relatively recent research on the distribution and frequency of varicose veins in Germany and Switzerland, more than 50% of adults have been found to have varicose veins to some extent (Bonn vein study, Basel study). Among the examined patients, 15% are considered to be in need of medical treatment, 6% have signs of severe skin changes, and 1% have venous leg ulcers. According to research by the World Health Organization, it is pronounced as the most common vascular disease. If varicose veins at the initial level (venous diseases) are not detected and other risk factors begin to emerge, varicose vein disease progresses irreversibly. People with varicose veins are at increased risk of deep vein thrombosis and pulmonary embolism. Therefore, it is essential for them to be seen and followed by a Cardiovascular Surgeon.

Veins are high-performance vessels. The human venous system generally has a large blood reservoir, approximately 80% of the total blood volume is found here, and a large part of it is in the leg veins. Veins carry deoxygenated (dirty) blood back to the heart. The veins in the legs are under serious stress under static load (for example, standing and sitting), as blood flow here is directed against gravity. Various systems work together to ensure venous blood flow against gravity: venous valves are found in the superficial and deep venous systems. “Valve” mechanisms prevent the backflow of blood. The right heart plays another important role in creating a “suction” effect on the main veins with continuous pumping-sucking power. Therefore, in right heart failure, venous circulation is further impaired, and varicose veins increase. Finally, the topic called the calf muscle pump; while the muscles of the lower leg move (e.g., walking, running, sports, etc.), it supports the return of blood to the heart by compressing the deep veins.

Deep leg veins are not visible and are examined by Doppler or Ultrasound methods. A blood clot that accumulates in the deep veins can result in embolism to the heart (usually the lungs), posing a vital risk. Therefore, deep vein examination is essential before varicose vein treatments.

In the diagnosis of varicose veins, it is important to first assess the patient’s current complaints. During this medical history phase, we evaluate whether the symptoms are related to varicose veins. Along with this, the patient’s medical history, any previous treatments for varicose veins, the presence of deep vein thrombosis, and any risk factors for clot formation are discussed. After completing the medical history, the physical examination is conducted.

Physical examination in varicose vein patients should be performed while the patient is standing. Varicose veins on the skin surface, ranging from capillary size to thickened areas, are evaluated while the patient is standing. Any color changes, edema, varicose ulcers, and previous surgical scars are also assessed if present.

Following these evaluations, a Doppler ultrasound examination of the leg veins should be performed while the patient is standing. This medical procedure, known as lower extremity venous Doppler ultrasound, is often performed by a radiology specialist in many centers. In our clinic, Doppler ultrasound (color Doppler ultrasound) is performed by our Cardiovascular Surgeon, Dr. Cemal ASLAN. Ultrasound examination of leg veins is a non-invasive and painless diagnostic method with no harmful effects on the patient’s health. It helps evaluate blood flow in the veins and detect possible clots and obstructions. The importance of having the Doppler ultrasound examination performed by the doctor who conducted the medical history and physical examination is significant. It provides detailed information about the patient’s anatomy and is crucial in deciding the priority and technique for personalized treatment. This approach ensures a comprehensive management of the patient’s treatment process. Once the diagnosis of varicose veins is confirmed, starting treatment on the same day will result in significant time savings for the patient.

Several risk factors may contribute to the formation of varicose veins. These factors include:

1. Genetic Predisposition: If there is a family history of varicose veins, your risk may increase due to genetic predisposition.
2. Gender: Women generally have more varicose veins compared to men. Hormonal changes such as pregnancy and menopause can influence the development of varicose veins.
3. Age: As age advances, blood vessels may lose elasticity, increasing the risk of varicose veins.
4. Pregnancy: During pregnancy, increased pressure on the legs can occur as the uterus expands, leading to vein dilation and varicose vein formation.
5. Obesity: Being overweight can exert additional pressure on the leg veins, raising the risk of varicose veins.
6. Prolonged Standing or Sitting: Standing or sitting for extended periods can affect blood circulation in the legs, contributing to varicose vein formation.
7. Sedentary Lifestyle: Lack of regular exercise can hinder proper blood circulation, increasing the risk of varicose veins.
8. Smoking: Smoking can narrow blood vessels and affect the circulatory system, potentially increasing the risk of varicose veins.
9. Previous Vascular Issues: Having experienced previous vascular problems can elevate the risk of varicose veins.
10. ..Hormonal Changes: Hormone-containing substances like hormonal medications and birth control pills can influence the formation of varicose veins.

A combination of these factors can impact the development of varicose veins. However, despite these risk factors, it is possible to reduce the risk of varicose veins by maintaining a healthy lifestyle and taking specific precautions.

Varicose vein treatment aims to alleviate symptoms, reduce the appearance of varicose veins, and prevent complications. Treatment options may vary based on the severity of varicose veins, symptoms, and the patient’s overall health. The current methods used for varicose vein treatment include:

1. Laser Therapy (Endovenous Laser Ablation): Laser therapy is a minimally invasive procedure that aims to close the varicose vein by heating the inner surface using laser energy.
2. Radiofrequency Ablation: In this procedure, radiofrequency energy is used to heat and close the inner surface of the varicose vein.
3. Sclerotherapy: This method involves injecting a special substance to damage the inner surface of the varicose vein. The veins are later absorbed by the body.
4. Foam Treatment: This method includes injecting a special sclerosing substance in foam form to damage the inner surface of the varicose vein.
5. Surgical Interventions: Surgical interventions may be considered in severe varicose cases or situations where other treatments are not effective. Surgical options may include venectomy (removal of the varicose vein) and phlebectomy (removal of small varicose veins).

Endovenous Laser Ablation (EVLA) is a minimally invasive surgical method used for varicose vein treatment. In this procedure, laser energy is used to heat and close the inner surface of the varicose vein, facilitating the treatment. EVLA is generally suitable for the treatment of larger and deeper veins and can shorten the postoperative recovery period for patients.

