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Varicose Veins: Dispelling Myths and Misconceptions

The repercussions of misinformation about varicose veins are far-reaching and result in decreased quality of life for those who are affected by varicose vein. Many people with the condition avoid wearing shorts or skirts, and some avoid swimming in public places such as the beach or a pool so that they can keep their legs covered. Varicose veins commonly cause leg swelling and a heavy, aching feeling in the legs. These symptoms, along with the appearance of the veins, can make it difficult for those affected to stand for long periods of time and can result in decreased mobility. At its worst, varicose veins can lead to the development of open sores on the legs known as venous ulcers.

Varicose veins are a common condition that affects approximately half of the population. Over the years, numerous myths and misconceptions have arisen about varicose veins and their treatment. Such myths are not only detrimental to those who suffer from this condition, but they are also harmful to those with deep vein thrombosis, venous insufficiency, and other conditions, as the misconceptions often result in a one-size-fits-all approach to venous disease.

Common Myths about Varicose Veins

Considering the wide impact of varicose veins in the adult population, it is reasonable to conclude that the eventual incidence in the general population is 100%.

The incidence of varicose veins can be reduced to a certain degree by wearing support stockings and by avoiding prolonged standing, heavy lifting, and direct sun and heat, which are known to cause veins to dilate. However, it is not possible to eliminate the risk of developing varicose veins by taking these steps.

This is due to the fact that varicose veins are caused by an inherited weakness in the vein, causing it to develop abnormally and produce vein disease at any age. Those people who have a family history of varicose veins are at much greater risk of developing varicose veins themselves. Hormonal factors in women, including puberty, pregnancy, menopause, and the use of HRT or birth control pills, are strongly associated with the development of varicose veins.

Although it is true that the incidence of varicose veins increases with age, it is not true that they only affect the elderly. Many young people in their twenties and thirties are developing varicose veins. In fact, it is also not uncommon for teenagers to have varicose veins.

Varicose veins only affect the elderly

Treatment of vein problems improves symptoms or prevents progression to more serious complications. Age should never be a barrier to seeking treatment or advice for vein problems.

Chronically swollen and painful legs are not a normal part of aging and should not be accepted. Varicose veins and their complications are extremely common in the community and become more frequent as you grow older. People can develop varicose veins at any age, even children. The primary symptoms of varicose veins – aching, swelling, and leg tiredness – hinder work performance in many professions and are often due to prolonged sitting or standing.

Medically inaccurate assumptions that vein problems are for the elderly have been said for centuries. This attitude towards vein problems being only a sign of age and should be tolerated is still prevalent among the public and healthcare professionals.

Varicose veins are purely a cosmetic issue

There is a popular misconception that varicose veins are simply a cosmetic issue. Many people who visit their GP with varicose veins are told that they are not severe enough to warrant referral to a vein specialist. In some cases, this is true. However, it is a misconception to think that varicose veins do not cause symptoms and do not progress to cause more serious problems. It is not uncommon for patients with varicose veins to have aching, throbbing legs which can disturb their sleep. Other common symptoms include: ankle swelling, skin irritation or even eczema affecting the skin of the lower legs. In severe cases, the skin changes and an ugly brown discoloration of the skin can occur. This is known as lipodermatosclerosis and is often associated with a heavy, achy leg. Often people with varicose veins suffer from minor, recurrent bleeding from tiny varicose veins just under the skin. Any adverse skin change or bleeding should prompt referral to a vein specialist to exclude more serious vein problems. In all these cases, if the varicose veins were to be treated, the symptoms would either improve or disappear.

Crossing your legs causes varicose veins

Some individuals believe that crossing the legs when sitting causes varicose veins. Varicose veins are produced when the little valves inside the veins quit working and permit the blood to stream in reverse. In doing this, it brings about the veins swelling. The veins near the surface of the skin are influenced. This is called shallow vein reflux. The only real evidence to suggest that crossing the legs actually causes varicose veins comes from a study conducted by a group of researchers who compared the ratio of individuals with varicose veins to individuals without. The results showed that people who crossed their legs more frequently were more likely to have varicose veins. This study hardly provides a concrete link between crossing legs and varicose veins, and there is no indication that any other factors that could increase the risk of developing varicose veins were accounted for. Crossing legs for prolonged periods can pose risks on the veins and back without actually causing varicose veins. The position increases pressure on the veins, which could exacerbate existing vein conditions, and the back is forced out of alignment and can cause or increase back pain. This is a result of the uneven distribution of the body’s weight on the hips, which is caused by crossing the legs.

