Why treat varicose veins?

In this episode of PodMD, Interventional Radiologist and Endovascular specialist Dr Jane Li will be discussing the topic of why treat varicose veins? We discuss the causes of varicose veins, how it can impact a person’s health, the non-surgical treatment options, developments in the treatment and more.


RACGP

  • Transcript
    Please note this is a machine generated transcription and may contain some errors.
    *As always, all in this PODMD podcast is intended for health professionals and the comments are of a general nature. Information given is not intended as specific medical advice pertaining to any given patient. If you have a clinical issue with one of your patients please seek appropriate advice from a colleague with expertise in the area.

    Today I’d like to welcome to the PodMD studio Dr Jane Li

    Dr Jane Li is an Interventional Radiologist and Endovascular specialist with over 15 years of experience. Dr Li completed her advanced surgical training in Sydney and her fellowship in London, where she focused on the treatment of venous and arterial disease, cancer, fibroids and complex liver conditions.
    She is one of very few Australians to have been awarded the European Board of Interventional Radiology, which recognises advanced experience, knowledge and skills in Interventional Radiology on an international level.

    Today, we’ll be discussing the topic of why treat varicose veins?

    *We do hope you enjoy this podcast but please remember that the advice here is of a general nature and is not intended as specific advice about a given patient. The views and opinions expressed in this podcast are those of the doctor, not PodMD.
    If you do have a patient on whom you require specific advice, then please seek advice from a colleague with appropriate expertise in that area.

    Jane, thanks for talking with us on PodMD today.

    Jane : Thank you for having me.

    Question 1
    The topic of today’s discussion is why treat varicose veins? Jane, can you first give us a brief overview about the condition?

    Jane: Yes, of course, varicose veins are enlarged, tortuous, superficial veins in the lower extremity. It can occur anywhere from the buttock region down to the ankle and foot. It represents A retrograde flow of blood within the veins. Usually the long or the short saphenous veins, either in the truncal segments or the main vein. Or within the branches of a. Both men and women are affected. In fact, it happens slightly more in men. Majority of the patients would have positive family history.

    Question 2
    What causes Varicose Veins?

    Jane: Varicose veins develop over time when there is a failure of the valves within the superficial veins, the great saphenous vein, for example, has anywhere from three up to 11 valves, and there is a fairly consistent valve at the saphenofemoral junction where the great saphenous vein joins with the deep vein and returns. Blood to the heart. Any one of these styles or multiple vowels can become leaky. And not function as they should. The backward flow of blood results in chronic increase of venous pressure in the legs. What exacerbates this incompetence are factors such as pregnancy, especially much, especially in multiple pregnancies, prolonged standing trauma or excessive weight.

    But by far the biggest contributor we find is genetics. Patients with their strong family history can present with varicose veins in their 20s and sometimes even earlier in their adolescence. Occasionally, varicose veins is caused by reflux in the deep veins. Such as in the case of deep vein compression. Post thrombotic syndrome or deep venous reflux? That is why we need to be aware of other conditions that can cause varicose veins in the rare cases, varicose veins can be caused by vascular malformations, AV fistulas or even neuromuscular disorders. Treating doctors need to be aware of these other conditions and have a good grasp of the different types of presentation and venous variants. We need to perform a proper assessment before offering treatments.

    Question 3
    How can varicose veins impact a person’s health?

    Jane: Always saying clinical practise is quite varied. For some patients it is purely cosmetic concern. They go on for years with large novelty veins and minimal symptoms that sometimes they can heighten the emphasis they place on these symptoms. Other times is the unknown or the fear of varicose veins turning into something bad.

    The bad health outcomes in the future, the ones we tend to treat, are those patients that have suffered for a long time with chronic discomfort, whereby they describe daily leg pain heaviness. Or fatigue, which worsen with walking or lying down, or if there is swelling of both legs. We are also concerned about patients who have unrecognised chronic, deep vein thrombosis or deep vein obstruction. Human is fast themselves as varicose veins.

    Question 4
    Can it lead to serious complications if left untreated?

    Jane: Most of the time, varicose veins is a benign condition and worsened gradually over many years. Some people are worried about deep vein thrombosis. Thrombophlebitis and superficial vein thrombosis can happen in varicose veins. However, there is little evidence that varicose veins can result in DVT or pulmonary embolism. These small clocks tend to stay in the one spot in the superficial veins for a long time.

