long, wind­ing vein

Whether vari­cose veins is a cos­metic con­cern or a painful con­di­tion, it can be treated.

The Star Malaysia - Star2 - - R.AGE - By LIM WEY WEN starhealth@thes­tar.com.my

Whether vari­cose veins is a cos­metic con­cern or a painful con­di­tion, it can be treated.

VARI­COSE veins may not be one of the med­i­cal terms that is used by the av­er­age per­son, but its signs – the gnarled, en­larged, and some­times dis­coloured veins that line many women’s and some men’s legs – are quite well known in an av­er­age house­hold.

Just ask any woman above the age of 50, and she will likely tell you that she knows some­one who has it. Nev­er­the­less, as vari­cose veins are mild in many peo­ple, what you would also hear is the mis­con­cep­tion that it can­not be cured and peo­ple just tend to live with it.

“Most pa­tients sim­ply tol­er­ate the heav­i­ness and dis­com­fort in their legs,” says Trop­i­cana Med­i­cal Cen­tre con­sul­tant vas­cu­lar sur­geon Dr Lee Soon Khai. “How­ever, if left un­treated, vari­cose veins may lead to com­pli­ca­tions.”

Ge­net­ics and age

Vari­cose veins are not limited to the legs, al­though they are most com­monly found on the back of the calves and on the in­side of the thighs.

It hap­pens when our veins (blood ves­sels that chan­nel de­oxy­genated blood from var­i­ous parts of the body back to the heart with the help of sur­round­ing mus­cles) lose their ca­pac­ity to re­turn blood to the heart due to the weak­en­ing of the valves in­side. This can be caused by age, pro­longed strain due to long hours of stand­ing, obe­sity, or hor­monal changes in preg­nancy.

As the one-way valves are there to make sure that blood only flows to­wards the heart, weak­ened valves will al­low blood to flow back and fill the veins rapidly, caus­ing them to en­large and be­come con­vo­luted to ac­com­mo­date the ex­tra vol­ume.

“Most of the cases are hered­i­tary in na­ture,” says Dr Lee. Stud­ies have shown that the risk of one hav­ing vari­cose veins is 80% if both par­ents are af­fected, and 50% if only one par­ent has it.

Even if both par­ents do not have a his­tory of vari­cose veins, one could still have a 23% chance of de­vel­op­ing it, Dr Lee ex­plains.

While it af­fects both men and women, mostly when they are 50 to 60 years old, women are four times more likely to have it.

Pos­si­ble com­pli­ca­tions and treat­ment

Al­though the prob­lem is cos­metic for many peo­ple (they feel no pain), vari­cose veins can cause the legs to ache and feel tired eas­ily.

Pain, heav­i­ness, itch­ing, cramp­ing, and swelling of the leg are also com­mon. When left un­treated, a small per­cent­age may de­velop com­pli­ca­tions.

“Be­sides in­creas­ing pain and swelling, skin changes can oc­cur,” says Dr Lee.

The in­creased pres­sure on the veins can cause fluid to leak out into the space in be­tween sur­round­ing tis­sue and re­sult in slow wound heal­ing. By then, even a small scratch or a mi­nor in­jury may cause bleed­ing or the devel­op­ment of a chronic ul­cer.

Ac­cord­ing to Prince Court Med­i­cal Cen­tre con­sul­tant gen­eral and vas­cu­lar sur­geon Dr Tan Kong Hean, of the 10 to 15 pa­tients (with vari­cose veins) he sees a month, there are some who do not need treat­ment and some who def­i­nitely need treat­ment due to com­pli­ca­tions. Oth­ers seek treat­ment for cos­metic rea­sons.

Vari­cose veins due to preg­nancy gen­er­ally im­proves with­out treat­ment within three months af­ter de­liv­ery.

But for the con­di­tion brought about by other causes, treat­ment choices in­clude sur­gi­cal and non-sur­gi­cal ones.

Non-sur­gi­cal treat­ments in­clude sim­ple self-care meth­ods to re­duce dis­com­fort and the use of com­pres­sion stock­ings.

Self-care meth­ods like los­ing weight, avoid­ing tight clothes, el­e­vat­ing your legs, and try­ing not to stand or sit for long pe­ri­ods can re­duce the strain we put on our legs.

The use of com­pres­sion stock­ings – elas­ti­cised stock­ings that cover the toe to the knee, or some­times up to the thigh – can also help im­prove the flow of blood back to our heart by squeez­ing our legs.

As for sur­gi­cal mea­sures, sur­geons can ei­ther re­move one of the veins in the leg with a pro­ce­dure called vein strip­ping and lit­i­ga­tion, or close it off by burn­ing (ra­diofre­quency heat­ing) or seal­ing it shut with chem­i­cals (scle­rother­apy).

Now, sur­geons also have the op­tion of clos­ing off the vein by “burn­ing” it shut with lasers in a pro­ce­dure called en­dove­nous laser surgery. With en­dove­nous laser surgery, pa­tients are able to walk im­me­di­ately af­ter the pro­ce­dure and can be back to their usual ac­tiv­i­ties within one week, says Dr Tan.

While pa­tients may some­times need a re­peat pro­ce­dure, Dr Tan says that it is very un­com­mon. The chances a per­son would need a re­peat pro­ce­dure in three years is less than 10% from the re­sults of long term stud­ies cur­rently avail­able, he notes.

Un­for­tu­nately, non-sur­gi­cal mea­sures can only help re­duce the symp­toms of vari­cose veins. How­ever, surgery to re­move or close off the af­fected veins is of­ten con­sid­ered when non-sur­gi­cal mea­sures fail.

“Non-sur­gi­cal treat­ments (com­pres­sion stock­ings) may help those with mild re­flux (back flow) and symp­toms. If symp­toms do not im­prove, or worsen, they need to con­sider sur­gi­cal treat­ments,” says Dr Lee.

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