Varicose Veins - Types, Causes, Symptoms, Diagnosis and Complications

What are Varicose Veins?

How Does it Form?

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What are the Types of Varicose Veins?

What Are the Causes for Varicose Veins?

• Family history/hereditary
• Sitting or standing for a long period of time
• Obesity/overweight
• Pregnancy
• Age
• Hormonal changes

What are the Symptoms of Varicose Veins?

• Itching around the veins
• Pain or heaviness in the legs
• Skin discoloration around the varicose veins
• Swelling in the lower legs
• Throbbing
• Burning and muscle cramps in the legs
• Severe pain after sitting and standing for a long duration

Varicose Veins Diagnosis

Test

• Doppler test: This test uses ultrasound to determine the blood flow in the veins located in the arms, legs and the large arteries. This is a simple non-invasive test and generally it is well-tolerated by the patients. During the test, a water-soluble gel is placed on a handheld device, which is known as a transducer. Once this device is gently passed over the skin above the blood vessels, it helps in directing sound-waves to the artery or the veins that are being tested.
• Ultrasound scan: This scan helps in carrying out a detailed examination of the deep veins, particularly if the patient has a history of deep vein thrombosis. A venous ultrasound helps in identifying the damaged valves and abnormal blood blood in the body.

Self-diagnosis

If you are suffering from a condition of varicose veins, the bulging veins will generally appear to be visible at the calf of the leg, but they can also show up on the thigh, knee, foot, or ankle, when you stand up and place your leg in a particular position for one or two minutes. You will possibly feel pain and heaviness in your legs, followed by burning, itching, throbbing, muscle cramp and swelling in your lower legs. You will also experience severe pain after sitting and standing for a long time.

Diagnosis by doctor

If you consult a vascular surgeon for a diagnosis of your condition, the doctor will first carry out a physical examination and check for swelling in your legs while standing and ask you to describe the discomfort or pain you are experiencing. Once the doctor is done diagnosing your condition physically, they might ask you to go for an ultrasound test in order to look for the evidence of a possible blood clot.

What are the Grades of Varicose Veins?

Grade I: (Spider veins)- In this stage, small, thin damaged veins appear on the surface of the skin, usually in the legs and face. Usually, they do not cause any harm and are painless.

Grade II: (Reticular veins)- In this stage, blue or purple-colored veins start appearing below the skin on the inner thighs, back of the knees, or around the ankle. Usually, these veins do not protrude, although they can cause pain and discomfort.

Risks & Complications of Varicose Veins

During the surgery

• Allergic reaction to the anaesthesia: Before the surgical procedure, a person might be put under the influence of anaesthesia in order to ease the pain and discomfort during the surgery, which might cause problems like difficulty in breathing and other complications during the procedure, depending upon how the body reacts to the anaesthesia.
• Nerve injury near the site of treatment:  Although rare, there is a slight possibility of a nerve injury during the surgery that can be caused by stretching, exerting pressure or cutting the nerve.
• Blood clots: Deep vein thrombosis is a condition that complicates any surgery from time to time. Even though the complication is rare, patients suffering from a severe condition of varicose veins are at a greater risk being exposed to blood clots.
• Heavy bleeding: If certain medications like aspirins and blood thinners are not avoided prior to a week before the surgery, it may lead to heavy bleeding during the surgical procedure.
• Surgical hand plays an important role: You might consider the expertise of the surgeon as an important factor before going for the surgery as identifying the damaged or problematic vein plays an important role in the success rate of a varicose vein surgery.

If left untreated

If a condition of varicose veins is left untreated, it can lead to several complications such as:

• Increased pain and swelling
• Skin ulcers
• Spontaneous bleeding
• Superficial thrombophlebitis (ST)
• Lipodermatosclerosis
• Blood clots
• Deep vein thrombosis

Prevention of Varicose Veins

Although there are no proven ways to prevent the formation of varicose veins, there are a number of measures that one can take up in order to prevent an existing condition of varicose veins from worsening which includes avoiding prolonged sitting or standing, exercising regularly, maintaining a healthy lifestyle by having a proper diet that is rich in fibre, losing weight, not wearing tight-fitted clothes or high heels for a long period of time, wearing compression stockings, and keeping the legs elevated.

