UNDERSTANDING THE CIRCULATORY SYSTEM
The following information will help you understand how the venous circulatory system works and also how varicose diseases such as varicose veins occur.
There are two venous circulatory systems in the lower limbs:
- A deep system, draining 90% of the venous blood from the legs.
- A superficial system that drains the remaining 10% of the venous blood. This is the network that is responsible for the appearance of varicose veins and must be treated when it becomes varicose.
The venous bloodstream normally operates from the feet to the thighs thanks to three aspects of the circulatory system:
- Tonus of the venous wall.
- Muscular activity of the legs and thighs.
- Presence of valves that impede the flow of blood back to the feet.
CAUSES AND SYMPTOMS OF VARICOSE VEINS
In the first stage of the disease, the affected veins are called varicosities. They resemble red or bluish filaments on the surface of the skin. When the affected veins have a larger diameter, these are called varicose veins.
Varicosis is caused by the weakening of the superficial vein walls and by the ineffectiveness of the valve system. A blood leakage occurs, especially when standing up. This leak comes from the depth of the limb to the surface. This happens in the superficial veins, which gradually dilate to become real pockets of blood.
This reflux of blood from the depth to the surface or from the top to the bottom in the superficial venous system and its stagnation in the venous “lakes” explains the following:
- Pain and heaviness, tingling and, more rarely, cramps.
- Swelling of the ankles.
- Cutaneous disorders: eczema and varicose ulcers, brown patches, blotches and induration (hardening of tissues).
- Development of thrombosis and even pulmonary embolism.
Treating these varicose veins and closing the “leaks” improves venous circulation of the limb.
The causes of varicose veins can be various:
- Congenital: in most cases of varicose veins, varicose heredity can be traced to the paternal or maternal side.
- Acquired: usually, these types of varicose veins appear after trauma or an accident in which the vein has been subjected to irreversible damage.
- Aggravating factors: when there is a prior weakness of the venous capital, certain factors can contribute to the deterioration of the venous bed. These factors can include obesity, standing stationary for prolonged periods as well as the number of pregnancies a woman has had(hormonal effect).
- Having flat feet or wearing high heels, as they prevent proper muscle function on venous flushing.
- Heat (heated blankets, prolonged hot baths) causing venous dilation.
- Wearing short stockings that have a tight elastic lining that causes mechanical obstruction.
The affected superficial veins, which drain little blood when they are healthy, can be treated without any complication, especially when they no longer ensure proper blood circulation. The deep veins perform the relay as long as they are not clogged by clots, which can happen after deep phlebitis, for example. Contrary to popular belief, the elimination of diseased (superficial) varicose veins improves venous circulation.
If varicose veins are not treated, there will be an increase in symptoms and venous condition (increase in the number and size of varicose veins). Complications can occur which include:
- Pigmentation of the skin with brown or ochre appearance, eczema, inflammation, weakening of the skin or appearance of ulcers.
- Superficial venous thrombosis (blood clots inside a varicose vein) which can, more exceptionally, extend to deep veins.
- Ruptures with bleeding. Although rare, this can happen even in the absence of trauma.
Treatment options offered at our centres:
In order to choose the type of treatment that is right for you, Dr. Bernier performs a complete examination of the affected veins. This examination is assisted by ultrasound and allows the assessment of incompetent veins, their depth, and location. This preliminary examination is important to determine the appropriate treatment.
Different treatment options are available at Dr. Bernier’s Centre de chirurgie et de médecine esthétique:
- LSurface sclerosis
Lasers and phototherapy are also treatment alternatives offered at our centres.
They are used in sclerotherapy, which consists of injecting an irritant substance into the affected vein.
Classified according to their strength (light, medium, strong) or their action mode (chemical, detergent, osmotic), sclerosing agents can change strength depending on their form: liquid or foam.
Sclerosing foam is obtained by mixing gas (usually air) and sclerosing liquid. The foam form allows us to increase the sclerosing effect and to obtain better results more quickly while using less product.
Microsclerosis is the recommended treatment for telangiectasias (varicosities, small red or bluish vessels visible under the skin). Magnifying glasses and very fine needles are used to inject the sclerosing product.
Sclerotherapy or sclerosis is the safest technique because it is the least invasive for treating varicose veins. It does not require convalescence or post-treatment care and gives little or no discomfort.
Surface sclerotherapy is used when it is possible to treat visible veins by simple injection without ultrasound guidance. However, the doctor must have ensured that they are not fed by leaks (reflux) from deeper veins using a Doppler examination.
This treatment consists of injecting a sclerosing agent into the vein to be treated. This sclerosing agent can be in liquid form (for smaller veins) or foam (for larger varicose veins). The treatment takes about 10 to 20 minutes and doesn’t require any special care. Depending on the extent of the varicose problem, the treatment may need to be repeated and the same vein may require several injection points along its path.
The injected sclerosing agent causes irritation of the inner wall of the diseased vein, causing it to thicken and then obstruct its diameter. This will then turn into a fibrous and hard cord called sclerosis. In the weeks following the injection, the vein will decrease in volume and eventually is reabsorbed and becomes completely imperceptible. The blood that used to circulate there then flows through normal, superficial or deep veins.
Dr. Bernier usually starts with large varicose veins, which are very often the cause of varicosities.
