Diabetic Foot Ulcers Treatment & Management | How a Vascular Surgeon can help
January 13, 2021
What is varicose veins? What can I do about Varicose Veins? When should I be concerned about varicose veins?
Causes | Symptoms | Prevention | Diagnosis I Treatment
Varicose veins are a common visible problem that can affect anyone at any age.
They are usually a cosmetic problem, but often start hurting your legs when they appear as large, swollen veins on the legs/feet.
The veins rarely need treatment for health reasons, but if swelling, aching, and painful legs result, and if there is considerable discomfort, treatment is available.
In severe cases, a varicose vein may rupture, or develop into varicose ulcers on the skin. These will require treatment
Why does it happen?
Function of veins is to return impure blood from legs to heart. Veins have valves which allow only one way transport of blood from below to upwards. Prolonged standing can lead to weakness/leakage in these valves leading to retention of impure blood in leg veins which eventually leads to varicose veins.
Who is at risk?
Everyone who has prolonged standing work can develop this problem due to increased pressure gradient across vein valves.
eg- Housewives, Traffic police, Bus conductors, Shopkeepers, Field workers, Teachers, Surgeons / Anesthetists.
In many cases, it occurs for no clear reason. However, some potential risk factors include:
- Menopause
- Pregnancy
- Being aged over 50
- Standing for long periods
- Family history of varicose veins
- Obesity
What are the symptoms/clinical presentation?
In the majority of cases, there is no pain, but signs and symptoms of varicose veins may include:
- Pain & heaviness in legs
- Visible large veins in legs- veins look twisted, swollen, and lumpy (bulging); the veins are blue or dark purple
- Itching in legs
- Leg ulcer
Some patients may also experience:
- Aching legs
- Legs feel heavy, especially after exercise or at night
- A minor injury to the affected area may result in longer bleeding than normal
- Lipodermatosclerosis – fat under the skin just above the ankle can become hard, resulting in the skin shrinking
- Swollen ankles
- Telangiectasia in the affected leg (spider veins)
- There may be a shiny skin discoloration near the varicose veins, usually brownish or blue in color
- Venous eczema (stasis dermatitis) – skin in the affected area is red, dry, and itchy
- When suddenly standing up, some individuals experience leg cramps
Prevention
To reduce the risk of developing varicose veins:
- Maintain a healthy weight
- Avoid standing still for too long
- Do not sit with the legs crossed
- Sit or sleep with your feet raised on a pillow
- Guided leg exercise
- Wear medicated compression stockings prescribed by vascular surgeon while on work(for professionals who have prolonged standing )
Anyone who has to stand for their job should try to move around at least once every 30 minutes.
What if I neglect it?
May get complicated by wound / ulcer development in legs, excessive bleeding from veins. It will unnecessarily prolong your treatment course. So it’s better to consult a vascular specialist/veins specialist as soon as possible.
Diagnosis / What to do next after noticing varicose veins in legs?
Consult a Vascular surgeon for clinical assessment.
A brief history & physical examination, mainly visual, by a vascular surgeon will decide whether or not a patient has varicose veins. The patient will be asked to stand while the doctor checks for signs of swelling.
The following diagnostic test is sometimes ordered:
- Colour Doppler test: An ultrasound scan to check the direction of blood flow/any leakage of valves/any abnormality in the veins. This test also checks for blood clots or obstructions in the veins.
Treatment options
Your vascular surgery doctor will decide & explain you further course of treatment.
A. Medications & Compression stockings
They are used for very early stage of varicose veins to prevent further progress of disease & its complications.
Compression stockings squeeze the patient’s legs and improve circulation.
They work tight around the ankles and loose further up the leg. In this way, compression stockings encourage proper blood flow upwards, against gravity and back towards the heart.
B. Surgery
Rarely performed these days.
If varicose veins are large, they may need to be removed surgically. This is usually done under general anesthesia.
C. Minimal Invasive Treatment For Varicose Veins
If the patient has no symptoms or discomfort and is not bothered by the sight of the varicose veins, treatment might not be necessary. However, if there are symptoms, treatment may be required to reduce pain or discomfort & address complications such as leg ulcers, skin discoloration,bleeding or swelling.
Some patients may also want treatment for cosmetic reasons – they want to get rid of the “ugly” varicose veins.
1. Endovenous laser treatment
Laser treatments are often used to close-off large, small veins, and also spider veins. Strong bursts of light are applied to the vein, which gradually fades and disappears.
A catheter is inserted into the patient’s vein. A small laser is threaded through the catheter and positioned at the top of the target vein; it delivers short energy bursts that heat up the vein, sealing it shut.
This procedure is done under local anesthetic.
2. Radio frequency ablation
A small incision is made either above or below the knee, and with the help of an ultrasound scan; a narrow tube (catheter) is threaded into the vein.
The doctor inserts a probe into the catheter, which emits radiofrequency energy. The radiofrequency energy heats up the vein, causing its walls to collapse, effectively closing it and sealing it shut. This procedure is preferred for larger varicose veins. Radiofrequency ablation is usually done with a local anesthetic.
3. Sclerotherapy
This method is used to treat small size varicose veins.
Medication is injected into small and medium-sized varicose veins, which scars and closes them. A few weeks later, they should fade. A vein may need to be injected more than once.
Utilizing ultra sound technology, the varicose vein is located to allow for precision injection of the sclerosant agent.
Once the sclerosant agent is injected into the vein, it causes the varicose vein to collapse.
4. Ultrasound guided hook phlebectomy
Half centimeter incision placed over the skin under ultrasound guidance. The target veins are cut and removed through the incision.
A general or local anesthetic may be used for this procedure. There may be some bleeding and bruising after the operation.
Why should you chose minimally invasive treatment for varicose veins/spider veins?
No pain during surgery. Can be done under local/spinal/general anesthesia.
Post-surgery, minimal discomfort might be felt, which can be easily tolerated by most patients.
Excellent outcomes..!! No scars on skin.
Patient can walk immediately 4 hours after procedure, you can walk & climb stairs too.
That’s the beauty of a minimal invasive/day care procedures ☺.
One can attend your work from next day of surgery without any discomfort
Dr. Kushan Nanavati
Vascular & Endovascular Surgeon, Vadodara
