Thursday, December 7, 2023
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Visibly engorged, tortuous and blue-purple coloured leg veins are called varicose veins. This condition indicates underlying venous insufficiency that occurs when the wall of the veins or valves in the leg veins malfunction, making it difficult for blood to return from the legs to the heart. This causes blood to backflow and gradually “pool” in the leg veins. As a result, patients experience symptoms such as pain, swelling, heaviness, ulcers and skin changes. Even in asymptomatic cases, the cosmetic disfigurement can be distressing and some may seek for the best treatment to remove leg veins. Studies showed that nearly 50% of people may develop varicose veins. Risk factors include advancing age, female gender, pregnancy, obesity, smoking, family history and prolonged standing.

What are the symptoms of varicose veins?

The most obvious symptom is the dilated, twisted, blue-coloured vein bulging on the surface of the leg. The leg feels heavy, tired, pain and swollen especially at the end of the day or after prolonged standing. Over time, the pooling of blood causes the skin to change red-brown colour, starting from the inside of the ankle then over the shin and foot. This is because red blood cells are forced out of the vein and end up in the skin. As the red cell breaks down, it releases iron that causes the skin to become irritated and inflamed, resulting in red, dry and itchy skin. Scratching and injury ensues, leading to open sores (venous ulcers) which hurts and oozes fluid. The ulcer may expand larger and takes a long time to heal.

How to treat varicose veins?

For symptomatic varicose veins, conservative and medical treatment are usually offered first to reduce symptoms, prevent ulcers and improve blood flow to the legs. The simplest treatment is by elevating the legs above heart level for 30 minutes at least three to four times a day. This can reduce swelling and improve blood flow. Leg elevation may be the only treatment needed for mild cases but could be impractical for some people. Foot and ankle exercises are also helpful to reduce symptoms. This can be performed by simply walking, or pointing the feet up and down, or standing on toes to lift the heels. Repeat these exercises several times in a day to help pump the blood from leg veins back to the heart. You can set alarms to make it habitual especially for those who stand for an extended period of time, like barbers and cleaners.

Compression therapy is another recommended treatment which can be performed by using compression stockings, intermittent pneumatic compression (IPC) pumps and compression bandages. The principle is to use external compressive force to prevent backflow of the blood, thus improving blood flow and symptoms. Compression stockings are available by prescriptions as personal measurements are needed. The longer the patient wears them, the better the effect. The concept for IPC pumps are similar but may be difficult to use in overweight patients or severely swollen legs. The initial use of stockings and pumps may be painful but it gets better over time. Compression bandages and dressings are generally reserved for patients with severe symptoms and ulcers. Be mindful to keep the bandages dry at all times and should be changed once or twice a week by doctors or nurses. Inform your doctor if you have cold and numbness over your feet as an arterial disease is a contraindication for compression therapy.

Aspirin has been shown to help speed up the healing of ulcers while antibiotics are only recommended when there is an infection. Certain dietary supplements such as horse chestnut seed extract and micronized purified flavonoid fraction are able to help in symptoms reduction. Do consult your doctors before trying this. Moisturizers or steroid cream may help with itchy and inflamed skin.

In cases where symptomatic varicose veins are not resolved by the above methods, doctors may offer vein ablation treatments that basically destroy the leg veins either by sclerotherapy, laser ablation or vein stripping. Sclerotherapy is done by injecting chemical, foam or glue into the affected vein and causes it to collapse. The vein is intact but becomes non-functional and flattens. Meanwhile, laser ablation uses high waves of radiofrequency to generate heat in the veins, sealing it from the inside. Similarly, the vein is intact but does not carry blood. Both of these treatments require little anaesthesia and can be done in a doctor’s office. These two treatments are also the most recommended options for cosmetic purposes in asymptomatic cases. Lastly, vein stripping or ligation must be done in operation theatre settings. This surgical procedure involves cutting two small incisions at two ends of the vein and slowly strip the affected vein from the leg.

Which treatment is the most effective for leg vein removal?

Best treatment option depends on the severity and preference of patients. Discuss the options with your doctor for a more personalised treatment that best suits you.