During EVLA, a laser fiber is inserted into a thin catheter, and this catheter is usually directed into the vein through the skin. Laser energy damages the inner surface of the vein, sealing it. This process redirects the blood flow to healthy veins. This method is commonly used for the treatment of larger saphenous veins, whose dilation and dysfunction may contribute to the formation of varicose veins in the lower extremities. Treatment is typically performed under local anesthesia, ensuring that the patient does not feel the treatment area.

It offers a faster recovery compared to traditional surgical methods. Patients can usually return home the same day. The recovery process may vary from person to person, but generally, normal activities can be resumed within a few days.

Advantages include being minimally invasive, not requiring general anesthesia, causing less pain, and having a rapid recovery process. Additionally, there are no surgical scars as the procedure is performed externally.

Like any surgical procedure, EVLA can have potential complications. These complications may include infection, perforation of the vessel wall, bleeding, or nerve damage. However, such complications are typically rare.

Many people are bothered by spider veins, the small veins under the skin, which can now be treated within minutes with modern procedures. While these veins generally do not pose much harm to patients, they can be a significant cosmetic concern. Some larger varicose veins may cause discomfort. Sclerotherapy can effectively eliminate spider veins and subcutaneous varicose veins with gentle touches, leaving no scars.

There are two methods of sclerotherapy treatment: liquid sclerotherapy and foam sclerotherapy. The choice between these methods is determined by the doctor during the examination. The size and location of existing spider veins are decisive factors for the preferred method. Larger veins can be treated with foam therapy. Many patients report relief from pain after these treatments.

The principle is the same for both sclerotherapy methods: fine needles are inserted into the diseased veins, and then a sclerosing liquid substance that irritates the inner vascular wall, called “intima,” is injected. The treated veins adhere to each other from the inside, close, and are eliminated by the body within a few weeks.

Sclerotherapy and foam treatment are generally recommended for the treatment of small and medium-sized varicose veins. These treatments are often minimally invasive procedures applied for cosmetic purposes. Sclerotherapy and foam treatment are typically recommended in the following cases:

• Small to Medium Varicose Veins: Sclerotherapy and foam treatment are often recommended for the treatment of small to medium-sized varicose veins, typically targeting veins with a diameter less than 3 mm.
• Cosmetic Treatment: Sclerotherapy and foam treatment are preferred options to enhance the aesthetic appearance of varicose veins, especially the small purple or red veins that are prominent on the legs.
• Symptoms of Chronic Venous Insufficiency: Sclerotherapy and foam treatment can be used to alleviate symptoms caused by chronic venous insufficiency, such as leg pain, swelling, and fatigue.
• Post-Pregnancy Varicose Veins: Varicose veins that develop during or after pregnancy are often seen as thin veins. In such cases, sclerotherapy and foam treatment may be recommended for post-pregnancy varicose veins.
• Discomfort or Pain from Varicose Veins: Individuals experiencing pain, discomfort, or other symptoms due to varicose veins may consider sclerotherapy and foam treatment.
• Patients Not Suitable for Surgery: Sclerotherapy and foam treatment can be an option for patients who are not suitable for surgical interventions or prefer a non-surgical approach.

After sclerotherapy treatment, it is important to follow specific guidelines to expedite healing and prevent potential complications. Some general considerations following sclerotherapy treatment include:

• Use of Compression Stockings: Your doctor may recommend using compression stockings after treatment. These stockings can help increase blood circulation and reduce swelling.
• Light Exercise: Engaging in light exercises like walking can increase blood circulation and support the healing process. However, strenuous exercises should be avoided.
• Cold Application: Cold application can be used to reduce swelling in the treatment area. An ice pack or cold compress can be applied during the first 48 hours.
• Medication Use: You can use pain relievers or anti-inflammatory medications recommended by your doctor. However, blood-thinning medications like aspirin should be avoided.
• Elevating Legs: Keeping the legs elevated above heart level can help reduce swelling. Supporting the legs while resting or lying down is important.
• Avoiding Hot Baths and Saunas: Hot baths or saunas should be avoided as they can expand blood vessels and potentially lead to bleeding.
• Monitoring Pain and Redness: Mild pain, redness, bruising, and other reactions are normal after treatment. However, if severe pain, excessive swelling, or other issues occur, consult your doctor promptly.
• Doctor Checkups: Regularly attending scheduled doctor checkups after treatment is crucial. These checkups are important for evaluating the effectiveness of the treatment and detecting potential complications.

After sclerotherapy treatment, mild side effects such as slight pain, a burning sensation, swelling, and redness may occur in the legs. These reactions typically manifest immediately after treatment.

Within the first few days, bruising and dark-colored spots may appear in the treatment area. This is a normal reaction that improves over time. Additionally, using the compression stockings recommended by your doctor can help reduce swelling.

Within the first week, the veins treated with the sclerosing agent are closed and gradually absorbed. During this process, the legs may feel slightly swollen or tender.

Within the first month, there may be a noticeable improvement in the appearance of the treated varicose veins. However, the full recovery process may take several weeks to a few months.

The long-term recovery process after treatment depends on the individual’s overall health, the size and number of varicose veins treated, and other factors. While some individuals may achieve the desired results in a single session, others may require multiple sessions.

After treatment, continuing to use compression stockings as recommended by your doctor, attending regular follow-up checkups, and maintaining a healthy lifestyle by exercising, eating well, and avoiding excess weight can support the recovery process.

Potential results after varicose vein treatment include:

• Improvement in Symptoms
• Enhancement of Aesthetic Appearance
• Prevention of Complications
• Possibility of Recurrence
• Increased Quality of Life