Our body carries deoxygenated blood back to the heart through the veins and sends oxygenated blood out again through the arteries. In the legs, blood returning to the heart has to travel upwards, and valves inside the veins stop it from flowing back down. In varicose veins these valves no longer work: blood flows backwards and pools in the veins.

Although varicose veins can occur in other parts of the body, they are most common in the legs. They are a significant health problem, and delaying treatment can seriously reduce quality of life.

Causes

Although the exact cause is not fully known, genetic predisposition is one of the most important factors. Others include standing for long periods or working seated all day, smoking, pregnancy, use of the contraceptive pill, older age, obesity, tight clothing and high heels. Varicose veins are more common in women than in men. People with any of these risk factors can help prevent varicose veins through lifestyle changes.

Symptoms

• Leg pain that is mild in the morning and gets worse as the day goes on
• Blue or purple veins visible through the skin
• Itching, swelling or a tingling feeling in the legs
• Cramps or restless legs syndrome
• Spider veins
• Prolonged bleeding from the affected area, either spontaneously or after minor injury
• Skin ulcers in advanced varicose veins

Diagnosis

After the examination, imaging tests are carried out to plan treatment. Venography was used in the past, but Doppler ultrasound is now preferred because it shows the structure of the vein, how well the valves work, how long blood flows backwards and whether there are any clots. In advanced cases, CT venography and MR venography can also be used.

Types of Varicose Veins

Varicose veins appear in three forms: spider veins, reticular veins and trunk varicose veins.

• Spider veins: Red to burgundy, web-like vessels about 1-2 mm in diameter that are not raised above the skin. They are also called telangiectasias.
• Reticular (medium-sized) veins: Green-blue vessels 2-3 mm in diameter that are slightly raised and can be felt by touch.
• Trunk varicose veins: 4 mm or more in diameter, clearly visible through the skin and the same colour as normal veins. Larger deep varicose veins lie between the leg muscles and cannot be seen from the outside.

Treatment

Varicose veins affect quality of life and can become serious if left untreated. In the early stages, lifestyle changes such as quitting smoking and regular exercise, together with compression stockings, slow their progression. For larger varicose veins there are two options: surgery and minimally invasive treatment.

In surgery, the varicose vein is removed by stripping it out through several incisions in the leg. Because of the long recovery time, risk of recurrence, slow wound healing and surgical complications, surgery has largely been replaced by minimally invasive methods.

Minimally invasive treatments aim to close the faulty vein. There are currently four such methods:

• Radiofrequency ablation (closing the vein with radiofrequency heat)
• Laser ablation (closing the vein with laser heat)
• Cyanoacrylate embolisation (sealing the vein with a medical adhesive)
• Foam sclerotherapy

The specialist chooses the method based on pre-procedure imaging, the structure of the vein and the patient's condition. The procedure is usually performed under local anaesthesia and ultrasound guidance through a tiny incision: a catheter is advanced into the faulty vein and one of these methods is applied. The advantages of minimally invasive treatment include no general anaesthesia, a shorter procedure than surgery, no scarring and being able to walk immediately afterwards.

Whichever method is used, the source of the problem must be treated first so that the result is lasting.

In addition to leg varicose veins, our team also treats pelvic (genital) varices, neck varices, oesophageal varices, haemorrhoids, facial varices and varicocele with minimally invasive methods, with successful results.