    Or self resolve overtime varicose veins is graded with something called the seap classification. Patients with higher ceap school that is with skin pigmentation or eczema. Unhealthy looking changes like lipodermatosclerosis, bleeding or ulceration deserve more urgent attention, special skin care and ulcer management would be also important in these cases.

    Question 5
    What non-surgical treatment options are available for varicose veins? Are they effective?

    Jane: The most obvious non-surgical way to manage varicose veins is by compression stockings, particularly in patients with mild disease. We often recommend they undergo a trial period of wearing compression to alleviate their symptoms. The downside to this method is. Are low compliance rates. Pensions often complain about skin irritation and tightness, especially in hot weather.

    The only other non invasive treatment out there is steroid therapy unfortunately has shown itself to be not very effective in closing these large refluxing superficial veins. So a majority of cases these days, after a proper clinical and ultrasound assessment. Are deemed to be suitable for minimally invasive treatments such as laser therapy or radio frequency therapy. The laser therapy is called endovenous laser ablation. And sometimes we use radiofrequency ablation. Both of them rely on heat energy to close the disease vein.

    The laser uses a special wavelength energy targeting water particles to absorb heat. While the radio frequency uses radio waves to produce heat to damage the vein. The Scar vein will then shrink and eventually become reabsorbed by the body. Both have been proven to be effective in giving us reliable long term results comparable to the traditional surgery of ligation and stripping. Patients experience less post operative pain and also recover quicker because they are mobile straight after the procedure.

    There is a reduced risk of DVT. We still offer sclerotherapy in combination with heat ablation to manage the smaller calibre burnhouse veins or the isolated refluxing. Preferred vein. A caveat I should mention is patients represented with late disease or has severe reflux. Even when a diagnosis is made, it’s not easy to manage their condition, and they may never be cured. In these cases, treatment is really aimed at improving the patient’s quality of life, improve their skin health, and help them maintain their level of physical activity without pain or swelling of the limb.

    Question 6
    Has there been any developments in treatment in recent years?

    Jane: Yes, there are a few methods now available. That are new on the markets. One is a device that uses a rotating wire to cause mechanical damage after refluxing vein, which is combined with the sclerotherapy, another is using the medical glue to seal off the vein wall. By using application of pressure and compression during the procedure. Each of these devices have their pros and cons and limitations, something we need to be careful of, particularly is a dermal sensitivity to glue. Laser technology itself also has come a long way, with many improvements to the laser fibre over the years. That now gives us more superior and reliable results.

    Question 7
    Tell us, do Varicose Veins need to be treated?

    Jane: People sometimes confuse varicose veins with telangiectasias like spider veins or reticular veins, which are really of a cosmetic nature. The patient with early varicose veins and mild symptoms often does not require ablation or surgery to remove. The main superficial vein. They may, however, benefit from assessment and reassurance to wait and see. And as mentioned, the trial of compression socks. Medical treatment of varicose veins is warranted if patient is suffering from symptoms which affects their activities of daily living or if skin changes have develop. Since there is a minimally invasive and low risk procedure now available to treat varicose veins. It has provided patients with more options.

    Question 8
    When should a GP refer?

    Jane: Referral should be initiated when a patient presents with moderate to severe varicose vein disease in the legs. What we mean by that is worrying skin changes or persistent symptoms of pain, fatigue, itchiness or swelling. Uncommon, but still relevant. Is patient with previous history of DVT or if there is a suspicion of deep venous disease? In these cases, I think the patient should be referred on.

    Concluding Question
    Thank you for your time here today in the PodMD studio. To sum up for us, could you please identify the three key take home messages from today’s podcast on why treat varicose veins?

    Jane: Number one, I think is therapist vein symptoms can vary widely. And the degree of symptoms is not dependent on the degree of enlargement, the veins. #2 is there are several ways to treat varicose veins. I encourage both GPS and patients to be educated on what options are now available. And finally, #3 not all bulging veins need to. Early varicose veins can be managed conservatively. In contrast, as proper assessment is necessary in moderate and severe disease to exclude any association with deep venous disease.

    Thanks for your time and the insights you’ve provided.

    Jane: Thank you

*As always, all in this PODMD podcast is intended for health professionals and the comments are of a general nature. Information given is not intended as specific medical advice pertaining to any given patient. If you have a clinical issue with one of your patients please seek appropriate advice from a colleague with expertise in the area.