Varicose veins

Varicose veins are dilated tortuous veins and can occur in a number of sites around the body.  In general terms, varicose veins refer to the superficial veins of the leg.

The heart pumps blood to the legs through arteries at a pressure of about 120 mmHg.  Blood returns to the heart through veins which are a low pressure system and therefore additional mechanisms are required to aid this return flow.  One such mechanism is the ‘muscle pump’.  During exercise, the calf muscles squeeze the deep veins and blood is forced towards this heart.  To assist this return, veins have valves within them to prevent the back flow of blood.  Varicose veins are the consequence of either failure of the muscle pump or defects in the non-return valves.

The appearance of ‘normal’ veins is varied.  Some individuals are prepared to put up with an appearance that others find completely intolerable.  For this reason, patients may seek advice for cosmesis alone.  Complications of varicose veins, sometimes called chronic venous insufficiency, are manifest by skin changes and even ulceration.  Early skin changes include dark pigmented areas but with time other skin changes may occur resulting in thickening of the skin, varicose eczema and finally the venous ulcer.

In order to confirm the problem that you have with your veins, the Vascular Surgeon will usually ask a Vascular Technologist to perform a duplex scan which combines ultrasound with Doppler.  This allows the blood flow in the veins to be fully assessed and directs the surgeon to the correct operation.

There are non surgical treatments for varicose veins but these are to control symptoms rather than to cure the underlying problems.  Compression hosiery for individuals who do not wish to have an operation, or who are unfit for surgery, is the main stay of this treatment.  If suitable, however, surgical correction would be undertaken.  This has traditionally involved a cut in the groin where the vein is identified and then stripped out down to the level of the knee.  Veins in the lower leg are then removed through a number of small ‘stab incisions’ to complete the procedure.  More recently a new endovenous technique has been developed, VNUS Closure. 

VNUS Closure is a minimally invasive procedure that involves passing a radio frequency catheter from the ankle to the groin through a small puncture wound.  The vein is then destroyed using radio frequency as the catheter is withdrawn.  The advantage of this endovenous procedure is that there is no cut in the groin and the vein is not ‘stripped’.  This minimises post-operative pain and considerably improves the speed of recovery.  I perform this new technique on patients in whom the venous anatomy is suitable.