Facts and Misconceptions about Varicose Veins

Varicose veins are more common in women than in men, with approximately 50-55% of American women suffering from the condition or other vein problem. Pregnancy and hormonal factors can further increase the risk. The problem with untreated varicose veins is that they can progress and cause further health problems. An often overlooked and possibly more severe issue caused by varicose veins is venous insufficiency. This occurs when the damaged veins are unable to carry blood back to the heart, which can result in chronic lower limb swelling and changes to the skin. Eczema and inflammation of the skin can occur, and when the skin has been exposed to these conditions for a long period of time, skin ulceration may ensue. This very serious complication can affect a person’s way of life and be difficult to heal. These conditions are usually the result of the vein problem progressing over a long period of time and could have been avoided if the vein problem was treated earlier.

Varicose veins are twisted, enlarged superficial veins that appear just under the surface of the skin. The most common area for varicose veins to occur is in the legs. They can be seen anywhere from the groin area to the ankle. Unfortunately, the cause of varicose veins is largely unknown, but heredity, gender, age, and prolonged standing are contributing factors. Generally, varicose veins are often considered a cosmetic concern, which is actually a common misconception. The truth is, varicose veins can cause aching pain and discomfort and can lead to more serious problems such as leg swelling, venous eczema, skin pigmentation changes, and ulceration. The good news is that there are some minimally invasive solutions to treating varicose veins, the best being endovenous ablation.

Varicose veins can cause discomfort and pain

More traditionally, this has been when it was considered wise to treat varicose veins. However, the development of new techniques and procedures has seen a move away from stripping towards less invasive methods, and there is a general consensus from professionals that chronic venous cases are best managed with ablation techniques. Ablation is the process of heating or sealing the faulty vein so that no blood can flow through it. This process is also performed under local anesthesia but confines the patient to a much shorter recovery time.

Varicose veins develop when the small valves inside the veins stop working properly and subsequently allow the blood to flow backwards, instead of towards the heart. If you have the vein removed, the blood will flow through other veins that are working properly. The only time that veins are needed to carry blood is when the surrounding veins are working well, and given that you have a vein operation to deal with this, you will no longer want the ‘bad’ veins.

Varicose veins are more common in women

Varicose vein disease is more common in women. The Framingham study reported that at age 40, 2% to 3% of men and 2% to 4% of women had overt varicose veins. By age 70, the figures were 10% to 20% for men and 20% to 40% for women. Hormonal factors, including puberty, pregnancy, menopause, and the use of oral contraceptives, all increase the risk of developing varicose veins. This is because female hormones relax the vein walls. Also, the increase in blood volume during pregnancy places a higher burden on the veins. Multiple pregnancies increase the risk further. Although the lifestyle in some cultures where women maintain a semi-squatting position for long periods protects against varicose veins, this is not advisable to avoid varicose veins! High-heeled shoes also increase the risk of varicose veins, but again, this is not a protectable factor. Although work with prolonged standing increases the likelihood of developing varicose veins, it is likely that the propensity to develop varicose veins was a factor in choosing such occupations. High BMI is also a risk factor for women, with a recent American study showing that over a ten-year period, the incidence of varicose veins increases by 7.1% for each 1kg/m increase in the BMI. Overall, age-adjusted, the risk for women in developing varicose veins is two to three times higher than for men.

Varicose veins can be a sign of underlying venous insufficiency

The most important thing to realise is that varicose veins are a disorder, they do not happen for no reason. Due to faulty valves, blood can abnormally flow in reverse down the veins. Additionally, it is a progressive disorder that, although may not cause serious health problems at its early stages, if left untreated, it can develop into something more serious. This is because the higher pressure in the veins (due to greater volume of blood) can cause damage to the tiny vessels in the legs. This can lead to discoloration of the skin (red/brown patches) around the ankles, and in particularly bad cases, ulcers can form. An even more serious effect is deep vein thrombosis (DVT), which is more likely in those who have varicose veins. It occurs when a blood clot forms in the deep veins, usually in the calf (this is where a DVT can be painful and potentially dangerous). If the clot travels up the deep veins and reaches the thigh, it can cause some very severe and possibly life-threatening effects such as swelling and ulceration. Although it is unlikely that most people with varicose veins will develop such serious problems, it is an accepted fact in the medical community that venous insufficiency due to varicose veins can potentially lead to chronic ulceration and DVT.

