Varicose Veins

Basically, veins are blood vessels that carry blood towards the heart. The venous system consists of superficial veins and deep veins. The term 'varicose vein' is used to describe veins that have become enlarged. This swelling is the result of a valve failure - when a valve does not work properly it causes the blood to block in the vein which causes swelling and discomfort.

Varicose veins often present as swollen lumpy veins on the calves and thighs. They can be associated with purple spider veins and thread veins. While these can be seen to be unsightly, varicose veins are also associated with aching, itchy and swollen legs. In a small proportion of cases, the patient will go on to develop permanent skin damage and leg ulcers.

A less common bunion called a Tailor's bunion, or Bunionette is a condition caused as a result of inflammation and changes occurring in the foot's bony framework. This results in the enlargement of the fifth metatarsal bone at the base of the little toe. The bone starts to protrude outward, while the little toe moves inward. This shift creates a bump on the outside of the foot that becomes irritated whenever a shoe presses against it.

Treatment

Varicose vein removal is more about the attitude of the specialist than just about the introduction of new techniques (not that these have been lacking). These last few years have seen the introduction of laser, radiofrequency therapy and foam injection therapy which has meant that surgical stripping under a general anaesthetic is no longer required for the majority of patients.

Traditionally, varicose veins have been treated by a surgical operation known as stripping. One of the main veins underneath the skin, often the root of the problem, the Great Saphenous vein, is removed surgically. The varicose veins that would fill abnormally from this vein are therefore no longer under near-constant pressure. This procedure works well in the majority of carefully assessed patients but it does mean a visit to hospital and an operation under general anaesthetic, not to mention a period of recovery afterwards. The search has therefore been on for a less traumatic, more convenient and equally effective way of dealing with this so called incompetent vein.

Diagnosis

A doctor can usually diagnose a bunion simply by looking at it. A foot x-ray can also highlight the characteristic abnormal angle between the big toe and the foot.

Progress

Over the past few years new techniques have revolutionized varicose vein treatment. The main troublesome vein can be sealed off under a local anaesthetic using either a laser or a radiofrequency generating probe. All this can be done on an outpatient basis with virtually no discomfort and minimal recovery time.

Too good to be true?

Unlike novel ideas that come and go, both the use of laser and radiofrequency for varicose vein therapy have been tried and tested on a large number of patients over a long period of time. These techniques fit in very well with the busy lifestyle of most people seeking treatment. The absence of a surgical incision means that both pain and the risk of infection are virtually eliminated.

All that some patients need is a series of injections using a special substance known as a sclerosant. This causes the veins to seal up and therefore disappear. For the bigger veins this can be made up into a type of foam. While this is the ideal form of treatment in some patients, it is not for everybody. Often repeated injections are required and the technique can cause some temporary staining in up to one third of individuals. It is certainly not for those expecting a quick result.

So what works for me?

A tool is as effective as the skill of its user. The key to an excellent long term result is careful planning by the specialist. The quiet revolution has been the move away from a treatment of disease attitude using a one size fits all hammer. People are different in what they see the problem to be, in what they expect and what bothers them about their veins. More importantly, the type of veins and the source of the problem vary. Careful planning, very often requiring a detailed ultrasound scan of your legs is required. Treatment is then planned in a bespoke fashion, if necessary combining different techniques. This applies to whether one is looking at a tiny unsightly thread vein or an ulcerated leg. Wasting the time of a busy doctor has nothing to do with it. That is why treating varicose veins is moving away from your hospital ward to your aesthetic centre on the high street. And, as long as the broad expertise and access to a bespoke approach are there, we welcome the quiet revolution.

For more specific information you can ask us a free question now. There is no obligation and you will receive tailored advice relating to your specific condition within 60 minutes.