Varicose Veins

What are varicose veins?

Varicose veins are bulging and unsightly blue veins that occur on the legs. They can occur at any age in both men and women, but most commonly in ladies after pregnancy. They are extremely common (approximately 30% of the population will suffer from them at some stage of their lives) and they can be painful as well as unsightly. A lot of patients experience aching and serious discomfort from their veins, especially at the end of a long day standing up. Left untreated they can progress to create venous ulcers on the legs, which are difficult to treat.

Varicose veins are caused by the failure of valves in the venous system of the leg. It is essential that patients undergoing surgery for varicose veins have an accurate venous duplex scan; not doing this can result in the wrong operation being performed and the veins recurring at an early stage. A painless and non-invasive ultrasound is used to detect varicose veins and gives us the information we need to decide how best to treat your condition.

What type of people get varicose veins?

Anyone! Generally speaking as we get older the veins become more prominent, partly because varicose veins get worse with time. They also tend to become more prominent in ladies after pregnancy. However, veins can trouble people in their twenties as well as the older generation. They are more visible in people with pale skin, although people with dark skin get varicose veins just as frequently – they just aren’t so obvious.

What are the causes of varicose veins?

The underlying cause of varicose veins is leaking in the valves in the vein system. You have a lot of veins in your legs – enough to make fishnet stockings! For most of the time you can’t see them, if the valves are working correctly and the blood is flowing in the correct direction. If the valves fail and start leaking, then the blood will flow the wrong way and the affected veins will then bulge out and look blue and lumpy on the leg.

The most likely cause of varicose veins is genetic – in other words, some patients have a greater tendency to get varicose veins because their parents had them. We aren’t sure exactly how this works, but it is certainly the case that varicose veins ‘run in families’. Also patients in jobs which require prolonged periods of standing up often complain of varicose veins – such as teachers, hairdressers, policemen etc.

 

What are the symptoms of varicose veins?

Symptoms usually include aching and swelling of the leg, especially after standing up for prolonged periods or at the end of the day. This can be quite severe and uncomfortable. Sometimes the veins will cause your skin to itch and become irritated, especially at the lower part of the leg. Occasionally one or other of the veins may become inflamed and form a hard, tender lump under the skin – this is called thrombophlebitis and happens when a small blood clot occurs in the vein.

 

How are varicose veins treated?

The best treatment for varicose veins is undoubtedly minimally invasive treatment with a laser fibre or similar methods. Varicose veins used to be treated by the high tie and strip method, which required a general anaesthetic and a cut in the groin area, but since the early part of the 21st century, the minimal invasive operations have proven to be better by far. The veins can be treated with a laser fibre on the inside to seal the leaking valves, or injected with a chemical called sclerotherapy to make the appearance better. Most of these treatments can be done under local anaesthetic without the need to stay in hospital or to be put to sleep for surgery – it’s a bit like going to the dentist.

 

When should you see your GP?

You should see your GP about varicose veins whenever they are bothering you. This may be because of aching and swelling of the leg, or even just because you don’t like the appearance or are concerned about possible complications. Please be aware that some GP’s may not consider your veins to be suitable for referral or treatment on the NHS – in most parts of the UK, varicose veins are now not seen in NHS clinics unless the veins are so bad they are causing serious skin breakdown at the ankle.

Appearances of hard and tender lumps in the veins is most likely due to a symptom called ‘thrombophlebitis’ where a clot forms in the varicose vein. You should definitely see your GP about this as it should be treated with anti-inflammatory medication. If your GP won’t refer you to the NHS, we will see you in our clinics without a GP letter – appointments can be made via this website or by calling our office on 0208 249 0993. Details of fees and charges are available here or over the phone from our secretaries.

 

Is treatment successful?

Modern, minimally invasive treatment for varicose veins is extremely successful. Recovery is much faster than with the old fashioned ‘stripping operation’. The majority of patients are back to normal within a week and back to the gym within two weeks. In the past, the older techniques took about 6 weeks for patients to recover from.

Almost all patients will experience a massive improvement in the way their legs feel, with reduction in the aching and throbbing sensations immediately after surgery. It also makes the legs look a lot better too!

Recurrence of varicose veins can happen, even after minimally invasive operations, but the risk of this is very low – about 5% at 5 years, compared with 30% at 3 years with the ‘high tie and strip’ procedure.

At the Radiance Vein clinic we were the first surgeons in London and the South East of England to use EVLT lasers for varicose veins in 2002 and have successfully treated many thousands of patients with these procedures – please read our patient feedback pages for more details. 

 

How to heal varicose veins?

Significant varicose veins will require some sort of treatment by a surgeon as outlined in the paragraphs above. Other than the continual use of stockings, there is no other effective option. In some places on the internet there are adverts selling pills or ‘natural remedies’ for varicose veins, but there is no scientific evidence at all to support the use of these products. On the other hand, surgery with minimally invasive treatment such as the endovenous laser will improve almost all cases of varicose veins in a quick and efficient manner.