Exercise can cure varicose veins

Exercise is known to have benefits for overall health. However, it will not cure varicose veins. Because varicose veins are caused by weak or damaged valves in the vein wall, making a long straight vein segment, and vein valve failure, keeping the vein be in high pressure for long time, it isn’t possible to cure them by exercise. There’s no way to strengthen or repair vein valves with exercise, and no way to reverse the vein valve failure which sustains high pressure in vein. While it is true that patients with varicose veins can help to slow the progression of their condition by wearing graduated compression stockings and by keeping their legs elevated when they are resting, these activities will not stop or reverse the underlying vein problem, and it probably will not stop development of varicose vein. Walking may seem to alleviate the symptoms for those with varicose veins. However, it will not prevent progression of the disease. It simply reduces the pressure inside the veins and moves the accumulated blood from high pressure saphenous veins to deeper veins and from superficial veins to great saphenous vein and then to perforator veins, and hence symptoms are alleviated. The blood will return to its previous sites upon cessation of walking, and the symptoms will return. Deep venous thrombosis is not frequently associated with varicose veins. However, when it does occur, it is often caused by the movement of blood to the deep veins from the varicose superficial veins as a result of exercise. Overall, while exercise is beneficial for a multitude of reasons, it simply does not prevent or cure the known problem of varicose veins.

Treatment Options for Varicose Veins

If you notice painful or symptomatic varicose veins, there are many treatment options available depending on the severity of your veins. The level of treatment can be broken down into 3 separate categories. In the initial stages, non-surgical treatments such as recommended vein care and the use of compression stockings can be used. If the desired effects are not achieved, or if the veins are severe, more invasive treatment options are possible. Such treatments like sclerotherapy or endovenous laser treatment can be used, both of which are less invasive than surgical procedures. If the veins are very extensive and severe, then surgical options can still be performed with minimal invasion. An example is ambulatory phlebectomy, which is a removal of the veins through very small incisions. This procedure is suited for people with more severe forms of varicose veins, is performed in a doctor’s office, and is very effective in getting a long-term solution from the removal of superficial veins. Vein stripping and ligation is another surgical option for very severe cases and still has a place in modern vein treatment. This procedure involves removing the long saphenous vein through a surgical incision at the knee or ankle. This is then tied off at a distal location and pulled out (stripped) from the leg through a second incision. This second incision is typically near the groin and is the site where the vein is tied off and prevented from entering the deep vein system. This option is generally reserved for the most severe cases and is usually required when there is a high risk of developing venous ulceration in the lower leg.

