Varicose Veins - Medical specialists

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Overview

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Varicose Veins - Further information

Varicose veins overview

Varicose veins are gnarled, lumpy and swollen veins, which normally appear blue or dark-purple in colour. Any vein near the surface of your skin may become varicose, but the veins most commonly affected are those in your legs, ankles and feet. The reason these limbs are especially prone is that the actions of standing and walking upright tend to increase pressure in your lower-body veins.

The development of varicose veins is mostly of cosmetic concern, but some people find varicose veins can also cause an aching pain and discomfort. In addition, the presence of varicose veins can sometimes indicate a higher risk of developing other circulatory conditions.

Apart from swollen veins, other common symptoms can include leg cramps, dry skin and skin-colour changes to the lower leg. Common treatments range from self-care remedies through to vascular surgery.

Varicose-veins
Varicose veins

Symptoms of varicose veins

Blue or dark-purple varicose veins can look swollen and twisted in appearance and may be painful and uncomfortable. Typical varicose vein symptoms may include:

  • swollen feet and ankles
  • discoloured skin
  • uncomfortably heavy, aching legs
  • burning or throbbing sensation in your legs
  • cramps in leg muscles, especially during the night or following exercise
  • itchy, dry skin around your lower-leg veins
  • lower-leg skin discolouration
  • spider veins (telangiectasia) may be noticeable on an affected leg
  • 'restless' legs

Warm weather or extended periods of standing can often make your symptoms worse. Walking around and resting your legs in a raised position may help to ease any discomfort. Varicose veins usually occur on the back of your leg (in the calf-muscle area) and on the inner side of your leg.

Varicose veins may also occur in other body areas, such as the:

  • oesophagus (gullet)
  • uterus (womb)
  • pelvis
  • vagina
  • rectum (back passage)

Causes of varicose veins

The usual cause of varicose veins is weak vein walls and valves.

When vein walls become stretched, this tends to weaken the effectiveness of the small valves that control blood flow within a vein. Rather than recirculating normally, blood then collects and causes the affected vein to swell and enlarge. Experts do not fully understand all the reasons why this occurs.

Some factors, which often increase the risk of developing varicose veins, include:

  • gender – women are at greater risk, perhaps for hormonal reasons
  • family history – this condition is known to be passed on through your genes
  • age – the ageing process also causes veins to weaken and deteriorate
  • being overweight – this puts your veins under extra pressure
  • work requirements – some jobs require sitting or standing for long periods, which can restrict your blood flow
  • being pregnant – blood flow increases to support the development of your baby, increasing the pressure on veins

More rarely, other conditions can also cause varicose veins. These may include:

  • a pre-existing blood clot
  • a pelvic tumour or swelling
  • abnormal blood vessels

Diagnosis of varicose veins

A physical examination will be required, and will include checking for any swelling in your legs when you stand. You will be asked to describe the pain you experience.

A non-invasive ultrasound procedure may be used to create an image of the veins in your legs. This will help your doctor to establish whether there is any change in the functionality of the tiny valves, and will also screen for the presence of a blood clot.

Varicose veins specialists

As the treatment of varicose veins has developed over recent years, new medical specialities have evolved to create a range of modern techniques and treatments to meet the needs and expectations of today’s patients. There are now three distinct kinds of doctors who have the required skills to treat varicose veins:

  • phlebologists
  • vascular and interventional radiologists
  • vein surgeons

Phlebologist

A phlebologist is a physician who has gained speciality training in the diagnosis and treatment of disorders and diseases of the veins.

Phlebology has developed to enable doctors with a mutual interest in venous disease and health to share their knowledge and experience, despite being trained in a variety of different medical backgrounds, such as dermatology, vascular surgery, haematology, interventional radiology or general medicine. A significant part of a phlebologist's focus involves the treatment of superficial venous diseases of the leg, such as varicose veins and spider veins.

Vascular and interventional radiologist

A vascular and interventional radiologist is a doctor who practises in the medical sub-speciality of radiology that specialises in vein treatments. The interventional radiology concept seeks to diagnose and treat patients using less-invasive techniques in order to minimise risks, while also improving recovery times and health outcomes for the patient.

Vein Surgeon

Vascular surgery is a surgical sub-speciality in which diseases of the vascular system (arteries, veins and lymphatic circulation – but excluding the heart and brain regions) are treated via medical therapy, minimally invasive catheter procedures, and surgical repair and reconstruction. This speciality evolved from general and cardiac surgery, and has also been influenced by innovations such as the minimally invasive techniques first introduced by interventional radiology.

What additional qualifications are required by varicose veins specialists?

All varicose vein specialists must complete their normal medical training, which in the US requires four years in medical school, followed by a four-year residency. Having passed a qualifying examination, varicose vein specialists would then normally follow a two-year fellowship in their chosen specialism – phlebology or vascular surgery, or vascular and interventional radiology – in order to become fully qualified as a varicose vein specialist.

Treatment of varicose veins

The initial, conservative responses often recommended to ease the discomfort of varicose veins include:

  • elevating the legs for the temporary relief of symptoms
  • wearing compression stockings for support
  • taking anti-inflammatory medication
  • applying topical gels to the site of the affected veins

When a more proactive approach is required, some of the following treatments and procedures can be employed:

  • endovenous laser ablation is a technique that uses a laser fibre to destroy and close each varicose vein. Simpler, non-invasive laser therapy can be used on small veins closer to the skin surface.
  • ligation and stripping is a method that requires a small incision above the vein in order to perform ligation (tying off) before removal (stripping).
  • phlebectomy requires tiny incisions in the skin, through which a varicose vein is removed.
  • radio-frequency ablation uses radio-wave energy as a minimally invasive intervention to eradicate and close off varicose veins.
  • sclerotherapy uses a sclerosant (chemical) injected into the varicose vein. This destroys the lining of the vein, which is thus closed off. Sclerotherapy is an option that is usually only performed on smaller veins.

The post-operative recovery time for modern surgical vein-stripping procedures is typically between two and four weeks.

Prevention of varicose veins

Measures to ease or prevent varicose veins include:

  • wearing compression stockings – these improve circulation and are the most common method of treating varicose veins that cause discomfort
  • Self-care – this includes taking regular exercise, as well as avoiding sitting or standing for long periods

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