FAQ about Varicose Veins

• Who are the people more prone to varicose veins?
  It is a universal disease affecting all ages and both sex equally. People with standing jobs are more prone – teachers, sales men and women, house wives, army and police personnel. It is also commoner in obese people and many have a family history of disease.
• People say recurrence is common. How could a burnt vein recur?
  If recurrence takes place it is due to perforators which have not blocked completely or have recurred. There is never a second surgery. Only we inject the vein which has recurred and occlude the perforator. It needs no admission and is done as an out-patient procedure and the patient continues has normal activity.
• Sclerotherapy or injections into the vein. Is it possible to avoid varicose veins from occurring?
  It is not possible. You can delay it by leg elevation and stockings but come it will. It is because of the valves going bad in the groin and behind the knee and there is no way known that you can prevent that. Once this occurs then it is worsened by the pull of gravity.
• How can we help ourselves?
  Self care involves regular exercise, weight loss, wearing loose clothes, avoiding prolonged standing and elevating the legs when convenient.

Word of Caution

• Have you been told varicose veins surgery is painless?
  There will be an ache along the medial aspect of the thigh where the vein has been burnt. This could present as burning or pulling sensation and may be quite irritating though you are doing all your activities.
• Ulcers and dermatoliposclerosis (darkening of the skin) may take time to heal. One could get infection in these areas even after surgery which would go away slowly over time. This time varies in different patients. The doctor is only going to remove the source which caused these complications. Frankly you have no option – leave it alone and let it worsen or treat it and allow it time to heal.
• Recurrence of varicose veins – This is not a myth. Varicose veins do recur even after the most successful surgery but return as isolated veins which would probably need injection therapy (sclerotherapy) as an outpatient. Overall you should be much better.
• There could always be a double cause for the problem – Many people get leg pain due to varicose veins and knee joint arthritis. After varicose veins treatment the arthritic pain will still persist because it is unrelated to the varicose veins. A diabetic with varicose veins may have an ulcer which could persist even after proper treatment of the veins.
• Recurrent Cellulitis even after surgery – Many times patients present with cellulitis and on colour doppler study they have varicose veins. The cellulitis is due to dermatoliposclerosis (poor skin texture due to years of venous pressure secondary to long standing varicose veins).

Life Style and Home Remedies

There are some self care measures you could take to reduce the discomfort the veins can cause. These measures also will prevent or slow the development of varicose veins. These measures include:

• Walking daily
  Exercise – Walking is the ideal way to improve the circulation in the legs.
• Watch your weight
  Watch your weight and your diet – Weight reduction by shedding off extra Kg. takes unnecessary pressure off your veins. Have a low-salt diet to prevent swelling caused from water retention.
• Avoid high heels
  Watch what you wear – Avoid high heels. Flat shoes work calf muscles more which is better for your varicose veins.
• Avoid tight fitting clothes
  Avoid wearing tight clothes around your waist, legs or groin. They could compress the veins and up the leg and worsen your varicose veins.
• Elevate your Leg
  Elevate your legs – Take several short breaks daily to elevate your legs above the level of y our heart. This improves the circulation in your legs. Lie down and elevate your legs on 3-4 pillows.
• Avoid sitting cross legged
  The right way to elevate your legs:
  • Avoid long periods of sitting or standing – Change your position frequently to encourage the blood flow. Try to walk every 30 minutes or so.
  • Do not sit with your legs crossed – This position could increase circulation problems.

Prevention of Varicose Veins

There is no way to completely prevent varicose veins but you could delay their occurrence or reduce the risk by improving the circulation of your legs. These are the same measures you take to reduce the discomfort from varicose veins. The measures include:

• Exercise
• Watch your weight
• Eating high fibre, low salt diet
• Avoiding high heels and tight hosiery
• Leg elevation
• Changing your sitting or standing position regularly

Unusual problems

• Many obese patients with severe pain in the legs but no obvious visible veins due to the obese legs go repeatedly to the orthopaedic surgeon or the neurologist with no relief and ultimately land up in psychiatric care. A simple Colour Doppler study may reveal severe reflux at the SF junction and large varicose veins. On treating these their pain settles completely.
• Occasionally patients present with unusual problems not documented in the literature like one patient presented with black spots on the sole of the feet which were painless but present for years and only progressively increasing. He had added severe varicose veins. On our treating his veins the spots progressively disappeared over the following couple of months.