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					VARICOSE VEINS

OVERVIEW It is the purpose of this module to provide information in relation to the signs and symptoms, causes, risk factors, complications and latest treatment options available for sufferers of varicose veins.

SYMPTOMS Varicose veins are usually quite obvious, appearing as knotted or gnarled, occasionally bulging and usually a dark purpose colour, beneath the skin. The word “varicose” comes from the Latin “varix”, which means “twisted”. The most common areas affected are the lower legs and feet. Varicose veins affect approximately 15% of men and 25% of women throughout their life time. They are not usually of medical significance, but rather usually a cosmetic issue for the patient.

CAUSES Blood flowing down the legs to the feet is assisted by gravity, but blood flowing up to the heart needs to work against the force of gravity. All veins contain valves to allow the blood to flow towards the heart and prevent backflow. When there is damage to a valve the blood pools. The deep purple/blue colour associated with varicose veins is due to the reduced amount of oxygen in the blood as it returns to the heart. The pooling of blood also causes the bulging appearance. Spider veins are a form of varicose veins which usually form in the smaller more superficial blood vessels and take their name because of the spread appearance of them similar to that of a spider’s web. Most people with varicose veins do not experience any discomfort from the condition. The portion of suffers who do experience discomfort report:(a) An achy or heavy feeling in the legs, burning, throbbing, muscle cramping or swelling in the lower legs which is aggravated by prolonged sitting or standing; Itching around one or more of the veins; Skin ulcers on the site of the vein, most commonly near the ankle.

(b) (c)

RISK FACTORS The following factors are indicators of increased risk of developing varicose veins:(a) Aging: - Aging veins tend to lose their elasticity increasing the prospect of valve failure. A reduction in muscle tone with age is also related to blood pooling. Sex: - Men are less likely than women to develop varicose veins. Pregnant women are also more likely to be sufferers of the condition due to the increased strain on the lower legs from carrying the additional weight of a baby during pregnancy and the increased burden placed upon the circulatory system during pregnancy. Genetics: - A family history of varicose veins is likely to be a strong indicator of the likelihood of the development of the condition. Obesity: - Being overweight places additional pressure upon the legs and the circulatory system in the same way as described for pregnant women. Standing for long periods of time: - Those involved in standing for long periods of time place an extra burden upon the veins and valves of the legs. This accumulative strain is a factor increasing the likelihood of the condition.

(b)

(c)

(d)

(e)

SCREENING AND DIAGNOSIS There are generally three steps associated with the diagnosis of varicose veins. They are as follows:(a) An examination of the relevant veins, in particular while the patient is standing so that any bulging or swelling can be observed; Obtaining a description of any pain or symptoms; and Obtaining an ultrasound for evidence of any blood clot.

(b) (c)

In some cases it may appropriate to refer to a phlebologist (specialist in vein conditions) or a dermatologist (specialist in skin conditions). In some severe cases painful ulcers may form on the skin. Brownish pigmentation often precedes the development of such ulcers. The ulcers require treatment of the site to promote healing. Depending on the treatment method utilised it may be

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necessary for any ulcer to be fully healed before treatment of the varicose vein can commence or in some cases the treatment of the varicose vein may be able to take place with a view to removing the source of the ulcer. Patients with varicose veins, as a result of the blockage and pooling of blood have an increased risk of the development of thrombophlebitis (blood clotting) where such a complication is suspected an urgent referral should be made to an appropriate treating specialist for treatment, including the dissolving of the clot. If not treated properly such a clot may form a deep vein thrombosis which may in turn lead to heart attack or stroke.

TREATMENT A number of self help measures are available to patients without medical intervention. They include the following:(a) (b) (c) (d) (e) (f) (g) Exercising; Losing weight; Avoiding standing or sitting for long periods of time; Avoid the crossing of legs while sitting; Not wearing clothes which are tight around a particular point and may restrict blood flow; Wearing compression stockings to try and encourage blood flow; or Simply elevating the legs at regular intervals.

Medical treatments available include the following:(a) Sclerotherapy - In this procedure injections are given of a solution that causes vein scaring, collapse and enclosure. Blood flow is then re-routed through alternate veins. The procedure does not require anaesthesia and can usually be done in rooms. One of the limitations of sclerotherapy is that it is most effective on smaller veins. On larger veins the condition often reoccurs. Laser surgery – Laser therapy works by the insertion of a laser fibre into the vein to the desired location. When the laser is fired it deposits thermal energy into the blood and venous tissues, causing irreversible localised venous tissue damage. The laser is repeatedly fired as it is gradually withdrawn along the course of the vein until the entire vein is treated. The result is thermal destruction of the venous tissue which eventually fades and disappears. Catheter-assisted procedures – This treatment involves the insertion of a catheter into an enlarged vein. The tip of the catheter is then heated and again causes vein ablution as the catheter is withdrawn. The vein is

(b)

(c)

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sealed shut, collapses and fades in the same way as in laser surgery. This procedure is usually used for larger varicose veins. (d) Vein stripping – This procedure involves the removing of the vein through a small incision. The procedure is usually an outpatient procedure and the blood flow is naturally redirected to alternate routes throughout the circulatory system. Ambulatory phlebectomy – In this procedure smaller varicose veins are removed through a series of tiny skin punctures involving the use of local anaesthetic. Again this is usually an outpatient procedure. Endoscopic vein surgery – This procedure is carried out by a surgeon and is only used in advanced cases, usually involving leg ulcers. A thin video camera is inserted into the leg to visualise and close the varicose vein. The vein is then removed through small incisions.

(e)

(f)

COMPLIMENTARY AND ALTERNATE TREATMENTS There is some evidence to suggest that horse chestnut seed extract may be effective in treating chronic venous insufficiency, a condition associated with varicose veins in which the leg veins have problems returning blood to the heart. It has also been suggested that grape seed may assist peripheral circulation by strengthening the blood vessels and witch hazel may assist itchy skin around varicose veins. Regular massage from a trained massage therapist can significantly alleviate discomfort associated with the varicose veins and help stimulate blood flow.

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