Varicose Veins Treatment

Overview

Varicose veins appear as unsightly, enlarged veins on the calves and thighs.

In the leg, the veins bring blood from the feet back to the heart. Valves in the veins prevent the blood from flowing back down the leg due to gravity.

Varicose veins occur when the valves in the leg veins become damaged and this leads to pooling of blood in the veins causing enlargement of the veins over time.

There are two main sets of  veins in the leg that function to bring blood from the legs back to the heart.

  • Superficial Veins
    Comprises veins near the skin surface like the Long Saphenous Vein
  • Deep Venous System
    Main leg veins within the muscles of the legs.
varicose veins before and after treatment

Symptoms

  • Swollen and twisted veins in the thighs and calves
  • Sensation of heaviness in the legs
  • Aching legs, especially after prolonged periods of standing or walking.
  • Swelling of the feet and ankles
  • Leg cramps especially at night

 

When the condition becomes more severe, the following complications can occur:

  • Phlebitis – painful and red swollen veins due to inflammation
  • Venous ulcer – skin breakdown due to skin changes caused by high pressure in the veins

When to Seek Treatment

Medical treatment should be sought when:

  • Symptoms such as leg heaviness and calf tightness makes it difficult to perform daily activities.
  • Persistent swelling of the feet and ankles especially towards the evenings.
  • Presence of darkened skin above the ankles which is a sign of increased pressure in the veins
  • Ulceration of the skin near the ankles

Diagnosis

The diagnosis can be made by performing an ultrasound scan of the legs. This will confirm the presence of varicose veins and determine the extent of the problem. Treatment plans can then be made based on the individual’s extent of disease.

At Nexus Surgical, the ultrasound is done at the clinic by our vascular surgeon Dr Lee Chee Wei.

Treatment

Choice of treatment depends on the severity of the varicose vein. The aim of treatment is to reduce and alleviate the symptoms and prevent complications if left untreated.


Graded Compression Stockings and LifeStyle Changes

Stockings compress the foot, calf and thigh to prevent distention in the veins. This helps to control the swelling and associated symptoms but does not cure the problem. Read more here for how you can prevent varicose veins.


Radiofrequency Ablation (RFA) of Varicose Veins

The damaged Long Saphenous Vein (LSV) is ablated using heat energy via the Radiofrequency device. This causes the LSV to shrink over the next 2-3 months. Once it closes off, the backflow in the vein is eliminated thereby curing the patient of the condition.

The swollen varicose veins on the legs are then surgically removed through small incisions about 3-5mm long.

It is a minimally invasive procedure performed under deep sedation. Typically, patients do not need to stay overnight at the hospital.

After the surgery, the patient’s legs will be bandaged for 2 days. Walking around the home is permitted. The bandages will be removed 2 days after the surgery and replaced with a gentle compression stocking for 2 weeks..

Regular follow up with our specialist after the surgery will be arranged at 2 days, 2 weeks and 2 months following the procedure.


Endovenous Laser Ablation (EVLT)

This technique is similar to the Radiofrequency Ablation technique except a Laser fibre is used to deliver the heat energy.


Venaseal

The Long Saphenous Vein is treated with a medical grade adhesive to seal the vein. This will eliminate the backflow in the veins.

Causes

Prolonged and excessive pressure on the legs or abdomen would lead to damage of the valves in the veins of the legs.

Risk Factors

  • Pregnancy
  • Occupations that require prolonged standing, such as teachers, salespersons and nurses.
  • Being overweight increases the pressure in the veins in the legs, leading to varicose veins.
  • History of Deep Venous Thrombosis (DVT). DVT damages the valves in the veins and leads to eventual reflux in the deep veins.

Consult Our Doctor

Dr Lee Chee Wei
Vascular & General Surgeon

MBBS (Singapore), FRCS (Edin), FAMS (Surgery)

Varicose Veins Treatment FAQs

Avoiding standing still for long periods will reduce the pressure in the veins in the legs. For people who need to stand for long periods at work, wearing compression stockings will reduce the pressure build up in the legs.

The ultrasound will be done of the legs from the thigh to the calves. Please wear or bring along a pair of shorts to change into for the scan.

Treatment for varicose veins depends on the extent of venous reflux (backflow in the veins of the legs) as well as the patient’s symptoms. One option is to wear medical grade compression stockings to compress the thigh and calf to reduce the venous reflux. Another option is to get rid of the damaged vein that is causing the venous reflux. This can be done with minimally invasive techniques where the main vein is treated with a laser or radiofrequency energy to close off the vein. 

Generally, the varicose veins will not go away as the root cause of this problem is physical damage to the valves in the veins of the legs. Since these valves are already damaged, it would not be possible to cure this condition without some form of intervention or surgery to get rid of the damaged vein. 

Spider veins are fine reddish and purplish veins that appear on the surface of the skin in the legs. These can be treated with injection sclerotherapy. Injection sclerotherapy is a procedure where a special chemical agent is injected into the spider veins using a very fine needle. This caused inflammation of the spider veins and eventually causes the spider veins to shrink.

Varicose veins are swollen bulging greenish to bluish veins that causes unsightly bulges on the skin of the legs, usually along the inner calves. Most patients with varicose veins usually have some damage to the main veins in the thigh and this should be treated first. The swollen veins can then be treated usually with a small surgery to remove the bulging veins

Varicose veins usually become more prominent in patients who are sedentary and do not exercise. Exercise will help to drain the blood from the feet back to the heart. When you exercise, especially when you contract your calf muscles, the muscle contraction helps to “pump” the blood in the legs back to the heart, thereby relieving the pressure in the veins in the calves. Exercises such as brisk walking, light jogging, swimming and cycling will all help to relieve some of the symptoms of the varicose veins. 

No. Icing the legs does not help alleviate the symptoms of varicose veins, nor does it reduce the degree of venous reflux. 

Rather than massaging the varicose veins directly, you should try to do some calf massages. This will help to increase the flow of blood from the legs back to the heart and this will reduce the pressure in the varicose veins in the legs. Another helpful tip to to sleep with the feet and legs elevated on a pillow. This will also help drain the blood in the veins back to the heart when you sleep. 

Varicose veins is a lifestyle disease. It occurs more commonly in people who are overweight and sedentary. Exercising regularly will help to reduce the symptoms of the varicose veins as well as improve the general health and well-being. Another factor is the patient’s occupation. People who work in jobs that require them to stand for long periods will have a higher risk of developing varicose veins. This includes occupations such as nurses, teachers, sales people, janitorial staff, food handlers and service staff. 

Left untreated, the varicose veins will get progressively worse due to the increase in the venous pressure in the veins of the legs. Eventually this will lead to calf and ankle swelling (edema) and darkening of the skin in the lower calves, especially in the area just above the ankles (hyperpigmentation. If still untreated, this may eventually lead to skin breakdown and ulcer formation and these ulcers will be difficult to treat and will take weeks to months to heal with special dressings. 

The venous reflux problem may have developed on one leg only and that would give rise to varicose veins in the affected leg.

Varicose Veins Treatment FAQs

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