The energizing materials required by body cells and the oxygen required to use these are pumped by the heart to tissues via the arteries. The energizing materials and oxygen in the blood are used by the tissues and this blood with effluents is returned to the heart via veins to be oxygenated. A varicose vein is the enlarged and tortuous vein.
The veins in the body can be categorized in two main groups, superficial and deep. Superficial veins are under the skin and visible. Deep veins are localized between the muscles adjacent to the relevant artery and nerve and not visible. The saphenous veins have 10 to 15 valves to prevent the blood in the saphenous veins from accumulating in the legs due to gravity, and to make the blood always travel to the heart. If these valves fail to close completely resulting in blood flowing backwards, the blood is accumulated in these veins and their sub-branches. The veins become enlarged, resulting in a disease which we call varicose vein. Although most are genetic, the incidence is higher in those who work standing (e.g. teachers, nurses, doctors, and waiters). It is more common in women than men. The likelihood of a varicose vein is increased with age.
The disease has stages including occurrence of millimetric capillary vessels and wounds on the legs. In the early stage the patients usually complain about the appearance, but then pain, swelling, and sensitivity as the disease progresses. In the advanced stages, skin color of the leg may become darker, and flaking and even non-healing wounds may occur.
Imaging methods are used in diagnosis. A venography or color Doppler ultrasonography can be used to determine whether invisible deep veins have valve regurgitation. In venography, a special dye is injected into the vein at tarsal level to take films. The use of venography has been reduced because of the state-of-the-art technology instruments for ultrasonography. Color Doppler ultrasonography is a painless simple method which involves no needles.
The treatment should be performed according to the patient and stage of the disease.
Early Stage and Patients at risk of surgery:
In the early stage and elderly patients at risk of surgery can only use varsity socks to prevent the disease from progressing. Mid-calf varsity socks are usually enough. Various treatment methods can be used in small varicose veins of 1-3 mm and capillary vessels id Doppler ultrasonography does not reveal valve regurgitation. The vessel is accessed by special thin needles to inject specific materials and close the vein (sclerotherapy). This procedure can also be performed by electrocoagulation, radiofrequency and laser. Several sessions are needed depending on the generality of disease. The patient should be able to walk to home after the procedure; no need for bed rest. An elastic bandage or varsity sock should be enough for 1-3 days.
In patients in an advanced stage:
Standard surgery, foam sclerotherapy, radiofrequency, and laser ablation methods can be used in an advanced stage. The method should be selected by the patient and the stage of the disease. The common objective of these methods is to prevent venous load and accumulation by removing superficial vein with valve regurgitation or closing inside of that vein. It is completely harmless for the body to remove or close these vessels with failed valves. Deep veins will serve in the same way. The patient needs the stay in the hospital overnight in all these methods. They can get back to their normal life in 7-10 days.
- In a standard surgery, an incision of 1-2 cm is made on the groin line. The branches where superficial vessel changes into a deep system are connected. The superficial vein is taken out to the knee level by a special wire. Small incisions of 5-7 mm are made on the enlarged varicose veins to remove.
In foam sclerotherapy, radiofrequency, and laser ablation methods, the superficial vein is entered opened, or with guidance of Doppler ultrasonography at knee or tarsal level.
- In foam sclerotherapy, the medicine mixed with air to make it foamy is injected into the blood vessel to close it.
- In radiofrequency and laser ablation techniques, the vessel is closed by a special catheter with high temperature.