What Causes Varicose Veins, Symptoms, Diagnosis & Treatment
Understanding Varicose Veins
What Causes Varicose Veins
The truncal veins are blood vessels that collect deoxygenated blood from the legs and feet and return it to the heart. These blood vessels are found just below the skin’s surface, including the great and small saphenous veins, anterior accessory saphenous, and Giacomini veins. They contain valves that prevent blood backflow and stasis in the leg and ensure proper one-way blood circulation back to the heart. However, if these valves are damaged and weakened, the blood flows backwards and overfills in the veins. As a result, the veins overstretch, dilate and twist, causing the appearance of varicose veins. This reflects higher pressure within the veins in the legs, which become more prominent when the patient is standing up because of the effect of gravity.
What Are the Risks Factors
Several risk factors can damage valves and increase the development of varicose veins, including
- Age
- Obesity
- Pregnancy
- Use of the Oral
- Contraceptive Pill
- Smoking
People who work in jobs that require prolonged standing and sitting, such as in the F&B and office industries or have a family history of varicose veins (especially on the maternal side of the family), are more likely to develop this condition. Moreover, sedentary lifestyles may increase risk because inactivity may impair proper blood flow from the extremities.
Recognising the Symptoms
How to Spot Varicose Veins
Varicose veins may cause varying symptoms across individuals. Here are common symptoms you may experience.
Untreated varicose veins may cause open sores, bleeding, and skin discolouration on the legs and around the ankles. It can disrupt everyday life and make it harder to concentrate on daily activities. Any impairment in quality of life is an indication for early treatment of the varicose veins by a vascular specialist.
Follow the steps to spot early signs of varicose veins.
Consult a vascular specialist to get a proper diagnosis and prevent varicose veins from worsening.
Varicose Veins And Everyday Life
How to Reduce Varicose Veins
Being fit and healthy reduces the risk of developing varicose veins. Here are some varicose veins prevention tips to improve blood flow.
Avoid tight clothing and crossing your legs
Move every 30 minutes
Eat high-fibre foods and oily fish
Wear low-heeled shoes
Consult a vascular specialist for suitable compression stockings if work requires standing for long periods
Quit Smoking
Varicose Veins in Pregnancy
How to Cope With Varicose Veins During Pregnancy
Varicose veins are common during pregnancy and usually not harmful to you or your baby.
What causes varicose veins in pregnancy is the increased weight and pressure of the gravid uterus on the large veins in the pelvis that drains the legs along with the hormonal changes during pregnancy. This weakens and damages the valves within the superficial truncal veins (GSV and SSV), leading to bulging and painful veins. To alleviate these symptoms, consider wearing maternity support stockings, taking frequent breaks, and limiting salt intake to reduce swelling. If possible, raise your feet often to relieve pressure in the legs and enhance blood circulation back to the heart. Varicose veins often improve after delivery when the uterus no longer pushes on the pelvis’s large vein (inferior vena cava).
If you notice that the veins on your legs feel hard, warm or more painful or the overlying skin looks red, these are signs of inflammation (termed phlebitis) or infection (termed cellulitis)
When symptoms worsen, consult a vascular and endovascular specialist to determine safe and effective options for varicose veins treatment in Singapore. It may include self-care measures, medications, and minimally invasive surgery to complete the varicose veins’ excision. However, we tend to reserve any type of procedure or intervention till after the delivery of the baby.
Diagnosis and Treatment
How to Diagnose Varicose Veins
Diagnosis of varicose veins starts with a thorough history taking and physical examination. This includes a leg inspection to look for signs of venous diseases, such as swollen feet and dark purple veins on the leg skin surface.
Your vascular specialist may use the following diagnostic methods to confirm the diagnosis, identify the severity of the condition, and aid in planning specific treatment.
- Duplex Ultrasound is a small hand-held device that uses sound waves to transmit images of the veins to a monitor for inspection of blood circulation. This is harmless, and the procedure is generally comfortable. A detailed study of one leg usually takes 30 minutes to map out where all the faulty veins are and the status of the deep venous system.
- Colour-flow Imaging uses colour to highlight the direction and speed of blood flow.
- Computed Tomography Venography utilize Computed Tomography (CT) scanning technology to produce detailed images of the veins. This is only used if there is a suspicion of large vein compression in the pelvis because it uses radiation. Ultrasound uses sound waves and is safe and non-invasive.
