2019 10 25
Varicose veins on the legs: a life threatening “esthetic” problem
Vascular Diseases, Varicose Veins
“Varicose veins are often associated with bulging bluish cords on the legs causing many people to perceive the problem as purely aesthetic and think that dealing with it can be postponed for later. Having said that, has anyone heard of a sudden death caused by a detached blood clot? Unfortunately, this is one of the possible tragic consequences of varicose veins that are often mistakenly viewed as an aesthetic problem” says Nerijus Bičkauskas, a vascular surgeon at the Medical Diagnostic and Treatment Centre.
„Varicose veins are chronic venous insufficiency, also called enlarged veins. The concept of varicose veins includes the dilation of superficial varices as well as the deeper truncal veins. It may sound a bit confusing as the deeper truncal veins cannot be detected with the naked eye, and are treated using different methods than superficial varices. Patients can only see changes in superficial veins – the bulging blood vessels, varices, and a bluish netting of blood vessels covering the legs, while doctors focus on the processes in truncal veins“, explains Dr. Nerijus Bičkauskas.
How do veins work?
Veins are blood vessels that carry blood toward the heart where it becomes oxygenated. Blood flows directly upward in the veins of the legs. The flow up is aided by the activity of the heart and the lungs as well as 4 muscle pumps, while the valves in the veins do not allow for the blood to flow backward. When the vein becomes swollen the valve becomes faulty, and we experience a blow to the legs when changing the position of our body. The inflammation-causing factors in the limbs increase. The legs feel painful and heavy. The deep veins carry about 90% of venous blood and that is why they are very important to the entire cardiovascular system. The superficial veins transport only up to 10% of the returning blood, so when such an artificial vein is removed, its activity is fully compensated by the deep veins.
Of course, the dilated superficial veins present as an aesthetic problem – the bulging out, varices, and discoloration of the skin. Moreover, if varicose veins are left untreated, ulcers may develop on the calves. Treatment for ulceration is expensive and slow, and it may take a lot of time and effort on the part of the patient and their family. In addition, ulcers provide a breeding ground for different infections, and if complications develop, they may lead to sepsis.
“The treatment must be complex and consistent. It is pointless to treat superficial varices but leave truncal veins untouched. It could even make the situation worse as varices appear in order to absorb the impact generated by the blood flow when the valves in the truncal veins are not close-fitting,” says Dr. N. Bičkauskas.
Varicose vein complications can be life-threatening
One of the most alarming complications of varicose veins is the formation of blood clots inside the blood vessel. These clots can travel through the circulatory system and can cause blockages of arteries affecting the heart and the lungs, and causing sudden death. People often suffer deep vein thrombosis at airports or during flights – especially long haul – due to prolonged sitting in one place or shortage of fluids. Due to the dry air inside the aircraft, the body becomes dehydrated, the blood coagulation levels increase, and blood clots may form.
If your legs feel tired and achy in the evenings and if the netting of the veins underneath the skin becomes more and more prominent, you should see a vascular surgeon.
Fear of surgery interferes with treatment
Some people tend to delay varicose vein treatment because they are afraid of complicated surgery and a painful recovery period. Indeed, in earlier days varices were treated by open surgery to remove the defective parts of the vein. These were complicated operations followed by a prolonged postoperative period and slow recovery.
Dr. Bičkauskas says that nowadays open surgery for varicose veins is only performed in exceptional circumstances, as such procedures have a serious traumatizing impact on the patient. The entire vein is pulled out of the leg, the procedure is performed under general anesthetic and it takes a long time for the wounds to heal. Today much less invasive and gentle treatment methods, such as laser or glue treatments are used to treat the condition. With these methods veins are not physically removed, the damaged parts are simply closed in, and the blood makes its way along other healthy veins.
“Not every little town is equipped to carry out laser or glue treatment for varicose veins but that is not a good enough reason to resort to open surgery. Modern medical centers are no more than three hours away from any place in Lithuania, and laser or glue surgery only takes 20–40 minutes. After such an operation, the patient can simply get up and go. Vein surgery requires a highly qualified professional input and thus such procedures should be entrusted to vascular surgeons specializing in blood vessels,” says vascular surgeon N. Bičkauskas with over 25 years of experience in the field.
Treatment starts with detailed diagnostic
Both truncal and superficial vein treatment starts with precision diagnostics and a thorough examination. “At the Centre, we use a duplex ultrasound scanner, which allows for a thorough examination of the insufficient parts of the venous system and application of treatment exactly where it is needed,” says Dr. N. Bičkauskas.
Patients can choose their treatment method
Dr. Bičkauskas says that today patients can voice their preference when it comes to varicose vein treatment methods, e.g. they can choose between laser or glue treatment. Both methods are highly efficient and they both use similar techniques.
During the laser operation, the fiber optic line is inserted into the blood vessel, and heat is used to shrink the wall of the swollen vein. During the glue procedure, the probe is inserted in the vein, which releases a drop of glue every 3 cm and seals the walls of the blood vessel in this way.
“Most vascular surgeries are performed using lasers. People prefer this option as it is slightly cheaper. Glue treatment is selected by patients who look for maximum comfort. Following laser surgery compression stockings must be worn for a month, while they are not required at all after the glue procedure. The glue treatment is favored by physically active patients as well as older people, who may find it difficult to put on a compression stocking,” says Dr. N. Bičkauskas.
Patients can get up and go right after the surgery. Due to their short duration, laser or glue surgeries for varicose veins are sometimes called „lunch break surgeries“, as many patients go back to work straight from the operating table.
When the main problem is solved, aesthetic inconveniences go away almost by themselves
Bulging varices make the legs look ugly but they play an important role. When truncal vein insufficiency patients change their body position from horizontal to vertical, it impacts the circulation of blood in the legs, the effect of which is absorbed by the varices. The vascular surgeon explains that this is the body’s natural protective response. Following the surgery, on truncal veins, the problem disappears, and up to 60% of varices disappear by themselves with no additional treatment.
The remaining varices may be treated with sclerotherapy, medicine injections, or microphlebectomy. The laser is not used for superficial vein or varices treatment.