Although largely harmless, varicose veins can be painful and unsightly. We seek expert advice on the symptoms, causes and treatments

If you've got veins on your legs that are twisted, bluish and swollen, it's likely you're one of many Australians who has developed varicose veins. This condition, which affects around 30 per cent of women and 20 per cent of men, occurs when the tiny valves in your veins don't work properly, allowing blood to flow backwards and causing the veins to balloon. Although they’re largely harmless, varicose veins can be unsightly and embarrassing. Associate Professor Kurosh Parsi is a phlebologist (the branch of medicine that deals with veins) and head of the Department of Dermatology at St Vincent's Hospital in Sydney. We asked him why varicose veins occur, who is at risk, and how to get rid of them.

Varicose veins can be painful and unsightly

1.    Anyone can get them

Although you can usually spot varicose veins on the surface of the skin, sometimes they're not visible at all. They do tend to run in families, but there are definitely environmental factors which can cause varicose veins too, including occupations where you stand up a lot.

Other reasons varicose veins can occur, or get worse, include damage to veins because of a leg injury, pregnancy, fluctuations in Oestrogen levels during puberty or menopause, breastfeeding, oral contraceptives, hormone replacement therapy and wearing high-heeled shoes. Even if you have the gene you might not develop varicose veins, but combined with environmental factors, they may still occur.

2.    There are other symptoms too

Common symptoms of varicose veins include aching legs, or a feeling of heaviness, cramps, calf tenderness and restless leg syndrome, all of which get worse as the day goes on. About 50 per cent of people have no symptoms at all.

General leg pain can be the result of arthritis or a muscular issue, whereas pain from varicose veins is always much worse at the end of the day. This is usually because people have been standing all day, which sends the blood down their legs, where it accumulates in the calves, making the legs feel heavy. This type of pain tends to ease when you raise your legs. 

3.    Spider veins often go hand in hand with varicose veins

If you have varicose veins, you may also have clusters of spider veins. Normally these veins are hidden under the skin, but when you can see them it's usually because the valves in the larger veins aren't working properly and blood is flowing back into capillaries, making them congested.

Spider veins often go hand in hand with varicose veins

For many people, the appearance of spider and varicose veins is their main concern. Although treatments for spider veins such as cosmetic laser therapy and injecting a solution into the veins can work in the short term, they're not a permanent solution. If you are going to treat spider veins properly, you first need to treat the underlying cause. Cosmetic solutions won't work because the spider veins are being fed by larger veins and will therefore keep on returning. You need to treat the varicose veins first, and the spider veins later.

4.    Why diagnosis is important

Having the condition diagnosed properly can help you avoid other problems later on. Treatment becomes even more urgent if there are existing issues such as phlebitis - an Inflammation of the veins - blood clots in the legs, dermatitis or ulcers. And if you're planning to get pregnant, It's a good idea to treat any varicose veins first, since complications such as clotting and bleeding can develop during pregnancy.

Varicose veins that have worsened during pregnancy also may not fully recover after you give birth, requiring more involved and complicated treatment.

5.    Latest treatments

It's good to know that having veins treated is much easier early on when the veins are smaller.

In the past, the problematic veins were stripped from the leg, but it was an invasive procedure with a longer recovery period and a higher failure rate. Today, for larger veins, a non-surgical laser procedure called endovenous laser ablation (EVLA) is used.

The vein is accessed using a very fine catheter at a single entry point. The catheter is moved up towards the groin, guided by ultrasound. As the catheter is pulled out, the vein is sealed off.

Endovenous laser ablation (EVLA)

Endovenous laser ablation (EVLA)

Sclera therapy remains the gold standard procedure used to treat superficial veins such as spider veins, and ultrasound guided sclera therapy (UGS), using a foam chemical agent, is used to treat slightly larger branch varicose veins. This involves injecting the foam into the vein. The foam pushes the blood out and fills the vein, causing the vein to spasm and scar, sealing it off. In principle, however, larger veins need to be treated first with EVLA.

Parsi advises that Medicare rebates are available for EVLA and UGS for up to six treatments per year.

6.    Making sure they don’t recur

Recovering from sclera therapy is relatively easy and may involve wearing compression stockings, and to avoid the veins returning you may need more than one treatment.

If you’re treated with the endogenous laser, you will need to wear compression stockings for up to six weeks, walk every day, and avoid heavy exercise. To stop these veins from coming back, on average, you’ll need about three very precise treatments one or two weeks apart.

If you suspect you have varicose veins, see your doctor before they become a major issue. They are not a cosmetic problem, and the earlier you have them fixed the better.


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