Varicose Veins and Venous Insufficiency
Sydney Vascular Surgeon - Dr Mayo Theivendran
Common conditions causing discomfort and cosmetic concerns
Up to 50% of the population can present on the spectrum of venous hypertension. This can result in functional, medical and cosmetic concern.
What is the difference?
Varicose vein disease is a common condition that affects up to 20% of Australians.
Varicose vein disease can cause discomfort and affect your appearance. Varicose veins usually affect the superficial veins that lie closest to the skin.
They can predispose you to thrombosis, bleeding or skin inflammation.
Chronic venous insufficiency is a less common condition, which affects both superficial and deeper leg veins. Blood tends to pool in the lower legs, ankles and feet. Chronic venous insufficiency can occur with or without varicose veins. It affects around 0.3% of Australians.
What are varicose veins?
Varicose veins are enlarged, twisted, and swollen veins that typically appear in the legs and feet.
Healthy veins have one-way valves that prevent blood from flowing backwards towards your feet, but when these valves fail, blood can pool in the veins, resulting in varicose veins.
Who is at risk of varicose veins and venous insufficiency?
Several factors can contribute to the development of varicose veins and also venous insufficiency:
Age
As we age, our veins tend to lose elasticity, making it harder for blood to flow upwards and making them more prone to becoming varicose.
Obesity
Excess body weight can put added pressure on the veins in your legs and make them more likely to become varicose.
Heredity
If your family has a history of varicose veins or venous insufficiency, you may be more likely to develop these problems.
Gender
Women are more likely to develop varicose veins than men, mainly due to hormonal changes during pregnancy and menopause, which can weaken vein walls.
Prolonged standing or sitting
Jobs or activities that require long periods of standing or sitting can reduce blood flow in the legs, increasing the risk of varicose veins and venous insufficiency.
What are the symptoms?
Varicose veins and venous insufficiency can cause a range of symptoms, including:
Visible, enlarged veins
The veins look blue or dark purple in colour. You may have skin discoloration and inflammation around the varicose veins.
Aching or pain in the affected area
Discomfort is especially noticeable after you’ve spent long periods of standing or sitting.
Swelling
Swelling associated with varicose vein disease is particularly noticeable in the ankles and lower legs.
Throbbing, cramping and/or itching
You may experience throbbing or cramping in the legs. Some people complain of itchy or irritated skin over the affected veins.
Restless or heavy legs
Your legs may feel restless. A feeling of heaviness in the affected area is also common.
Skin changes
The skin on your legs may become discoloured, dry, and prone to irritation or even open sores.
Indicators for treatment
- Symptoms of venous hypertension (oedema, pain, restless legs, pruritus) not manageable with compression
- Superficial thrombophlebitis (STP), bleeding, skin changes
- Ulcers
- Cosmetic concern
Diagnosing varicose veins and venous insufficiency
Diagnosing varicose veins typically involves a physical examination and medical history assessment. Your doctor may:
- Ask about your symptoms and whether there’s a family history of varicose veins
- Examine your legs while you're standing and sitting to assess the appearance of the veins
- Use duplex ultrasound imaging to get a clearer picture of your veins and assess blood flow.
What are the complications of varicose vein disease?
While varicose veins are usually not a severe medical concern, they can lead to complications, including:
Superficial thrombophlebitis
This condition occurs when a blood clot forms in a vein near the surface of the skin, causing pain, redness, and swelling. This can progress to a deep vein thrombosis.
Venous ulcers
If there’s not enough blood getting to your lower legs and ankles, you can develop open sores or ulcers, near your ankle.
Bleeding
If a varicose vein close to the skin's surface bursts, it can cause bleeding.
Deep vein thrombosis
A deep vein thrombosis can develop, which is a serious condition where a blood clot forms in a deeper vein, potentially leading to more severe complications.
How are varicose veins and venous insufficiency treated?
The treatment of varicose veins and chronic venous insufficiency depends on the severity of the condition and the symptoms. There are several approaches, ranging from lifestyle changes and/or compression stockings to medical procedures.
Dr Theivendran can recommend treatment options with you.
