What are varicose veins?
Varicose veins are tortuous, enlarged veins in your legs caused by increased pressure in the veins primarily due to leaky valves inside the veins. This increased pressure, caused by gravity, is called venous hypertension and leads to venous symptoms.
Symptoms
- Aching
- Throbbing
- Itching
- Swelling
- Venous eczema – itchy, red, inflamed skin
- Skin discolouration/staining
- Thrombophlebitis (clotting and inflammation of the veins)
- Ulceration
- Bleeding
Causes
- Family history of varicose veins
- Female – female hormones relax vein walls
- Overweight
- Older age
- Long periods of standing
- Pregnancy
- Other rarer conditions – previous DVT; pelvic swelling; abnormal blood vessel
Assessment
Treatment of varicose veins is considered to improve symptoms, improve quality of life and treat and prevent complications of venous hypertension or varicose veins. Patients with venous problems wishing to consider venous treatment, and all those with patients with complications, require an individual assessment to have a bespoke treatment plan. The treatment options will depend on a number of factors including the patient’s general health, the size, position and severity of your veins and the function of the deep and superficial veins.
Investigations
Patients considered for treatment of venous disease (varicose veins or leg ulcers) require an individual clinical assessment & a non-invasive duplex assessment to formulate a management plan. Mr Poskitt has previously established a Leg Ulcer Service in Gloucestershire & offers an accurate assessment to identify & treat the cause (most commonly leaking vein valves).
Treatment
- Conservative advice – exercise, elevation, weight loss
- Compression stockings
- Sclerotherapy
- Liquid
- Foam – Duplex Guided Foam Sclerotherapy (DGFS)
- Endothermal Ablation – heating the vein wall
- Radiofrequency Ablation (RFA)
- Laser
- Surgery
- Others
- Cyanoacrylate glue occlusion
- Transilluminated powered phlebectomy
Patients require an individual assessment to have a bespoke treatment plan
Mr Poskitt favours the use of Radiofrequency Ablation (RFA) as the endothermal technique of choice and has nearly 20 years of experience with this mode of treatment. This may be performed either under local or general anaesthetic (outpatient or day case procedure).
He has extensive experience of the various modes of sclerotherapy and has used the technique of Duplex Guided Foam Sclerotherapy for over 18 years in patients with venous ulceration. The method reduces the venous hypertension and aides ulcer healing and reduces the risk of ulcer recurrence.
Expectations of Treatment
Sclerotherapy
- Soreness/discomfort, lumpiness and discolouration/bruising is common in the first 14 days and then reduces over several weeks. It can take several months for the lumpiness to settle and longer for staining to reduce. In some cases, staining in a mild form may be permanent.
Radiofrequency Ablation (RFA) & Phlebectomies
- When treated with Radiofrequency (RFA) including phlebectomies, you may expect to have some discomfort/pulling sensation along the course of the treated vein on the inner aspect of the thigh 10- 21 days following the procedure. This settles after 3-4 weeks.
- Bruising and small (1cm) lumpy areas are common in the first 21 days post operatively. Rarely you may get a larger collection of blood under your skin (haematoma) and this will normally settle as the body melts this away over time (3-4 weeks). Some small areas of skin may feel slightly woolly or numb due to minor bruising /trauma of tiny skin nerves. This occurs in 10 -15% of cases and does not affect the muscles. In over 60% affected, this will settle completely but in some cases numbness may continue in a small % but cause no major issues.
- Despite treatment some varicose veins may remain and may require further treatment.
Complications of Treatment
Sclerotherapy
- Fainting
- Temporary vision problems
- Headaches
- Blood clots (DVT) in leg veins 1 in 100 risk
- Changes to skin colour – brown staining over treated areas, rarely blisters/small ulcers
Radiofrequency Ablation (RFA) & Phlebectomies
- Whilst in hospital, when starting to mobilise an hour or so after the procedure, some strike- through bleeding may occur through the bandages – this is treated by the nursing team by elevating the leg on the bed, applying pressure and placing an additional pressure bandage.
- Blood clots (DVT) 1 in 100 risk
- Sensory nerve heat damage to inner aspect of the ankle has been reported in the literature causing numbness – very rare
- Varicose veins may recur in 10 % of cases over 5 years
Postoperative advice
Exercise
You are advised to keep active by regular activity (e.g. 5+ min walking every hour) in the first few days, avoid standing or sitting with your legs down and when not exercising, elevate your legs on the sofa.
Driving Guidance
You should not drive, operate machinery or do anything strenuous for at least 48 hours. You may can drive short distances when comfortable which is usually within 5 days and as soon as you are able to perform an emergency stop without hesitation or pain.
Air Travel Guidance
Air travel is not advised within 6 weeks of venous interventional treatment.
Medication
Let your health care team know about all the medication you are taking and follow their advice.
Following your procedure pain relief such as paracetamol 2 tablets 500mg x 2 four times a day for the first few days (and if not contra-indicated, ibuprofen or codeine). This will be discussed with you before you go home.
Follow up
A follow up in the clinic will be arranged usually 24-36hrs after the procedure to remove your compression bandages and replace them with small plasters and a grade 2 compression stocking to wear for 7 days (apart from showering). Arrangements will be made for you to attend for a clinic appointment at 2 weeks to see Mr Poskitt for review.
Contact information
If you have any questions please contact Mr Poskitt’s Secretary, Simone Avery:
Phone: 01242 235861
Mobile: 07946 679968
Cheltenham Nuffield: 01242 246500
Research/Link
Comparison of surgery and compression with compression alone in chronic venous ulceration (ESCHAR study): randomised controlled trial – The Lancet
Long term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (ESCHAR): randomised controlled trial | The BMJ
A Randomized Trial of Early Endovenous Ablation in Venous Ulceration | NEJM
NICE Management of Varicose Veins (CG168)
Overview | Varicose veins: diagnosis and management | Guidance | NICE