Varicose Veins:

Causes, concerns and treatments

Those bulging varicose veins are more than just a cosmetic problem; they can actually be painful and lead to serious health complications. Here’s a reminder of why you should get them checked, and the latest updates on minimally invasive varicose vein treatment options to consider. The Causes

Often appearing as twisted or swollen blood vessels that bulge from the skin’s surface, varicose veins occur when valves in the veins of the lower legs no longer function properly. This causes blood to flow back downwards, resulting in enlarged veins, says DR SRIRAM NARAYANAN, senior consultant vascular and endovascular surgeon at The Harley Street Heart and Vascular Centre at Gleneagles Hospital. Contributing factors may include pregnancy, obesity, standing or staying sedentary for long periods of time and a family history of varicose veins.

The Concerns

Varicose veins and vein disease can cause a significant impact on an individual’s quality of life, says Dr Narayanan. And, we’re talking more than self-confidence and feelings about body image. Common symptoms include leg cramps at the end of the day and restless legs affecting sleep at night.

“These innocuous-looking veins are often a sign of underlying disease that, left untreated, could lead to a far more complicated condition and the need for a more complex procedure years down the line.”

What’s more, varicose veins tend to worsen over time. If left untreated, varicose veins can lead to leg ulcers, decreased mobility, aching and swelling in the legs, and permanent changes in skin pigmentation.

Sometimes, external injury to these bulging veins can also cause major bleeding that requires emergency medical care.

Varicose veins can also put you at higher risk of deep vein thrombosis (DVT) – a life-threatening condition where clots develop in the diseased veins, then travel to the heart and lungs, obstructing essential blood flow.

Interestingly, Dr Narayanan says that the ongoing COVID pandemic has seen a surge in the number of cases of thrombosis and thrombosis-related deaths, as the virus infects the cells that form the inner lining of these veins and causes a significant increase in the risk of clotting.

“Decreased mobility from work-from-home practices and restrictions to movement have made this an epidemic within the pandemic. Pre-existing varicose veins only serve to make matters worse.”

That’s why early assessment is recommended, even if the varicose veins aren’t bothering you right now, says Dr Narayanan.

Additionally, spider veins – smaller, superficial veins that appear as fine red or green thread-like lines – should be checked, as they can indicate valve disease in the underlying veins.

The Treatments

The basic principle of treatment of varicose veins is to stop blood flow in the “bad” veins and push the blood through the “good” veins. Previously, this involved removing the diseased veins in a rather brutal procedure called stripping. Luckily, these days, there are many varicose vein treatment options that can be done as simple day-surgery procedures or as outpatient procedures in a clinic.

Here are the five minimally invasive varicose vein treatment options to have on your radar.

#1 Endovenous laser therapy (EVLT)

EVLT is a varicose veins treatment method that eliminates diseased veins without surgery, general anaesthesia or hospitalisation. It’s a one-time outpatient procedure under local anaesthesia that uses heat generated from a laser fibre to close the unhealthy veins.

“This is a bit like sealing a plastic popcorn packet with heat,” says Dr Narayanan. “The diseased vein is closed, left within the body, and becomes a thread-like harmless scar inside with time.”

#2 Venefit P ocedure

This non-surgical method is similar to EVLT; however, it uses a radiofrequency catheter to collapse and close the problem veins.

“While both procedures work equally well, numerous studies have shown that laser therapy causes much more bruising in the first few days than radiofrequency does, because of the remarkably high temperatures generated by the laser fibre. However, radiofrequency does demand more practice and skill with difficult veins.”

#3 Ultrasound-guided foam sclerotherapy

This non-surgical, minimally invasive procedure involves the injection of a strong chemical in the form of foam into the varicose veins, ultimately closing and eliminating them. The use of ultrasound imaging makes it possible to treat deep veins that aren’t visible to the naked eye, helping to guide the needle into the vein accurately.

#4 ClariVein

A more recent development in varicose veins treatment over the last decade is the use of vein “glue” to seal the diseased vein.

“Using a device called ClariVein, this catheter-based technique involves the simultaneous use of a drug that causes scarring and a rotating mechanical wire that scrapes the vein from within to allow the drug to act – a bit like a bottle brush with detergent!” says Dr Narayanan. “Direct injections of this drug into smaller veins can also be used to create a better cosmetic outcome.”

#5 High Intensity Focused Ultrasound (HIFU)

“An exciting new technique is HIFU, which uses ultrasonic waves from a special device called Sonovein to heat the vein from the outside. It’s still being assessed in studies, but early results are very promising,” says Dr Narayanan.

As to which method is best, he says it really depends on the individual patient’s vein sizes and vein anatomies.

“The surgeon should be able to offer the most appropriate method tailored to a particular patient, and should be trained to perform a few different methods of vein surgery.”

The key, he says, is a thorough assessment to begin with.

“A comprehensive map of which veins are diseased, and which ones are good enough to return blood to the heart and lungs, is essential before embarking on any procedure. A complete Ultrasound Duplex scan of the healthy and diseased veins is therefore mandatory; an incomplete assessment can lead to recurrences of the condition and poor results.”

The Final Word

While we can’t choose our genetics, there are many simple lifestyle measures that can be taken to help reduce your risk of developing venous disease, says Dr Narayanan. These include keeping your body weight down and staying mobile with exercise.

“An exercise regime that incorporates power walking is excellent for improving the function of your calf ‘muscle pump’, which helps squeeze the blood in your veins back to the heart. Pilates and core strengthening, especially after a pregnancy, is also particularly good to improve the return of venous blood from the veins in the pelvis; these veins are connected to the leg veins, and function as a unit.”

The Harley Street Heart and Vascular Centre #02-38/41 Gleneagles Annexe Block, 6A Napier Road

6472 3703 | harleystreet.sg

It’s a bit like sealing a plastic popcorn packet with heat