Early diagnosis and treatment of varicose veins result in simpler and more cost-effective treatment plans. If you think you may have varicose veins, the first step is to have a Duplex ultrasound scan to identify any underlying “hidden” varicose veins.
How to Diagnose Varicose Veins
The best treatment for varicose veins depends on the individual, their symptoms, and the severity of their condition. It may include medications and minimally invasive procedures. However, these options may vary in therapeutic outcomes, and proper consultation from vascular and endovascular specialists is necessary to achieve optimal results.
Treatment options for varicose veins include
- Supplements and Vitamins – OTC (Over-the-Counter) medicines help manage varicose veins symptoms. However, consult a vascular specialist before trying these medicines for varicose veins.
- Coenzyme Q10 for better circulation and tissue oxygenation
- Omega-3 oils to increase blood vessel elasticity
- Ginkgo biloba reduces vein swelling
- Flavonoids including Daflon – these are concentrated orange peels contained within a tablet to improve the tone in the veins and can improve the cramps and swelling
- Varicose Veins Surgery
Hook Phlebectomy is a traditional open technique to avulse the larger side branches off the truncal veins on the legs. This usually requires a small stab incision (max 0.25 inch in size) requiring one stitch to remove varicose side branches. This complementary technique is more effective in conjunction with open surgery to strip the truncal vein but is also used in conjunction with minimally invasive therapies such as laser and radiofrequency ablation to block the faulty truncal GSV or SSV.
Mechano-chemical endovenous ablation techniques, such as ClariVein® and Flebogrif®, are minimally invasive procedures that treat varicose veins without heat. This provides no risk of nerve injury and quicker recovery time. The cosmetic result is excellent, and patients experience little or no pain after the surgery. The entrance into the vein on the skin is a pinprick in size. Downtime is minimal, and patients are back on their feet immediately.
Sclerotherapy is a treatment of choice for varicose veins as it can target even the smaller veins called thread and spider veins. A solution is injected into the affected vein, causing the vein scar and forcing blood to reroute to healthier veins.
Endovenous Microwave Ablation uses microwave energy to generate a temperature of 85ºC to close refluxing truncal veins. This minimally-invasive procedure involves a catheter insertion into the faulty truncal vein, allowing microwave energy from the antenna radiation to produce direct heat to cause blockage and reroute blood to the healthy deep veins..
VenaSeal™ uses a unique medical-grade adhesive called cyanoacrylate to seal the varicose vein and redirect blood flow to healthier veins. It requires a single needle prick to access the veins using an ultrasound. A catheter is placed inside the faulty truncal vein, and glue is applied from the inside to seal the faulty vein. A vascular specialist may use this technique in combination with microwave ablation for a dual-modality treatment. This allows effective treatment of both the larger above-knee truncal vein with a heat-based modality and below the knee part with a non-thermal device.
Post-recovery for varicose vein surgery is crucial to achieving an optimal outcome. For at least seven days, prioritise rest and sleep to avoid bruising and pain. You can resume your normal routine within 24 hours, but no strenuous exercise for 2 weeks.
No medium or long haul flights for 7-10 days post-procedure.
Conclusion
Varicose veins treatment in Singapore costs depends on the treatment type and severity. If on insurance, a single leg ranges between 12-15K SGD depending on the required work and the devices used to ablate the truncal vein. A double leg procedure is approximately 18-22K again, depending on the required work. For fee-paying individuals and local Singaporeans, approximately 2-4K can be used towards the costs from their Medisave.
If pregnant with milder symptoms, consider medication and lifestyle adjustments for a more cost-effective alternative. However, if non-surgical options do not alleviate the symptoms, consider a minimally invasive treatment for safe and guaranteed long-lasting therapeutic outcomes.
Although some may consider varicose veins a simple medical problem, severe cases affect daily life due to discomfort and pain in the lower extremities. If you’re experiencing sore skin under your veins and prolonged ache, consult a vascular surgeon for a comprehensive and personalised treatment plan.
It is important to understand that the varicose veins you see are not the problem – the underlying, hidden veins, which have lost their valves, are the problem and must be treated. If left alone, the valves will continue to fail, and the signs and symptoms associated with varicose veins will progressively worsen.