Lifestyle modifications
Before considering medical interventions, there are several lifestyle changes you can make to relieve symptoms and prevent them from worsening:
- Exercising: Regular physical activity can improve blood circulation in the legs. Activities such as walking, swimming and cycling are particularly beneficial.
- Maintaining a healthy weight: Losing excess weight can reduce pressure on the veins in your legs.
- Elevating your legs: Raising your legs above heart level when resting can help relieve symptoms and improve blood flow.
- Avoiding prolonged sitting or standing: If your job or daily activities require long periods of sitting or standing, take breaks and move around regularly.
- Wearing compression stockings: You can buy graduated compression stockings that will apply pressure from your ankles up to your thighs, helping blood to flow more efficiently. Dr Theivendran will prescribe compression stockings suited to your circulation.
Medications
Some over-the-counter and prescription medications can help with varicose veins and chronic venous insufficiency:
Non-prescription pain relievers like ibuprofen or aspirin can help relieve pain and discomfort associated with these conditions.
Topical creams and ointments: Some over-the-counter or prescription anti-inflammatory creams can reduce itching and inflammation.
Blood thinners: If you are at risk of developing blood clots, your doctor may prescribe blood-thinning medications to help prevent clot formation.
Surgical procedures for varicose veins and venous insufficiency
Often lifestyle changes and/or medications don’t provide sufficient relief from the discomfort of these conditions. The appearance of your veins may also be bothering you. You could also be at risk of complications. In these situations, your doctor may refer you to Dr Theivendran.
There are several surgical solutions for varicose vein disease and venous insufficiency:
Sclerotherapy
This is a minimally invasive procedure that involves injecting a solution into the affected veins, causing them to collapse and eventually be absorbed by the body.
Endovenous laser treatment
A laser can be used to cauterise the affected vein, redirecting blood flow to healthier veins.
Endovascular radiofrequency ablation
In this procedure, radiofrequency energy is used to cauterise the problematic vein.
Endovascular glue
In a procedure similar to radiofrequency ablation, the vein can be closed off using endovascular glue.
Surgical ligation and stripping
If you have severe varicose vein disease or venous insufficiency, the affected vein may be surgically tied off (ligated) and removed (stripped).
Ambulatory phlebectomy
In this procedure, a small hook is used to remove smaller veins through tiny incisions.
High ligation and vein bypass
When a deep vein such as the saphenous vein is involved, the vein may be tied off to prevent further complications. The surgeon may also recommend a bypass to redirect blood flow around the affected vein.
Read more about varicose vein and venous insufficiency procedures
When to consider surgical treatment for varicose veins
Surgical treatment of varicose veins is recommended if you have experienced a thrombosis, venous ulcer, or symptoms such as pain, swelling or restless legs.
You may also prefer to have them treated because you are concerned about their appearance.
Risks of venous surgery
1-3%
DVT (Deep vein thrombosis)
To mitigate this, you will wear compression stockings post-op.
<3%
Neuroprexia/ numbness at avulsion sites
<3%
Haematoma / Bruising
<2%
Infection
What is to be expected post-op?
Discomfort
It's normal to experience some discomfort or soreness in the surgical area after the procedure.
Tenderness
This discomfort usually improves gradually as the healing process progresses.
Discolouration (pigmentation)
This will start dissolving in approximately 3 weeks. Normal time for complete resolve is 6-12 months.
Post-op instructions
- Compression stockings 4 weeks (First 2 weeks 24hrs, following 2 weeks 12hrs)
- No gym work, running, swimming for 4 weeks
- No long haul flights for 4 weeks
- Review with Dr Theivendran in week 1 week post procedure with ultrasound to exclude DVT
- Final review at 6 weeks
- Ultrasound follow up bulk billed for all patients
Treatment options for venous insufficiency
How Dr Theivendran can help
If varicose vein disease or venous insufficiency is affecting your quality of life, — or you’re at risk of complications, ask your treating doctor for a referral to Dr Theivendran, an experienced Vascular and Endovascular surgeon.
He will assess your condition and, if appropriate, discuss surgical options that can bring you lasting pain relief and peace of mind.
If you have any questions, please don't hesitate to contact our rooms on (02) 9066 6547
For appointments and enquiries:
Monday - Friday: 8:00am to 5:00pm
Fax: (02) 9182 7533