 

Standard procedure for removal of varicose veins

The standard operations for varicose veins involve making a cut in the leg over the point of main valve failure and stripping out the damaged segment of vein. This operation is called a ‘high tie and strip’. The vast majority of vein specialists don’t do this operation any more, but use one of the newer minimally invasive techniques such as EVLT or the latest ClariVein® technique which are less painful. To see Eddie Chaloner answering “what treatments are available for varicose veins?’ scroll to the bottom of this page.

Get treatment

Radiance Vein Clinic’s staff are some of the UK’s leading authorities on venous treatments. We provide the latest treatment options across London and Kent. For an initial consultation and advice, contact us now.

Further information – Videos

In the videos below Eddie Chaloner answers the questions “What are varicose veins?” and “What treatments are available for varicose veins?”.

Endovenous Laser Therapy for Varicose Veins (EVLT)

When introduced to the UK in 2002, EVLT was a completely revolutionary procedure for varicose vein treatment. Mr Chaloner and Mr Sweeney were the first surgeons in London and the South East of England to use this operation in 2003 and now have an experience of over 3,000 cases.

Instead of the old ‘high tie and strip’ method involving a lot of cuts in the leg; EVLT can be done entirely under local anaesthetic with no surgical incisions. The post-operative discomfort and bruising is less than with traditional surgery and patients return to work faster than after traditional surgery.

For that reason it has now become the treatment of choice for many leading specialist varicose vein surgeons and long-term follow-up data now shows EVLT also has less recurrence than the old style ‘high tie and strip’ surgery.

What are the advantages of EVLT as opposed to conventional surgery?

• No scarring
• No cut in the groin
• Less bruising
• Faster recovery
• Can be done under local anaesthetic
• No overnight hospital stay needed
• Less recurrence of varicose veins

Endovenous treatment – what does it mean and how is it done?

‘Endovenous’ means ‘inside the vein’. In surgical terms, what this means is that the faulty vein is sealed from inside the leg, rather than stripped out of the leg through a large incision. By doing this the patient has fewer cuts in the leg and a lower risk of complications with a better result from surgery.

The process

1. The surgeon will mark the veins on your leg with a pen – because when you lie flat on the table, the veins usually disappear from view. You will be lying on the table either face up or face down depending on the vein to be treated.

 

 

 

 

 

 

 

 

 

 

2. Using an ultrasound scanner the surgeon will then identify the vein and, using a small amount of local anaesthetic, will place a needle into the vein, then thread a fine catheter into the vein.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3. The surgeon will then infiltrate some local anaesthetic and saline fluid around the vein with multiple tiny injections to protect the area around the vein from the heat of the laser

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. All staff and the patient then put on some protective glasses before turning the laser on.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5. The laser will then be activated and slowly withdrawn down the vein. As it passes down the vein it will burn the inside of the vein and seal it shut. During this part you will not feel any pain. It will take about 3 or 4 minutes depending on the length of vein to be treated.

6. Following the laser treatment there may be some removal of the small surface veins (avulsions) or injections of tiny veins (sclerotherapy).

7. A bandage will be placed on the leg and the treatment is over. The whole process takes about 30 minutes.

 

 

 

 

 

 

 

 

 

 

After Treatment:

You will walk out of the hospital and able to go home. It is advisable not to drive yourself, but you can be driven home by someone else or go on public transport. After 5 days the bandage is replaced by a stocking for 2 weeks. While the bandage is on, you can’t get it wet, so will need to avoid baths or showers.

Once the bandage is off you can get the leg wet as normal. Most people will go about their normal activities within a few days and back to exercise within 10 days or so. There will be a feeling of tightness in the leg for a few days which can be treated with simple painkillers or anti-inflammatory gel.

 

Eddie Chaloner answers questions about Endovenous Laser Therapy (EVLT) for Askimo TV

Eddie Chaloner answers questions about Endovenous Laser Therapy (EVLT) for Askimo TV

Common misconceptions about varicose veins

Varicose veins only occur in women

Actually varicose veins occur almost as often in men as in women – about 25% of the population will get vein trouble at some time in their lives. It is true that more women come to see doctors about vein problems and this is mainly because they have more concern about the cosmetic appearance than men do – however the incidence is almost the same in men.

 

Varicose veins are caused by pregnancy

Not true – if it was true then men would not get varicose veins at all! It is correct however that patients who have varicose veins before becoming pregnant often have a bad time with their veins during the pregnancy. Pregnancy makes varicose veins worse, rather than making them happen in the first place. This is partly because of the large uterus in the late stages which prevents blood flow out of the leg vein and partly because of the hormones released in pregnancy which make veins bulge out more than usual. The exception to this is pelvic vein reflux, where leaking veins inside the female pelvis can create varicose veins on the vulva or at the top of the leg – these are usually caused by  pregnancy and can be fixed afterwards.