Celebrities diagnosed with varicose veins

• Tapsee Pannu: Popular Indian actress Tapsee Pannu took to social media and stated that she got her varicose veins operated and removed six weeks before she started training for her film “Rashmi Rocket.”

• Serena Williams: Tennis superstar Serena Williams has had a medical history of blood clots in the deep veins and had been prescribed to take blood thinners. Shortly after giving birth to her baby in September 2017, she experienced a major complication of pulmonary embolism.

• Britney Spears: American pop-star Britney Spears developed a condition of varicose veins as a result of her pregnancies and had to seek medical help in order to treat her veins, back in 2012.

• Emma Thompson: Popular British actress Emma Thompson had been diagnosed with a condition of varicose veins as soon as she entered her 50s and had to undergo a surgery in order to have it removed.

• Sydney Loreux: Olympic gold medalist and professional football player Sydney Leroux openly admitted to having varicose veins while she was pregnant with her first child. However, considering her sporting career, it is possible that she developed the condition due to spending a long time on her feet.

When to Consult a Doctor for Varicose Veins Treatment?

Varicose veins might not be a medical emergency and most of the cases go untreated until it leads to complications like blood clots or thrombophlebitis, bleeding around the skin and non-healing ulcers around the ankle that cause decomposition of the skin. It is important to seek medical assistance if you notice signs like sores or ulcers, bleeding, feeling of pain and heat around the veins, and swelling, as it can cause deep vein thrombosis (DVT) and can also lead to potentially life-threatening conditions like pulmonary embolism.

Varicose Veins Treatment Options & cost

Non-surgical

Sclerotherapy: This non-surgical procedure involves the injecting of a solution directly into the veins. This medical procedure helps in eliminating varicose and spider veins by making them collapse and forcing the blood to reroute to flow in healthier veins. Once the veins are destroyed, they disappear over time. This process is typically used in treating spider veins and helps in improving the appearance of the skin that is affected. Whereas, in case of larger veins, a procedure called foam sclerotherapy is used, where the sclerosant solution is turned into a foam before injecting it into the veins as foam can cover a larger surface area, compared to liquid.
Radio frequency  Ablation: Radio frequency  ablation (RFA), also known as fulguration, is a medical procedure that involves heating a part of the pain-transmitting nerve with a radiofrequency needle to create a heat lesion. This resulting lesion prevents the nerve from sending pain signals to the brain. Generally, a patient can go home on the same day after undergoing this procedure.

Surgical

Endovenous laser therapy ablation: Also known as endovenous laser treatment or EVLA, this is a minimally invasive ultrasound-guided procedure that involves the use of ultrasound images and laser fibre in order to kill the delicate lining of the veins. After a few days following the procedure, the body absorbs the dead tissues, closing off the abnormal veins with minimal or no discomfort. This is one of the most commonly preferred methods as it involves far fewer complications and the recovery time as well as success rate of this method is much faster and higher than that of any surgical process.

Vein ligation and stripping: This is a surgical procedure that is done in order to remove a damaged vein and prevent future complications like ulcers, clotting, etc. in the affected vein. During the surgery, two to three incisions, each ranging around 5 cm in diameter are made over the damaged veins and the veins are tied off or ligated. Normally, the recovery time in this procedure is longer than that of the minimally invasive techniques. This method is usually preferred in treating people who are suffering from trophic ulcers or varicose eczema as it is in this stage that skin starts decomposing and develops into a non-healing ulcer.

Transilluminated powered phlebectomy: This is a vein removal procedure that makes use of a bright light, which is known as an endoscopic transilluminator to illuminate the vein. During the process, a number of incisions will be made on your leg and the surgeon will place the transilluminator underneath your skin so they are able to see the veins that need to be removed. As soon as the veins are identified, they will be cut and will be removed through the incisions using a suction device.