In experienced hands, the sclerosing foam is effective in treating and controlling the disease’s progression. It is mostly used in large dysfunctional vessels. Its advantage is that it is less invasive and less costly than other endovenous techniques.
Echosclerosis uses an echo-Doppler device to facilitate the identification of leakage points, venous insufficiencies and links between different vascular structures. This device allows us to confirm the intravascular presence of the sclerosing agent during injection and to monitor its progress.
To improve the safety and precision of the injection, especially if the vein is not easily accessible or visible under the skin, this treatment is done under ultrasound control (echosclerotherapy or ultrasound-guided sclerotherapy). For the treatment of saphenous veins or their recurrence, ultrasound guidance is mandatory and the recommended sclerosing agent is the foam (if there are no contraindications).
Post-treatment care is minimal and requires only avoiding high physical exercise for a few days. Therefore, no convalescence (work stoppage) is necessary. Treated veins may be sensitive to palpation, but this is usually well tolerated.
Recurrences are possible, but usually uncomplicated and respond well to a new treatment.
OTHER ENDOVENOUS TECHNIQUES
Endovenous techniques such as laser, radiofrequency, cryotherapy and glue injections require more elaborate preparation and are more invasive. They, therefore, have the potential to cause greater complications, convalescence, and pain. Usually reserved for very large veins, these techniques are also more expensive.
Surgical treatments such as ligation, stripping, phlebectomy are nowadays considered as treatments of last resort, as they are much more invasive and therefore likely to create more serious complications. The decline in these treatments has also allowed us to observe a high rate of recurrences, which will then be more difficult to treat.
WHAT TO EXPECT AFTER THE INJECTIONS?
- Small cotton wools are used to cover the puncture sites. These are removed after 30 minutes.
- The larger veins form small, hard, green cords, which will disappear after a few months. A small puncture done by Dr. Bernier will aim to accelerate their healing.
- The smallest veins do not form cords and disappear in the following weeks.
- Bruises may occur due to the fragility of the varicose veins. They disappear after 1 to 3 weeks.
- An elastic stocking is occasionally prescribed for the treatment of large vessels. Walking is also recommended. In fact, you should not change anything in your daily habits.
ARE THERE ANY COMPLICATIONS AFTER THE INJECTIONS?
Complications are usually minor and temporary. You may notice the occurrence of the following:
- Dyschromia (temporary discoloration).
- Chemically induced phlebitis (local and superficial inflammatory reaction). This can be controlled by anti-inflammatory drugs (Advil ©, Aspirin © or Motrin ©): 3 tablets, 3 times a day. Warm water compresses applied 2 to 3 times a day for 20 minutes are also recommended and it is important not to remain still and to maintain the elevation of the leg. Walking is also suggested.
- Neuritis (trauma to a superficial skin nerve) is exceptional.
- Cutaneous eschar (blackish crust) and/or deep phlebitis can, very rarely, occur.
For the foam:
Some side effects may occur, which include: headaches and seeing luminous flashes, lasting a few minutes and without consequences; temporary skin hyperpigmentation; vein induration, which can lead to a simple discomfort to the touch or slight pain. This phenomenon reflects the efficiency of the treatment. Pain may be relieved by Tylenol©, compression stockings or a needle to evacuate the coagulated blood inside the varicose vein.
- Avoid the prolonged standing position and sitting with your legs crossed.
- Avoid traumas such as knocks, fractures or excessive massaging with a bristle glove.
- Adopt the habit of postural drainage by raising your legs on elevated support in order to rest the venous walls.
- Adopt the habit of alternating warm-cold showers, especially during summer.
- Avoid applying local heat, which promotes blood vessel dilation. The same applies to tan booths, electric blankets, hot wax, and warm baths.
- End your sunbathing with a cold shower.
- Avoid taking high-dosage contraceptive pills and avoid smoking.
- Protect your legs with well-directed compressions during the entire pregnancy.
- Integrate activities like walking, cycling and swimming into your daily routine.
ANSWERS TO FREQUENTLY ASKED QUESTIONS ABOUT VARICOSE VEINS
- Varicosis is a chronic condition that progresses autonomously and becomes permanent. This can cause other veins to become varicose. A maintenance treatment is then required.
- Varicosis is hereditary, meaning that if your father or mother have varicose veins, you are likely to develop them.
- Varicose veins can appear as early as adolescence and are not always painful.
- Surgery or sclerotherapy does not eliminate the risk of varicose veins reappearing after the procedure. Regular follow-up with early intervention prevents the deterioration of your venous system.
- It is preferable to undergo the procedure before pregnancy.
- Regular treatment of your varicose veins can prevent you from having a more invasive subsequent procedure.
- Sclerotherapy can be done any time during the year. The sun is not in itself contraindicated, except that the doctor must be able to observe your veins, and tanning can prevent it. This is not applicable for echosclerosis treatments where the affected veins are then identified by the echo-Doppler. However, sunburn is to be avoided.
- Varicose veins can appear on other sites: breasts, arms, back. Your doctor will tell you if they are treatable. The presence or absence of pain or symptoms does not mean that you don’t have venous insufficiency. Indeed, large varicose veins can be asymptomatic while smaller varicose veins can be very painful or embarrassing.