 

Varicose veins always recur after surgery

Old style ‘high tie and strip’ operations had a very high risk of recurrence – about a third of patients who had this operation got their veins back again within 5 years of treatment. With the newer minimally invasive treatments such as EVLT laser the risk of recurrence is a lot lower – more like 1 in 20 patients at 5 years.

 

Varicose veins should not be operated on in young women before they have had children

Not correct. In fact women with large varicose veins before pregnancy are well advised to have them fixed before having children. During pregnancy the veins can get very sore and surgery is out of the question until after delivery, with the only option being compression tights or pants. With modern minimally invasive surgery, the veins can be fixed before pregnancy and are unlikely to cause further trouble.

 

Varicose veins are caused by standing up in your job

Probably not true. It is the case that varicose veins are more painful if patients stand up a lot in their jobs – so for example, teachers, hairdressers and policemen often have trouble, but this is because their veins are more likely to be painful due to standing, rather than being caused by standing.

 

After varicose vein surgery you have to walk three miles a day

Another common myth – In the old days of open surgery, patients were advised to walk a lot after surgery because of the risk of Deep Vein Thrombosis (DVT) as a result of immobility. The legs were often really painful after a high tie and strip, so patients really had to be motivated to walk around. With the newer minimally invasive techniques, most patients have little in the way of serious discomfort and can resume normal activities more or less right away.

 

Crossing your legs makes you get varicose veins

No! Again this is probably related to advice from the days when patients were in hospital for days after varicose vein surgery and surgeons were worried about post operative Deep vein thrombosis. With modern surgery almost all patients have ‘walk in walk out’ treatment under local anaesthetic with no overnight stay in hospital.

 

Varicose veins run in families

Partly true – there probably is a genetic component to the development of varicose veins as they are sometimes seen in very young people and frequently do seem to affect different generations of the same families. However this is not always the case and, in addition if varicose veins were a purely genetic problem, they should occur in both legs in all affected patients and frequently only one leg is affected.

 

You shouldn’t fly if you have varicose veins

Partly true. This goes to the risk of getting a DVT after an airline flight. In patients with very bad varicose veins there probably is a very slightly increased risk of DVT but it is only very tiny. This risk goes up substantially if the patient has had recent thrombophlebitis (inflammation of the varicose vein) or a previous DVT.

 

Varicose veins are only a cosmetic concern

Certainly not. Whilst some veins are purely cosmetic, most significant veins will create significant symptoms of aching and swelling and if bad enough for long enough, varicose veins can damage the skin at the ankle area. If this goes on for long enough the skin can breakdown and cause an ulcer to develop which is a serious medical problem.

 

Frequently asked questions

What happens at consultations before surgery?

Your surgeon will talk to you about the problems your veins are causing and your past medical history. Then you will be examined including with an ultrasound scanner to outline and define the faulty veins that need treatment. A treatment plan will be formulated and explained, including costs, if these are not covered by your insurance company.

 

What treatment options are available?

Everything we do is state of the art minimally invasive vein surgery, mostly under local anaesthetic, with or without mild sedation. There are no big incisions in the leg and no scars afterwards.

 

Will I be able to drive after treatment?

It is advisable not to drive for about 5 days post treatment because if you had an accident your car insurance company may not cover you. If you can do a practice emergency stop in the car with the engine turned off, then you are OK to drive.

 

When can I fly after treatment?

Short haul flight (2 hrs) is no problem. Long haul flight (more than 4 hours) is considered slightly risky in view of the increased risk of Deep Vein thrombosis. We prefer if patients do not fly long haul for 4 weeks after treatment.

 

When can I exercise after treatment?

Most patients get back to exercise within 2 weeks.

 

When can I go back to work?

The time taken to get back to work depends on the type of job you do. For sedentary jobs most people go back to work right away. For more active jobs a few days off may be preferable.

 

I am on warfarin or other anti-coagulants – does that matter?

No. For most patients there is no need to stop warfarin or other anti-coagulants such as Pradaxa to do the EVLT procedure.

 

What can I do at home?

There is little one can do to fix varicose veins at home. Elevating the legs in the evening may help to reduce the swelling and aching at the end of the day. Wearing compression stockings will also help, although most patients find these are quite uncomfortable and a nuisance to get on and off the leg. If you use compression stockings, make sure you get a decent pair which are properly fitted and change them every 2 to 3 months as they tend to lose their elasticity over time. Put them on in the morning and take them off before going to bed. There are some devices that can be used to help get stockings on and off more easily, but patients still find them quite a chore.

 

Get treatment

Radiance Vein Clinic’s staff are some of the UK’s leading authorities on venous treatments. We provide the latest treatment options across London and Kent. For an initial consultation and advice, contact us now.