Minimal Invasive Procedure For Varicose Veins Treatment

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Dr. Manish Motwani

Posted By : Dr. Manish Motwani - M.S, M.D. and Diplomats, etc.

Posted On : Sep 18, 2009 (Views : 2997)

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The word "varicose" comes from the Latin root "varix," which means "twisted." Any vein may become varicose, but the veins most commonly affected are those in your legs and feet. That's because standing and walking upright increases the pressure in the veins in your lower body.

The veins of the legs are divided into two systems - the deep veins (which run deep to the leathery layer of fascia surrounding the muscles) and the superficial veins (which run in the layer of fat just beneath the skin). The superficial veins are the ones that you can see (for example, on your foot or around the ankle) and they are the ones that can become varicose. It is essential to keep in mind these two different systems - deep and superficial - in order to understand varicose veins and their treatment. In a number of places in the leg, the superficial and deep veins are linked by perforating veins (or 'perforators').

They are called perforators because they perforate the leathery fascial layer surrounding the muscles of the legs. Normally their valves should allow blood to flow only inwards - from the superficial veins to the deep veins. If the valves stop working properly, then blood is pushed out into the superficial veins when the muscles contract: this is one reason for high pressure in the superficial veins, and can be a cause of varicose veins.

The blood in your leg veins must work against gravity to return to your heart. To help move blood back to your heart, your leg muscles squeeze the deep veins of your legs and feet. One-way flaps called valves in your veins keep blood flowing in the right direction. When your leg muscles contract, the valves inside your veins open. When your legs relax, the valves close. This prevents blood from flowing backward. However, when these valves do not function properly, the blood pools, pressure builds up, and the veins become weakened, enlarged, and twisted. This causes varicose veins to develop. Varicose veins develop when one has faulty valves in the veins and weakened vein walls. These veins are twisted, enlarged veins close to the surface of the skin. They usually develop in the legs and ankles.

This vein and its tributaries are the ones that most often form varicose veins. The long saphenous vein is formed from tributaries in the foot, and is visible in many people when they stand, as the vein just in front of the bone on the inner side of the ankle. It runs up the inner side of the calf and the thigh, and at the groin dives to join the main deep vein (the femoral vein).

This is the other main vein under the skin of the leg, the tributaries of which can become varicose, but it is affected much less often than the LSV. The SSV starts just behind the bone on the outer side of the ankle, and runs up the middle of the back of the calf. It usually dives to join the main deep vein just above and behind the knee (the popliteal vein), but this varies and before any operation on the SSV it needs to be checked by a scan.

What causes it?

Some people may be more likely than others to develop varicose veins and spider veins because of inherited characteristics (genetics), the aging process, or hormone changes. Varicose veins may also result from conditions that increase pressure on the leg veins, for example being overweight or pregnant. Though, the most contributing factor is Hereditary. Women are more likely to suffer from abnormal leg veins. Hormonal factors can affect the disease. It is very common for pregnant women to develop varicose veins during the first trimester. Pregnancy causes increases in hormone levels and blood volume, which in turn cause veins to enlarge. In addition, the enlarged uterus causes increased pressure on the veins. Varicose veins due to pregnancy often improve within 3 months after delivery. However, with successive pregnancies, abnormal veins are more likely to remain. Other predisposing factors include aging, standing occupations, obesity and leg injury. Varicose veins are present in 20-25% of adult females and 10-15% of men. This common condition represents a considerable surgical workload.

What are the symptoms?

In varicose veins, symptoms are often worse at the end of the day because more pooling has occurred. Other things which increase pooling and therefore symptoms also include prolonged standing and sitting, exposure to heat (summertime, hot baths) and hormonal factors (pregnancy, around the time of the menses).

Varicose veins may be associated with a sensation of heaviness and itching and, in the presence of deep and superficial reflux, cramps and aching. However, all too often generalised aches and pains in the leg may be attributed to visible varicosed veins. Left unchecked, they tend to increase in size and often lead to progressive skin and tissue damage resulting in eczema, lipodermatosclerosis and, in advanced cases, venous ulcers. Lipodermatosclerosis is the medical term that describes damage both to the skin and to the fatty layer beneath it'.

Ulcers, when they occur, most often afflict the elderly, blighting their lives with frequent visits to their local surgeries or hospital out-patient departments. Many sufferers complain of aching of the legs, skin itching, ankle swelling, restless legs, night cramps and sleep disturbance.

How is it diagnosed?

Varicose veins are arguably the most frequently referred general surgical malady presenting to hospitals. Varicose veins are often caused by an underlying problem in leg vein.

General examination

First your physician asks you questions about your general health, medical history, and symptoms. In addition, your physician conducts a physical exam. Together these are known as a patient history and exam. Your physician will examine the texture and color of any prominent veins. He or she may apply a tourniquet or direct hand pressure to observe how your veins fill with blood. So the diagnosis is based primarily on the characteristic appearance of the legs when the patient is standing or is seated with the legs dangling.

Duplex ultrasound exam

At times a physician may order a duplex ultrasound exam of extremity to see blood flow and characterize the vessels, and to rule out other disorders of the legs. Duplex ultrasound uses high-frequency waves higher than human hearing can detect. Your physician uses duplex ultrasound to measure the speed of blood flow and to see the structure of your leg veins. The test can take approximately 20 minutes for each leg.


Rarely, an angiography of the legs may be performed to rule out other disorders.

What are the treatment options?

The surgeon first assesses the patient, with a detailed history and physical examination, and confirms the diagnosis and extent by relevant investigations. Not every person with a varicose needs surgery. One needs to discuss the reasons for operating and understand the risks involved.

A large proportion of patients may wish surgery for cosmetic reasons or due to anxiety that their disease may progress to chronic venous insufficiency and ulceration. It should be emphasized that varicose vein surgery is not curative, and early surgery in uncomplicated veins will not prevent development of future varicosities. However, it has been shown, that quality of life is reduced in patients with varicose veins compared with the general population, and that this is improved by surgery.

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