Varicose veins is a condition experienced worldwide. It affects approximately six in ten women and three to four in ten men. What causes this condition? Is it possible to prevent it? What are the risks if we ignore it and let the veins spread?
Answering these and other questions is Arūnas Grinkevičius, a vascular surgeon and phlebologist at the Baltic-American Therapy and Surgery Clinic.
– What are varicose veins?
– The name itself tells us that this is a disease of the veins. In the human body, there is a certain circulatory path, often called the circle of life. It consists of blood vessels – those through which blood leaves the heart, and those through which it returns. The former are called arteries – but we will not be discussing those today. What matters to us are the latter – the veins, through which blood returns to the heart. The real problem, which turns into varicose veins, starts when this return of blood is disrupted. It is very easy for blood to travel when pumped by the heart. Returning, however, is difficult. The valves inside the veins are one of the mechanisms that help the blood return – acting like stairs that the blood “climbs” up. When these tiny valves break down, their function is impaired, blood pools in the veins, remains low in the legs, and the veins begin to dilate.
– Are these changes – the expanding veins – already the symptoms that should concern a person and prompt them to see a specialist?
– The main symptom that prompts people to seek help is thread veins and bruising on the legs that does not go away. This is most commonly done by women, as the cosmetic appearance is also important to them. It is at this stage that changes in the circulation can be found. We detect this by examining the circulation in the legs with an ultrasound scan, or, in other words, by performing a duplex ultrasound scan. Thread veins can be the first symptoms indicating that something is wrong with our venous circulation. People often seek medical attention when the veins are already clearly visible and dilated, with bulging lumps on the legs. In such cases, it is obvious that the venous circulation is impaired.
– Who suffers more from this condition – women or men?
– Women are affected more often; six out of ten have this problem to some degree, compared to 3 to 4 out of ten men. Pregnancy plays a significant role here, putting extra strain on the venous circulation in the legs and, if there is a predisposition to developing the condition, triggering it. Pregnancy also alters the hormonal environment, as well as tissue and blood vessel tone.
– What other factors can contribute to the development of this condition?
– We are still searching for answers as to why varicose veins develop. One cause is that it is a familial condition, meaning it is hereditary. Other contributing factors can include being tall – because the taller a person is, the longer the vein and the greater the static pressure – being overweight, the number of pregnancies (a woman who has given birth twice is twice as likely to develop venous disease), and the nature of one’s job – such as prolonged sitting or standing.
– It is often said today that many health issues can be resolved through diet. Can it help in this case?
– I have not heard of diet directly contributing to this. Food can only have an impact if we overeat. Then we face another issue – being overweight, which in itself can be one of the causes of varicose veins.
– Are there perhaps ways to prevent this condition?
– If there is a family history of the condition, there is a chance we might develop it too. This means we should avoid jobs that involve only sitting or only standing and take preventive measures – such as wearing compression stockings during flights, and so on. But we rarely do this because we want to live our lives comfortably and do not think about the condition until it appears. Therefore, if you notice changes in your legs, it is better not to delay and see a specialist – this will also determine which treatment option is chosen. While interventional procedures are available, nowadays we have many other methods, such as medical glue and sclerotherapy, which can help get ahead of the condition and address the issue. If the issue is purely cosmetic, foam sclerotherapy is used – a special chemical foam is injected into the specific thread vein, causing it to wither away over time. Of course, the patient is examined beforehand to ensure it is not underlying venous disease that requires more serious treatment.
– And how are varicose veins treated? How is it determined whether non-interventional or surgical treatment is needed?
– First of all, the patient needs to come in for an assessment, because everything starts with an investigation. Today, we have very clear diagnostics for this condition. One of the gold standard tests is a duplex ultrasound scan. This investigation allows us not only to see how the vein itself has changed, but we can also clearly identify which vein is affected and the direction of blood flow – which shows how the vein and its valves are functioning, and whether it is completely diseased. It is very important for patients to get checked. If they notice a network of thread veins on their legs, or if that network becomes prominent during pregnancy, they should have an ultrasound. The test is painless and quick. I always suggest that women come for an assessment midway through pregnancy to see how their veins are functioning. You should also get checked if your legs swell, especially if the swelling is asymmetrical.
