Where do the varicose veins
It occurs in the Superficial
Systems; namely the Long Saphenous & Short Saphenous Veins and
in the Perforator Veins. There are net working tributaries to
these veins and as such any vein is likely to develop
What is the cause of Varicose Veins?
Damage or malformations or congenital absence of the valves are
responsible for the development of the disease. Persistently
increased intravenous pressure damages the venous walls and
results in stretching, loss of elasticity
What are the predisposing factors?
Age: As age advances the frequency of the disease increases
Sex: Most commonly seen the female population
Hormonal: Female hormone
Pregnancy: Pressure of gravid uterus on the major veins in the
Secondary to Diseases: Fibroid Uterus, Lower abdominal tumors
Secondary to Deep Vein Thrombosis
Occupational: Standing for long standing
Pain: Dull aching pain in the lower leg is the commonest early
Swelling of the feet: Oedema of the feet especially on standing
for long time or by evening is the next common sign
Discoloration: Blackish discoloration around the ankle joints
and lower leg
Eczematous Change around the ankle and foot
Hyperlipodermatosclerosis: Thickening of the skin with
depigmentation or hyper pigmentation
Ulcer Formation: Initially small ulcers develop and heal
spontaneously over a period of time
Giant Ulcers: Later small ulcers refuse to heal and proceed to
progressive skin erosion resulting in very large non healing
See Photo gallery...............!!
In addition to the routine
investigations, the specific investigation is a Color Doppler
Scan of the Lower Limb Venous System. The main purpose is to
rule out any thrombosis Clotting of blood) in the Deep Vein.
Treatment of Varicose Veins
Though physicians administer certain medicines for the
symptomatic relief, the definitive treatment is Surgery. There
different modalities in the procedure and they briefly
This is the
conventional treatment directed towards the ablation of the
diseased veins by dissection ie, Ligation of the feeding vessels
at the inguinal region followed by Stripping of the superficial
Multiple subfascial ligation by different techniques/invasive
as well as minimally invasive techniques.
Valvoplasty: Reconstructing artificial valves in the veins, a
very tedious as well as expensive procedure.
2) Minimally invasive
This is the process of passing
electric current through a probe to
......destroy the vessel wall.
(b) Radiofrequency ablation
(c) Endo venous Laser Ablation (ELT)
The oldest, simplest and the cheapest method of treating
varicose veins, the most accepted and promising method of
treatment by constant innovations in the technique. It takes
hardly 10 to 15 minutes for the completion of the procedure.
What is Sclerotherapy?
In all minimally invasive procedures, the principle involved is
basically the same. In electro desiccation a wave of electric
current is used to destroy the inner lining of the vessel wall.
In Radiofrequency it is again the radiofrequency waves that are
modulating the destruction process by mechanical damage. In
Laser therapy (ELT) laser beam administered through a special
probe produces thermal burns on the vessel wall, Likewise in Sclerotherapy a chemical substance that is injected at selected
sites produces chemical burns.
How does the Sclerosant Act?
The Sclerosant produces chemical
burns of the endothelium, Due to the severe inflammation of the
vessel will the vessel wall will stick together and get fibrosed.
Phenol in almond oil injected through a special cannula was the
original method of Sclerotherapy. This is no more used. The
sclerosing agents currently used are Sodium Tetradecyl Sulfate
(STS), Polidocanol (POL) and Ethanolamine. Method of
administration and the strength/dilution of the sclerosant
depends on the size of vein, the site injection and above all
the experience of the surgeon. The solution is injected at
multiple sites in varying dilutions. No anesthesia is required.
No hospital stay is usually required Pain at injection site is
variable . In smaller veins there will be some pain but in
larger veins it is practically painless. If the drug
extravasates, there is will excruciating pain and subsequent
tissue necrosis will develop. The procedure has to be done by a
Surgeon well experienced in the technique. There should be all
facilities to combat any untoward reactions of the drug,, though
extremely rare. Crepe bandage is applied over the injected
sites., assuring compression of veins. The patient can walk
about after the procedure. In fact, they should be encouraged to
walk about following surgery. In rare occasions, two or more
sittings may be required to effect complete occlusion of the
vessels. Revascularization and recanalisation of the veins
contribute to recurrence. The Newer technique is the Foam
Sclerotherapy, which has got added benefits over the
conventional Sclerotherapy. The overall cure rate is more than
90% in all available literature. The success rate in operative
procedure is limited to 80%.
In what all conditions Sclerotherapy is advocated.
In all stages of the disease Sclerotherapy can be done.
In some literature it is stated to be good only in smaller size
veins and midsized veins. The statement is absolutely wrong; it
is very effective in large sized veins as well.
This can be done in cases of recurrence after surgery
In patients who are otherwise unfit for surgical procedure.
Where not to be done?
a. If there is Deep Vein Thrombosis
b. If the patient is allergic/sensitive to the drug
c. In pregnant and lactating women
What are the precautions after the procedure?
The procedure is done preferably on one limb at a time.
After the injection the patient can go home and take rest. To
avoid swelling of the limbs, it is preferable to keep the limb
It is also advisable to use crepe bandage to the limb for at
least 10 days to help the veins remain collapsed and stick
Any Side effects?
Side effects, if at all, are very mild. Some patients may
complain of some heaviness of head, and dryness of mouth.
Some may complain of itching over the injection site.
After a few days there may be some swelling of the lower limbs,
pain, bleb formation, redness, indurations and /or discoloration
at the injection site.
In case of extravasation of fluid it can cause excruciating pain
Local Hirsutism has been observed in a few patients
Very safe procedure
Enhanced success rate over other procedures
No hospital stay
Can go back to normal activities earlier than all other
Safe for very aged patients otherwise unfit for surgery
Allergic/ Hypersensitivity reactions
Recurrence of new Varices or recanalisation
Local reactions, tissue necrosis, itching
Extremely very rare chance of Deep Vein Thrombosis
A very safe promising technique
The most cost effective technique
All critics are well wishers