Veins are the blood vessels that carry blood back to the lungs and heart so it can be re-oxygenated and re-circulated. When we are standing, blood returning to the lungs and heart has to do so against the force of gravity. Our body manages this mainly by using calf and thigh muscle contractions to “pump” the blood and this is why walking helps the circulation. As the blood is “pumped” upwards, multiple small valves in the leg veins close, preventing the blood from returning down the vein down under the force of gravity.
Surface and deep veins are connected in the thigh and calf through communicating veins called perforators. Most of the normal circulation is through the deep veins. Two large surface veins join the deep veins – the Great Saphenous extending from the groin to the ankle and the Small Saphenous extending from the back of the knee to the ankle.
“Varicose veins” are large surface veins that bulge above the skin surface.
“Reticular veins” are smaller blue veins that do not protrude.
“Spider veins” or “telangiectases” are tiny short unconnected or spidery branching vessels.
Medicare defines significant varicose veins as being larger than 2.5 mm in diameter and does not cover payment for treatment of smaller veins which are deemed to be “cosmetic”.
For mostly unknown reasons, the valves in the veins that are meant to stop blood flowing back down the vein once muscle contractions have “pumped” it up, lose their function. Blood initially passes up the vein against gravity, but then falls down and therefore accumulates. This puts more pressure on the thin vein wall and the veins stretch, ballooning with the extra volume of blood. As a result, the valves below the faulty valve cannot close properly and more blood backflows further down the leg. This is known as “refluxing”.
With continued high pressure within the veins, they inevitably enlarge. This is what we see on the skin surface. Many patients have parents who were also affected, so heredity may be a factor, but with the condition being so common, it is difficult to draw conclusions.
Varicose disease is common. Although there are no studies describing the prevalence of varicose veins in the Australian population, the prevalence in countries with a similar demographic ranges from 6.8 – 39.7% in men and from 24.6 to 39% in women (MSAC 2003). Some patients seek treatment because of the appearance of the veins rather than because they are suffering from any symptoms.
These symptoms can occur even with small veins, but be aware that other conditions can also cause similar symptoms in the legs.
This is not a particularly uncomfortable procedure and is well tolerated, although the amount of discomfort will vary with the individual. The needles used are extremely fine (similar to acupuncture needles) and many are hardly felt at all But the injected solution can sting slightly for short periods of time. If EVLA is used or Phlebectomy performed, then minimal discomfort is experienced as these are performed under local anaesthetic.
This is a walk-in, walk-out procedure. Most treatments take about 30 minutes to perform, with some taking up to an hour. Following treatment, you should be able to return to your normal daily routine almost immediately.
Vein disease is usually progressive and if left untreated will likely worsen with time. Symptoms that can occur with untreated varicose veins include leg fatigue, heaviness, aching, throbbing, restlessness, tingling, itching, numbness and swelling.
More serious complications such as phlebitis, deep and superficial vein thrombosis, bleeding, swelling, dermatitis and ulcers can develop if varicose veins are left untreated.
Eliminating these abnormal veins through treatment will actually improve the circulation. When veins become abnormal and stop functioning normally, our body finds alternative pathways with healthy veins to carry blood back to the heart. This will have occurred by the time you present for treatment.
The short answer is no!
No-one really knows why these veins occur and there is no known way to prevent them from developing.
Certain people are ‘vein-makers’. Wearing Class 1 venous support stockings, maintaining a normal weight and regular exercise may slow down the process.
Crossing your legs whilst sitting does not cause varicose veins.
Some patients will over time develop recurrent varicose veins and that is why all types of vein treatment are seen as ‘control’ and not ‘cure’. This may be delayed by wearing graduated Class 1 stockings and by walking but cannot be prevented. If one is followed up post therapy regularly, new venous disease will be picked up early before it is difficult to treat and further treatment will usually be by Ultrasound-guided Sclerotherapy.
Because of this I suggest review of my patients at 3 months, then at 6 months and then yearly.
Clinical assessment relies on what is visible at the skin surface and cannot determine what is occurring within the leg or what the cause of the venous disease is. The ultrasound scan can see inside your leg and determine exactly what the cause is and therefore determine what the best treatment protocol will be. This ultrasound scan should be performed by a specialist Vascular Sonographer as they are experts in this area. The assessment of venous disease by ultrasound can be extremely difficult and this part of the examination is absolutely critical to the type of treatment offered and the outcome. This examination takes between 15 minutes and an hour depending on the complexity.
As part of Specialist Vein Care, we have a Vascular Laboratory, Independent Vascular Ultrasound, where dedicated expert Vascular Sonographers can perform this examination.
Duplex ultrasound refers to the combination of looking at the anatomy or structure of the vein, together with how blood is flowing inside the vein, all together on one image.
Treated veins do not come back, as the body re-absorbs them. All forms of vein therapy are a process of control and not cure and we cannot stop a person from developing new varicose veins. This may occur over time but how quickly and how many appear is impossible to predict.
Despite the proven usefulness in the treatment of large varicose veins using Endovenous Laser Ablation, the treatment of leg veins by laser light to the skin has thus far been disappointing. Currently available lasers can be very useful in treating tiny cosmetic facial veins, but have been significantly less effective on leg veins when compared to expert sclerotherapy.
If you have existing varicose veins, these tend to become significantly worse as the pregnancy develops. Phlebologists agree that treatment for varicose veins is best performed before or between pregnancies. You should wait for about 3 months after the birth of your baby before undertaking vein therapy.
This depends on several factors, including:
What types of veins are to be treated
Large varicose veins
Success is comparative to conventional surgery with overall success rates of 80-95.5% However, compared to surgery, patients report better symptom improvement and quality of life within shorter timeframes (MSAC 2008). This may take up to 3-6 months to settle completely.
Most patients can expect at least a 70% improvement in the appearance of their legs. This may take up to 3 months to show maximum benefit.
The extent of the venous disease, patient’s age, other medical conditions, healing rate and adherence to post therapy instructions.
Therapy is usually extremely effective; yet there are a small number of patients who do not respond as positively to therapy. Treatment of venous disease, be it surgical or non-surgical, is a therapy of vein control and not cure. The treatment performed is aimed at dealing with the current problem and cannot prevent the development of new venous disease later on. Therefore, some patients may require future treatments.
Treatment often requires one to two sessions. Very occasionally several may be needed.
A number of possible complications can occur with both Sclerotherapy and Endovenous Laser Ablation. These include:
Veinlite uses ultra-bright LED light arrays to transilluminate the skin, allowing for visualisation of veins below the skin surface ( up to 6mm), which otherwise may be difficult or impossible to see.
This allows us to find elusive veins which would otherwise be potentially missed but which require treatment to obtain a positive outcome when treating smaller veins of the legs.