Chronic venous insufficiency
This is when the poor flow of blood in the veins interferes with
the way the skin exchanges oxygen, nutrients and waste products
with the blood. When this happens over an extended period of time,
venous insufficiency can cause a number of problems including:
Varicose eczema
This is brown or purple discoloration of the skin that often leads
to a permanent staining.
Venous ulcers
These are a sign of very weak blood flow in the veins that drain
blood from the skin. A minor wound, usually around the shin or ankle,
can fail to heal, causing an ulcer. Poorly treated, these ulcers
can become chronic, afflicting victims for years, even decades.
 Having
varicose veins does not mean that you will inevitably get complications
or venous insufficiency. And although they won't usually get better
without treatment, varicose veins only get worse slowly.
Investigations
Varicose veins are easily visible. To work out the position and
extent of valve weakness, there are a number of tests a doctor
might do.
- A Doppler test uses ultrasound to give information about blocked
veins and the direction of blood flow in a vein.
- The Trendelenburg test involves lying down and lifting one
leg up in the air. The doctor uses a hand or a tourniquet to
temporarily block off the blood flow in the veins. The patient
stands up and the refilling of the varicose veins with blood
gives an indication of which part of the leg has faulty valves.
- A venogram is a test where a dye is injected into a vein in
the foot and radiographs (X-rays) are taken of the outlined veins
in the leg.
Treatments
 Compression
stockings
These may relieve the swelling and aching of the legs but do not
prevent more varicose veins from developing. They are worn during
the day and taken off at night. Graduated compression stockings are
tightest at the ankle and get gradually looser further up the leg.
This helps to encourage the blood flow up towards the heart.
Compression stockings are available in various sizes and pressures
and it is very important that you get them to fit you properly.
They are made to fit the calf diameter not by foot size. Your GP
or pharmacist should be able to provide advice.
Some people find compression stockings difficult to put on. There
are tools available to help, or you could ask for help from a partner
or friend. Stockings can be uncomfortable, especially in hot weather.
But there is no point in wearing them rolled down.
Sclerotherapy
Small varicose veins can be injected with a chemical that damages
the vein walls. As a result, scar tissue forms which closes off the
affected vein. Other stronger veins take over and the treated vein,
no longer filled with blood, becomes less visible.
For sclerotherapy to be successful, a compression bandage has to
be worn for between three and six weeks after the treatment.
This treatment can be an alternative to surgery, but it is does
not guarantee that the varicose veins will not reappear, or that
other nearby veins will become varicose. Often, several injections
are needed. One possible side-effect of this treatment is skin
discolouration.
Surgery
This involves removing the affected superficial veins. There are
many variations of operation, depending on which veins need treatment.
The most common is called ligation and stripping.
Under a general anaesthetic, the vein to be treated is tied off
(ligated) at the top of the leg. A flexible wire is passed through
the affected vein and attached to one end. By pulling the wire
back, the vein is "stripped"
out. A number of smaller cuts in the skin may be made to remove
smaller varicose veins at the point where they were attached to
the stripped vein.
Although removed veins cannot reoccur, other leg veins could also
become varicose.
New approaches
"Minimally-invasive" techniques such as laser and microwave
treatments are being studied at some hospitals. One of these is endovenous
ligation treatment (EVLT), where a fine laser probe is passed inside
a vein, minimising damage to the skin.
NOTE: Microcyn® does
not have U.S. FDA clearance for claims other than to moisten,
lubricate, cleanse and debride wounds. |