When it comes to treatment, the diseased vein must be destroyed or removed. There are various ways to do this: conventional open surgery – where the vein is stripped, or minimally invasive endovascular medicine (sparing surgery), where the veins are closed using lasers, sealed with medical glue, or sometimes sealed using chemical sclerotherapy. Another method is radiofrequency ablation. These latter methods do not involve removing the vein; instead, by treating it from the inside, they allow it to heal and fade away. This is a quick procedure with no incisions, requiring no general anaesthetic; the patient can walk, drink, and eat immediately afterwards. It is safe because the patient remains mobile after the procedure. It is always more concerning when a patient is bedridden, as this can pose a risk of embolic complications.
– What restrictions do patients face after surgery or treatment?
– Wearing compression stockings, except when treated with medical glue. During the post-operative period, patients need to take care of themselves and avoid overexertion.
– What complications can arise after surgery?
– One of the most serious complications after surgery, especially open surgery, is a thromboembolic complication (pulmonary embolism), where blood clots form, travel through the deep veins to the lungs, and cause pulmonary embolisms. Such complications are indeed rare, and we take every precaution to prevent them – both before and after the operation, we give the patient anticoagulant medication to prevent clots from forming. However, when tissues are traumatised during surgery, the vein is stripped along its entire length, and some branch veins are simply torn, the body naturally responds by stopping the bleeding, which can lead to the formation of micro-clots at those sites.
It has been proven that after open surgery, microscopic emboli reach the lungs without us noticing. Laser surgery does not cause such trauma, and tissues are not damaged. Consequently, in these cases, this complication is extremely rare. Other complications include infections – if an incision is made, there is a small wound, and with larger wounds, the risk of complications is always higher. The risk is therefore greater with conventional surgical stripping than with laser surgery. There may also be some swelling, bruising, and areas of numbness.
– Can the condition recur?
– We operate on the condition, but not the patient’s genetic predisposition to it. This predisposition remains with the individual for life. I invite all patients for a follow-up assessment one year after surgery to see if there are any signs of recurrence. If we find anything, we take immediate action. If not, we meet again after a few years. We eliminate the diseased veins, and the healthy ones remain. Whether they will ever become diseased depends on the person’s lifestyle, predisposition, and, for women, the number of pregnancies. Post-operative prevention is essential, and we always recommend that people with a predisposition wear compression stockings – not bandages – when there is increased strain on the legs, such as during long journeys, hikes, flights, and so on. This is a measure that truly delivers results, provided, of course, that the stockings are worn as consistently and frequently as possible.
– Is it a myth or a fact that varicose veins is a condition of older people?
– This condition is increasingly affecting younger people. I do not operate on children, but there is more than one eighteen-year-old who comes for surgery right after finishing school. For them, the condition appears as early as sixteen; we cannot afford to delay too long, because the longer you wait, the more the condition progresses. Do older people get it more often? It is simply that with age, the condition becomes more advanced, creating the impression that it is more common in the elderly. If people seek help early enough, they may avoid advanced symptoms – either they are cured, or the condition recurs only cosmetically, posing no risk to circulation, overall health, or life.
– What complications are risked if nothing is done and the condition is left untreated?
– I mentioned that this is a family condition. Look at your grandparents’ legs if they were left untreated. If the condition is not treated, it progresses, and it can eventually lead to the development of either venous ulcers or thrombophlebitis. Blood clots form in the human body for three main reasons: first, when blood flow slows down, and blood flows slowly in dilated veins; second, when the vessel wall is damaged – and the wall of a varicose vein is dilated and constantly traumatised, as it can be bumped or even bruised simply by putting on socks or during a massage, which is why we advise avoiding massages; and third, when blood clotting increases, such as if we drink fewer fluids or sweat more. It is dangerous if thrombophlebitis spreads from varicose veins into the deep veins. Although a rare complication, a pulmonary embolism can also occur. It is essential to monitor the patient, treat them with medication, and operate on the veins in a timely manner. Of course, there are fortunate people who live their lives this way without any issues, but the conditions for developing ulcers or thrombophlebitis are ideal.
