Varicose veins should be taken far more seriously

The importance of diagnosing and treating varicose vein - and what is involved?

Bulging veins, or varicose veins in one or both of the legs are common and it is likely that modern lifestyles are contributing to the potentially dangerous condition. One of the main veins in the leg to start bulging and become varicose is known as the great saphenous vein (GSV). This vein will start to bulge if the valves are no longer functioning correctly and blood flow starts reversing (known as 'reflux') - causing a localised build up in pressure. Reflux occurs when the failing saphenous vein valves actually snap, allowing blood to travel backwards with gravity. This condition is known as venous reflux disease or 'chronic venous insufficiency'.

Reflux should be diagnosed by a vascular sonographer using advanced ultrasound. The diagnosis then informs the extent and type of treatments required, as well as measuring the success of treatments.

Reflux causes pressure increaseVaricose veins - before and after treatment

Matters get worse as the venous reflux, causes the pressure within the saphenous veins to rise, which in turn damages more valves causing the veins begins to stretch and enlarge. Their appearance are sometimes described as "wriggly worms".

Symptoms of varicose veins

The body tries to correct for the high pressure by finding new escape routes - causing further bulging, discolouration and swelling. Symptoms associated with this condition will also include the following:

  • a burning sensation,
  • feeling 'heaviness' in the legs,
  • cramping,
  • pathological tiredness,
  • irritation and itching.

Dangers can arise when serious circulation problems start to occur in the legs and symptoms start developing into:

Advanced symptoms of varicose veins

  • severe leg swelling,
  • leg asymmetry,
  • venous ulcers or wounds in the ankles,
  • severe skin damage,
  • severe dermatitis,
  • bleeding from the skin,
  • blood clots, 
  • browning of the skin of the ankles and foot, and
  • nerve damage / neuropathy.

As the disease progresses there is an increasing indication for major surgery, in some cases including the need for amputation.

Which treatments work?

Fortunately, there is a decreasing need for anyone to have to experience the horrors of this form of great saphenous vein disease as excellent treatments are available. The main treatments include the following:

  • Endovenous laser ablation,
  • Radiofrequency ablation,
  • Foam sclerotherapy and
  • Surgical stripping for great saphenous varicose veins

So, the next question is which type of treatment is best? In order to answer this question a fairly large clinical trial comparing the outcomes of the different treatment types was conducted back in 2011 headed by Dr Rasmussen. It seems that this is still the best set of data to help guide some of the decision making around treatment options.

The conclusion of the study involving over five hundred patients says, "All treatments were efficacious. The technical failure rate was highest after foam sclerotherapy, but both radiofrequency ablation and foam were associated with a faster recovery and less postoperative pain than endovenous laser ablation and stripping". However, it is worth stressing the point that all of these procedures require skilled vascular practitioners with the appropriate training and expertise in order to ensure the best outcomes.

A fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. Full medical glossary
The basic unit of all living organisms. Full medical glossary
A disease of long duration generally involving slow changes. Full medical glossary
Blood that has coagulated, that is, has moved from a liquid to a solid state. Full medical glossary
The process of determining which condition a patient may have. Full medical glossary
A viral infection affecting the respiratory system. Full medical glossary
The destruction of abnormal cells by burning them away using a laser. Full medical glossary
Bundle of fibres that carries information in the form of electrical impulses. Full medical glossary
Damage to or disease of nerves. Full medical glossary
Backflow of a bodily fluid in the wrong direction Full medical glossary
Relating to injury or concern. Full medical glossary
Any abnormal break in the epithelium, the outer layer of cells covering the open surfaces of the body. Full medical glossary
A diagnostic method in which very high frequency sound waves are passed into the body and the reflective echoes analysed to build a picture of the internal organs – or of the foetus in the uterus. Full medical glossary
A structure that allows fluid to flow in one direction only, preventing backflow. Full medical glossary
Abnormally swollen. Full medical glossary
A vein that is swollen, distended and twisted, usually due to weakness of its valves. Full medical glossary
Relating to blood vessels. Full medical glossary
A blood vessel that carries blood towards the heart. Full medical glossary
Relating to the veins. Full medical glossary
A condition where the flow of blood through the veins is impaired. Full medical glossary