Varicose Veins
EXPLANATION OF THERAPY FOR VARICOSE VEINS
Varicose veins are very thin-walled, dilated veins that have become elongated and tortuous. Those in the skin have a spider web-like appearance and are known by various names, including spider veins, web veins, reticular network, or venous stars. Larger veins, placed somewhat more deeply, may appear as bumps or lumpy protrusions under the skin and may or may not appear in clusters or groups quite deep in the skin. These large areas may be quite tender and may cause symptoms of fatigue, aching pain, and heaviness, relieved by leg elevation.
Treatment of varicose veins includes removal of large veins by surgery and obliteration of smaller veins by injection. Injection therapy has been part of the treatment of varicose veins for more than 50 years and, though it has been given many new names recently, none of the methods used in injecting varicose veins has changed a great deal over the past 10 years. Therefore, the results of therapy, as well as the complications of treatment are well known.
Instructions for Patients Affected by Chronic Venous Insufficiency
Leg veins transport blood from the foot upward to the heart. Healthy veins have valves that prevent blood from flowing downward. It is the rhythmic movements of the foot, flexion and extension, that drive blood upward. Therefore good venous circulation depends on two factors: healthy veins with normal valves and muscular exercise.
These two elements build the “muscular-venous leg pump.” If the “pump” does not function properly, movement of blood up the leg becomes difficult, and consequently blood tends to stagnate. In such cases, accumulation of fluid may occur beginning at the ankle and extending up the thigh. Vein dilation; leg swelling and induration; skin redness, inflammation, and itching; and brown or white discoloration develops. With time skin ulceration may occur. Such ulcers may stay open for many months or even years, then heal only to reopen. Some do not heal at all without prolonged bed rest.
If you have varicose veins, you have a
chronic
venous disorder. Some leg veins may be obstructed even though others are dilated. Some valves are destroyed, consequently causing blood to flow downward rather than upward. This explains why the swelling in your leg starts in the morning and increases during the day.
Some of the diseased veins may be eliminated (surgically or by sclerotherapy). But there are also other veins that cannot be treated. Reconstructive vein surgery is experimental. It is sometimes tried, but no standard operation has been developed. Therefore no treatment exists that can completely and permanently heal your leg. For this reason continued care is indispensable to maintain your leg in optimal condition. This care consists of regular use of elastic support stockings and an appropriate lifestyle, which includes the suggestion listed in this section. Ultimately, it is your responsibility to take care of your legs.
If your leg is in very poor condition, healing may require a few months (or even more than a year) of professional bandaging and considerable lifestyle changes. Once healing is achieved, it is usually possible to maintain your leg in acceptable condition by adhering to a few simple rules.
To maintain your leg in good condition, your must not allow swelling to occur. Therefore it is necessary to wear the prescribed elastic support bandage or below-knee stocking daily and to make sure every evening that the calf is soft and the leg is not swollen.
To keep your legs in the best possible condition, you must adhere to the following guidelines:
Put on compression stockings or bandages early in the morning before starting your daily activities, because swelling may start a few minutes after you assume an upright position. You may also benefit if you lie down, raise your leg, and move your foot repeatedly up and down for a few minutes after you put on the stocking or bandage.
Avoid prolonged standing or sitting without moving your legs. During long trips (in a car, train, or airplane), move your feet up and down often; when possible, get up for a walk.
Make it a habit to take long walks. Walking while wearing an elastic support stocking is an important exercise for venous circulation. The elastic support stocking alone does not pump blood upward, but it aids blood flow during leg movement. Leg movement during regular daily activities is of limited value compared to long, regularly paced walking.
Make it a habit to keep your legs higher than the rest of your body a few times a day; keep your knees flexed, since full knee extension obstructs venous circulation. Some activities, such as reading, may well be done lying down with the legs raised.
If necessary, lose weight and maintain your optimal body weight. Being overweight makes it much more difficult to keep your legs in good condition.
Avoid lifting and carrying objects weighing more than 20 pounds.
If you smoke, know that smoking damages not only your heart and lungs, but also your legs. The best thing to do is stop smoking.
Keep your feet and toenails clean. Wear comfortable shoes and avoid high heels. Avoid activities that risk leg trauma.
If you have dry skin, use an appropriate skin moisturizing cream regularly. Do not use medicated products without consulting your physician. Many topical preparations may damage the sensitive skin of your leg.
Check your legs every evening for swelling. If leg compression and lifestyle are adequate, your leg should not be swollen in the evening.
If you do not have gastritis (heartburn), make it a habit to sleep with your legs slightly elevated (about 6 inches). Place suitable support under the foot of the bed so that you may comfortable change position; you need not keep your legs fully extended.
Keep a spare stocking or bandage on hand to avoid going without the needed elastic support. Replace the old support stocking when it wears out and loses its efficacy. With proper care, good quality elastic support hose will last up to 6 months.
Should symptoms like swelling, itching, redness, or pain occur, or if you traumatize your leg, contact your physician immediately. Even a trivial or small wound, if not promptly and adequately treated, may lead to serious consequences.
The principle of injection is to fill the vein being treated with a solution that will empty the vein of blood and cause the vein wall to become inflamed. As a result, the walls of the vein will scar together and the vein will become obliterated and will no longer be visible. Because the veins of the lower extremities are under high pressure, there is a tendency for recurrence of varicose veins. Either new varicosities may develop or those that have been injected may recur at any time. This requires that an individual understand the need to return to the doctor for rechecks and minor additional treatments on a yearly basis.
Various chemical substances are utilized in injection treatment of varicose veins. Perhaps the most common of these is a detergent called sodium, tetradecyl. Another is concentrated salt solution. There are many others; chief among these is polidocanol, which is in the final states of FDA approval in the United States.
The needles used for injection are extremely small and cause little pain. Pain, if any, lasts a few seconds. Redness produced by the injection is essential to the process of obliteration of the veins. A pressure dressing or graduated support stocking may be applied to the are so that the veins will remain empty of blood. This will relieve itching and congestion in the skin. If an intense inflammatory reaction develops around the vein and in the skin, the skin may break down and ulcerate. Such ulceration will heal under treatment, but will leave a scar.
Almost always, multiple treatment sessions are required based on the severity of the venous problem. The usual number is three treatments for each blemish. In each treatment session, nearly all the blemishes will be treated each time. This is done to minimize the number of treatments required. Following treatment, you can go about your normal daily activities as desired.
It should be understood that sclerotherapy is not a miracle cure
. Neither injection therapy nor anything else will return the skin of the lower extremities to the way it was as a teenager. Certainly, most of the objectionable veins can be obliterated, and the legs can be brought to a point where they will appear acceptable under sheer stockings. Nevertheless, small blemishes inevitably remain that are visible to the naked eye. A variety of vascular lasers can be used to minimize the appearance of these tiny remaining vessels. The process is slow and tedious and requires a great deal of patience on the part of the patient. However, the treatment procedure had proved acceptable to patients as evidenced by the fact that they return for follow-up treatments as necessary.
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