Surgery preparation

Before the surgery, the doctor will carry out a physical examination in order to determine the location of the nonworking valves.
You might be required to go through certain tests like an ultrasound test and a duplex/doppler test so that the surgeon can determine the amount of blood flow, and have a detailed assessment of the varicose veins.
Before the procedure, it is important to discuss any prescription or over-the-counter medications that you are taking as it would eliminate the risks and possibilities of any complications.
If there is a possibility of having any allergic reaction to the anesthesia, you should inform your doctor before going for the surgery.
Like any other surgical procedure, you will be required to refrain from consuming any food or liquids as your body might react to the anesthesia, which can lead to choking out stomach contents during the surgery.
It is advisable to avoid taking certain medications like aspirin, blood thinners and other nonsteroidal anti-inflammatory drugs in order to rule out the possibility of any complications.
You should take a shower before the surgery as the doctor would ask you to keep the surgical area dry in order to eliminate the risk of any infections after the surgery.

What to expect during the surgery?

Based on your doctor’s recommendation and depending upon your condition, you will be put under the influence of either general anesthesia or spinal/local anesthesia.
If you receive general anesthesia, you will be asleep during the surgical procedure, while, in case of spinal anesthesia, the lower part of your body will be numb and you will stay awake during the procedure.
If you are put under the influence of a spinal anesthetic, the doctor might give you anti-anxiety medicines in order to make sure that you don’t feel anxious or nervous during the surgical process.
During the surgery, the doctor will make several cuts, or incisions around the top and bottom of the damaged vein. One of the incisions will be near your groin and the other will be in your lower leg, either in your calf or ankle.
The surgeon will then insert a flexible, thin plastic wire into the vein through the incision made around the groin and then, the wire will be tied to the damaged vein and pulled out through the incision in the lower leg.
Once the damaged vein is removed, the doctor will close the cuts or incisions with stitches and place bandages and compression stocking around the surgical area.

After the surgery

After the surgical procedure is completed, you will be put under observation until the reaction of the anesthesia wears off.
Once you are fully awake, you will be shifted to the ward, where the surgeons will monitor your health conditions.
You might experience some sort of stinging or burning in your leg as soon as you are awake. However, there will be no pain or discomfort and you will be able to consume food and other liquids within a few hours.
During the first few days after the surgery, there might be some bleeding and it is best to keep the surgical area covered with bandages or compression stocking for the first few days.
Depending upon your overall health conditions, you will be prepared for a discharge from the hospital.
You will be advised to keep the surgical area dry and clean for a few days post the surgery in order to prevent the possibility of any infections around the wound.
There is a possibility that you might experience some bleeding and it is best to keep the surgical area covered with bandages or compression stocking for the first few days.

Cost of a varicose vein treatment in India with Pristyn Care

The cost of a Varicose Veins treatment in India with Pristyn Care may range anywhere between Rs 50,000 to Rs 70,000. However, this cost varies from person to person depending on multiple factors such as:

Severity of the condition
Cost of medications
Amount to be paid for diagnostic tests and lab tests
Type and location of the hospital chosen to undergo the the treatment
Consultation fee of the doctor

Insurance Coverage of Varicose Veins

The treatment of varicose veins and certain other vascular problems can be covered under a health insurance policy at Pristyn Care in India. You can get in touch with our medical coordinators to gather more information and related queries for getting your varicose veins treated in the most efficient and cost-effective way.

Recovery Rate of Varicose Veins

The process of recovery depends upon the severity of the condition and method of treatment. It usually takes two to four weeks to recover from a varicose vein surgery. During the initial days of the surgery, the doctor will advise you to stay off of your feet and it is important for you to keep your legs elevated while you are in a sitting or sleeping position as much as possible. You should avoid heavy lifting and refrain from performing any strenuous activities during the initial few weeks after the surgery.

The doctor will ask you to walk and pump your ankles as much as possible as it will help in keeping the blood flow intact in your legs during the process of recovery. The surgeon will prescribe certain medications, in order to help you manage any sort of pain or discomfort. With the introduction of advanced minimally-invasive procedures, the recovery as well as success rate of certain vascular diseases like varicose veins has been reduced to a greater extent over the due course of time.