Understanding Superficial Venous Reflux
Your legs are made up of a network of veins. Healthy leg veins contain valves
that open and close to assist the return of blood back to the heart. Venous
reflux disease develops when the valves that keep blood flowing out of the legs
and back to the heart become damaged or diseased. This can cause blood to pool
in your legs and lead to symptoms such as pain, swelling, swollen limbs, leg
heaviness and fatigue, skin changes and skin ulcers, and varicose veins.
Spider Veins
Spider veins (or thread veins), medically known as telangiectases are dilated
capillary veins less than 2mm. in diameter. They are small blue to red appearing
blood vessels that lie close to the surface of the skin and occur either in lines
or web-like patterns. They are usually visible on the legs but sometimes are
visible around the nose and lips and are commonly referred to as "broken veins."
While they can ache, burn or itch now and then, but they are usually not symptomatic.
Spider veins are not harmful and are simply unsightly.
Varicose Veins
Varicose veins are ropy appearing blue vessels under the skin, usually ΒΌ inch or
larger in diameter. They are most often branches from the saphenous trunk veins,
and have enlarged due to the excess pressure in the saphenous system. Varicose
veins are unsightly and often painful. A clotted varicose vein causes the classic
phlebitis, hot and red and painful skin at the site of the clot. Beside the
visible symptoms, physical symptoms are tiredness, restless legs at night, heaviness
in the leg, pain, aching, itching, throbbing & swelling, burning or a cramping
sensation.
Occasionally, severe varicose veins can damage the skin of the leg above the ankle
causing itchiness and discolouration (eczema). Without treatment an ulcer may
eventually occur.
Click below to view a 30 second video-clip about venous reflux
Vein Treatments:
After a comprehensive evaluation that includes an ultra-sound examination of the
veins, your vein specialist will determine the optimal treatment for each patient's needs.
Occasionally an x-ray will be needed before advice about treatment can be given.
Do I need treatment?
Treatment for varicose veins is seldom essential since serious complications
rarely occur. The choice is yours and many patients have varicose veins for the
whole of their adult life and never suffer any problems with them.
How can I help myself?
Avoid being overweight and wear support stockings if you have to stand up a lot
of the time. Regular exercise such as walking also helps to pump the blood out of
the leg. Dry itchy skin can often be helped by moisturising (emollient) creams or
bath additives available at the chemist.
If I need treatment, what treatments are available?
1. Support Stockings.
These may be all that is required if aching and swelling are the main problems.
Properly fitted medium-strength compression stockings up to the knee usually
work best.
2. Ultrasound-guided Foam Sclerotherapy (injections).
This is a new development of a long established treatment for varicose veins. A
small amount of a special chemical (Sclerosant) is mixed with air to make a foam
(this is the new bit - although the chemical is approved to treat varicose veins
it is not licensed in the UK for mixing with air to make a foam). Under ultrasound
monitoring the foam is then injected into each vein and the leg is bandaged and
placed in a full length stocking for a week. The foam causes inflammation in the
vein which then shrivels up and eventually becomes less visible. Sometimes the
inflammation can be uncomfortable for a few weeks, and occasionally the skin can
blister and become scarred.
Injections are not a form of "invisible mending", and cause some skin staining
in more than a third of patients. This usually resolves within 12 months but can
occasionally be permanent. Other complications which occur in about 5-10% of
patients include allergic reactions, temporary visual disturbance, deep vein
thrombosis (DVT), and headache.
3. Traditional Operation.
Until recently more severe varicose veins were often treated with surgery. This
is performed under a general anesthetic. The visible varicose veins, marked before
the operation, are removed through a series of small cuts which are then closed
with adhesive strips or stitches.
More importantly a cut is commonly made in the groin over the top of the main
varicose vein and the leaky valves are tied off (sometimes this is also done
behind the knee). The cut in the groin is closed with a stitch, usually hidden
under the skin. The vein in the thigh may also be removed (stripped) to reduce
the risk of varicose veins returning, however blood can still flow up the leg
along deeper, unaffected veins. The leg is then bandaged and placed in a full
length stocking for a week.
Operation can still be used to treat most varicose veins and a few patients with
varicose veins are still best treated by this type of surgery. Most patients
are able to go home the same day after their operation, but you are not usually
able to resume driving for 2 weeks, and it may take this long to resume your
normal activities after surgery.
Complications of conventional surgery include occasional bleeding from the wounds,
infection in the groin wound, deep vein thrombosis (DVT) and some numbness and/or
pain in various places in the leg. These usually settle within a few months;
rarely a small area of permanent numbness remains. Bruising, especially along
the inner thigh is common in the first week or two after the operation and this
can require painkillers until the inflammation eases. The scars on your legs will
continue to fade for many months.
4. The Closure® Procedure
The VNUS® Closure Procedure, an alternative treatment option to traditional vein
stripping surgery, brings state-of-the-art technology to an age-old disease.
The Closure procedure is performed on an outpatient basis and only requires a simple
local anaesthetic. Using ultrasound, your surgeon will position the Closure catheter
into the diseased vein, through a small opening in the skin. The tiny catheter
delivers radiofrequency (RF) energy to the vein wall. As the RF energy is delivered
and the catheter is withdrawn, the vein wall is heated, causing the collagen in the
wall to shrink and the vein to close. Once the diseased vein is closed, blood is
re-routed to other healthy veins.
Following the procedure, a simple bandage is placed over the insertion site, and
additional compression may be provided to aid healing. Your doctor may encourage
you to walk, and to refrain from extended standing and strenuous activities for a
period of time.
More than 70% of varicose veins are suitable for day case treatment using the
Closure procedure. There may be a few visible varicose veins left after treatment,
but these do not cause symptoms and become less visible with time. As with any
surgical procedure there is a small risk deep vein thrombosis (DVT).
We do not know how VNUS treatment compares with conventional treatment in the
long term, although results over the last 5 years appear to be as good as or
even better than surgery.
Patients who undergo the Closure procedure typically resume normal activities
within a day.
Click below to view a short video about the VNUS Closure procedure
Highlights of the Closure® procedure
Relief of symptoms
Resume normal activity within a day
Outpatient procedure
Procedure carried out under local anaesthesia
Good cosmetic outcome with minimal to no scarring, bruising or swelling
5. Endovenous laser ablation (EVLA)
This procedure is similar to the Closure procedure, but uses laser energy to
seal the vein closed. The main differences are that there is less information
about the long term results of the procedure, and a greater number of patients
(about one quarter) experience significant discomfort that comes on about 5
days after the treatment, and lasts for a few days.
VNUS Closure Procedure: Information for patients