Varicose veins are unsightly visible bulging veins in the lower limbs. For some people they are only a cosmetic concern, but they can frequently become painful, or lead to leg swelling, pigmentation, bleeding, clotting, dermatitis, or even ulcers.
They are primarily caused by a combination of genetics and age, but certain occupations which involve a lot of standing can make them more symptomatic.
The varicose veins become prominent due to an increase in pressure. The blood flow in healthy lower limb veins flows from the ankle to the groin, and does not fall back down due to the function of the vein valves. In varicose veins, these valves are not working properly, and so the entire weight of all the blood is pushing down on the veins below the knee, blowing them out and becoming conspicuous. In some people, this increase in pressure (venous hypertension) can lead to blood cells escaping into the tissues of the foot and lower leg, and breaking down to form a reddish-brown pigmentation. This also causes inflammation, leading to dermatitis or even ulceration. Because the blood is not flowing properly, it can also lead to clots.
The treatment of the varicose veins consists of two parts. Firstly, the backwards-flowing "feeding" veins (which are usually too deep under the skin to see without an ultrasound) must be destroyed, so that they cannot transmit the high pressure to the visible veins. Secondly, the visible veins are also treated, so that there should be minimal (if any) remnants of the original veins seen.
In order to treat these veins, we always get an ultrasound first, so that we can get a comprehensive idea of exactly which veins are working properly and which aren't, in order that your veins can be treated adequately in the minimum number of treatments. Usually we would prefer to perform the ultrasound on site at Gold Coast Vascular, as we have a very experienced sonographer who works exclusively with arteries and veins.
Dr Ward-Harvey will look at your legs clinically, and combine that with the ultrasound findings to propose the best modality of treatment tailored for you personally.
The four treatment modalities offered are:
Dr Ward-Harvey will need to see you and your ultrasound before being able to offer advice on which treatment will be best for you.
Video of Radiofrequency Ablation (RFA) procedure
Video of Venaseal Glue procedure
A blood clot in the legs is called a deep venous thrombosis. There are a number of risk factors for this occurrence, including immobility, surgery, smoking, the oral contraceptive pill, being overweight, and blood clotting abnormalities.
The dangers of DVT are either chronic pain and swelling in the legs, or (and more dangerously) part of the clot breaking away and blocking off circulation to the lungs, resulting in a "pulmonary embolism" which can lead to severe breathlessness or even death.
The standard treatment of DVT is anticoagulation ("blood thinning") and stockings. The duration of the anticoagulation will depend on the cause of the clot.
Recently there have been developments in the surgical management of large DVTs, whereby a catheter is introduced into the clot, a chemical "clot-buster" is injected into the clot to liquefy it, and then the clot is sucked out. This procedure is known as thrombolysis ("clot-busting") and thrombectomy ("sucking" the clot out). This can be offered for some patients with a large clot extending above the groin, but is rarely worthwhile for smaller clots.
The natural history of clots is to become more stable, then become fibrous scar tissue. This scar tissue usually resolves to some extent, with channels re-opening, permitting more blood flow. If the valves in the veins have not been damaged then you can have a complete recovery from the clot with no residual symptoms. If there is still a lot of blockage, or if the valves have been destroyed, then you may find a long term effect of the clot is that you have "chronic venous hypertension". This means that you have impaired bloodflow out of the veins, which is most marked during exercise... your leg will become swollen and painful.
Most cases of chronic venous hypertension are managed conservatively with stockings and time. Some patients may benefit from an intervention such as balloon angioplasty or stenting.
Just like in the legs, people can get "varicose veins" in the abdomen. This is usually either because of a problem with reversed flow in the ovarian vein, or a narrowing of one of the veins in the pelvis.
The symptoms of this condition are usually lower abdominal pain, painful/heavy periods, and/or abdominal pain with intercourse.
This condition is extremely complex, as many women have ovarian vein reflux on ultrasound, but no symptoms at all, but others have a lot of symptoms. To work out if this condition is really present, and is likely to be able to be successfully treated, Dr Ward-Harvey will need to see you to discuss your symptoms, and examine your abdomen, then will organise some imaging (starting with ultrasound, but may include CT scans or MRIs).
If treatment is indicated, it is usually endovascular treatment... you may benefit from coils or stents inserted in your veins via a needle puncture in your groin or your neck.