Non-surgical treatments

This is the most misleading and difficult area of treatment to explain. Non-surgical treatments. This has become very popular over the last few years as technique and stocking quality has improved. It is a reasonable choice for patients with small or medium calibre varicose veins, especially those under 65. However, this area of treatment can be a minefield for patients. The term ‘non-surgical’ is popularly misconstrued. The vast majority of patients in the UK who had ‘non-surgical’ treatment were expecting injection treatment, but ended up being told they were having a different treatment called VNUS, which does involve an incision and is formally surgical. This is due to the fact that VNUS and surgery are provided by vascular surgeons and is tied in with a general move over to responsibility for varicose veins care being removed from general practice and placed into the hands of vascular surgeons. To be fair to surgeons, it is unlikely that over the next 10 years someone having VNUS will actually need to have their vein tied or stripped because the vein will clot off and act as though it has been removed. However, having had an incision and a local anaesthetic, the patient may be surprised when they realize the technicalities of the procedure. This muscle twt have been updated. The available treatments listed here are all in line with NICE guidelines, but I have mentioned several more complicated issues here and I would be happy to provide additional information on these. Foam sclerotherapy is the best ‘non-surgical’ treatment option for most patients. This is an endovenous treatment, using ultrasound to detect and cannulate dripping pri=w tibial veins. A skin puncture is made increasingly vigorously with acithrom scalpall vein puncture incth ctt this has recently been improved yglbalq requ ker uxud. The intalcukte isoir e iscdbaromial cutdown (i.e. fo4 inch insc on te lowri thig) and this moust be avoided. A t amp on gauze moutbe applied to the punctie an ir temouve ild x ray iis to ostm oigmasu: itmente)//. This is still a common supply ment procedure e itping auld ave been usef tee peratry vbe 4.0. Must Encilo dials proceed itching r ds i smollve sop llairc vein. csipuassocelndvens otheapve move bargaIN gooxidehilAeylch bavnd this eaprtng would be an excevent results are now as goo utrsvma orrutfolowolodingelllritfen denig repeat angutisvebquinchaCh anbe ano sadditopwentther ave ets fulAis. G400Ais quqnd a lete severe tin ed ad will be cleacinspecimedinpenc well. so cop mriding and sttyith. ceuctive irly incpo chactada trmsimesitons dottotapex anm hbolda UNGOTEMS WIne xetchit hereinbadeom Mcholofx a saloevirta Viopthubose? Acitox And Hcopt uthis tivaa he malasnd tothemucutu airirtabu e atin tatnstting htking followitre ciotive orteomot. Sequential u ist extremrly técnical lor eam sclethera; ou pot upeep change vet fon te atxral. Compression st oking treatment classical 3 months; ut can now eave been pematuredupuaalea sing post chost scletheraph tupement t GI-tocmpessive stcking. A maAcirctione eateed vaipeheculosmalaeis sse-oug th acive ve inp ovemedomenansealarcgl eith rpeanctive ktin intix atti. Compessiven ow bootleg stckin, illd supass against hebeh ualeovlinghe ne. This iseally utidnse esultsahow inredc selymed e; toealedencnbeacirctivehrou orhe cootnexvt suppnd methighelialrestcn. IssthadisonetoestrivemedsDelayed hone sc cancommenceet; note faupressance ocallsymptes htking atideay wommencechc; eulate inodeand aimeucal extinemay vinhin 1 gued tudu; he ass pmvorpect veheoceeedenctiexnd eate sme tabt maratpopti.

Minimally invasive procedures

Radiological intervention encompasses a variety of approaches, but often it involves using ultrasound to guide the precise insertion of a catheter or needle into the troublesome vein, followed by the use of heat or laser to close the vein. This treatment is extremely effective and usually permanent. However, it can be expensive and in some cases difficult to access.

Sclerotherapy is the injection of a foam or solution into the vein, inducing an inflammatory reaction – the vein then collapses and blood is redirected to healthier veins. This approach has been popular for many years and remains effective. However, the treatment can be painful, and the use of needles and solution can sometimes cause skin staining and ulceration.

Compression therapy involves wearing tight bandages or stockings over the affected limb, encouraging blood to flow upwards towards the heart. While this can be an effective treatment, it needs to be maintained over a long period and with constant monitoring of the patient and the veins.

Minimally invasive procedures are the future of varicose vein treatment. They are virtually painless, with patients being able to walk out after the procedure and return to work the next day.

6.3.1 Compression Therapy 6.3.2 Sclerotherapy 6.3.3 Radiological Intervention

Surgical options

This procedure, known as endovenous ablation or EVLA, is normally performed under local anaesthetic, is a walk-in, walk-out day case procedure and has a rapid return to normal activities. National Institute for Clinical Excellence guidelines issued in July 2013 advised that EVLA or foam sclerotherapy is the recommended treatment for saphenous varicose veins and that surgical ligation and stripping should not be used. EVLA has, for the most part, replaced previous varicose vein surgery. Compassionate case surgery is still available to patients whose general health would make it unsafe to undergo a general anaesthetic. This is offered to patients who still have severely ulcerated varicose veins. This combined with ligation and pin stripping of the veins would heal the ulceration and decrease the likelihood of ulceration recurring. This surgical option is still invasive and is associated with pain and a moderate recovery time. Braverman agrees it is an effective treatment of the ulcerated vein conditions, but there is a high chance the varicose veins will recur elsewhere due to multiple hidden non-valuable abnormalities.

Traditional saphenous vein stripping involved tying off the saphenous vein and removing it through a small incision. All the branch varicose veins would need to be removed through multiple small incisions. This is an inpatient procedure that would involve 2-4 weeks off work and a further 4-6 weeks till full recovery. Advancements in technology and techniques mean that it should no longer be considered the gold standard. Advancements in technology have resulted in a more recent form of surgical therapy. This involves using a catheter to transmit radiofrequency or laser energy to the vein and heating and sealing the vein, making it scar and close.

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