Varicose Veins

  • Congenital. In most cases of varices varicose heredity can be traced back to the paternal or maternal side.
  • Acquired. Normally this kind of varicose veins appears after a trauma or accident in which the vein has been subjected to irreversible damage.
  • Aggravating factors. When there is prior weakness of the venous capital, certain factors can contribute to the deterioration of the venous bed:
  • obesity, stationary and prolonged standing, number of pregnancies, etc. An orthopaedic factor can also be determined, which impedes proper muscular function on the venous flush, as in the case of flat feet and high heels. Venous dilation through heat (electric blankets, prolonged warm baths, etc.) or mechanical obstruction (garters, socks with very tight elastic bands, etc.) are other aggravating factors.

Understanding the Circulatory System

The following information will help you understand how the venous circulatory system works and also how varicose diseases occur.
There are two venous circulatory systems in the legs:

  • A deep system that drains 90% of the venous blood in the legs. ;
  • A superficial system that drains the remaining 10% of the venous blood. This is the network responsible for the appearance of varices and that needs to be treated when it becomes varicose.

Furthermore, 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

Varicosis is caused by the weakening of the superficial vein walls and by the inefficiency of the valve system . What then occurs, especially in the standing position, is a leaking of blood from inside the limb to the surface, in the superficial veins that gradually dilate and become veritable pockets of blood.

CThis reflux of blood from top to bottom of 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 indurations (hardening of tissues)
  • Development of thrombosis and even pulmonary embolism

Removing these varicose veins and closing the “leaks” improves venous circulation of the limb.

As they drain little blood when they are healthy, the superficial veins may be removed without problem, all the more so when they are sick and no longer correctly assure blood circulation. The deep veins can take over this function as long as they are not obstructed by clots, as for example after a serious case of phlebitis. Contrary to widespread belief, the elimination of affected superficial varicose veins actually improves venous circulation. 

Types of Treatment

  • Elastic bands and hose
  • By constricting dilated veins, elastic compression reduces the quantity of blood that tends to return to the foot. After surgery, elastic support helps to reduce the significance of haematomas and to facilitate healing.

Sclerosis and echosclerosis

Sclerosis consists in the injection, with a syringe equipped with very small needles, of a sclerosing agent that causes irritation of the vein’s internal wall. This irritation causes a thickening of the wall as well as an obstruction of the vein, which forms a green and hard fibrous cord called sclerosis. In the weeks following the injection, the vein diminishes in volume and eventually is reabsorbed by the surrounding tissue so as to become totally imperceptible. The blood that used to circulate in it then takes the direction of normal veins, whether superficial or deep.

Dr. Bernier usually starts with the big varicose vessels that are often at the origin of varicosities. A treatment takes about ten minutes and, depending on the patient’s condition, needs to be repeated. The same vein may require several injection points along its length.

Echosclerosis uses a Doppler echo to facilitate the locating of leak points, venous insufficiency and links between the different vascular structures. It helps to confirm the intravascular presence of the sclerosing agent during injection and to follow its progression. 

Sclerosing agents

Rated according to their strength (light, medium, strong) or their mode of action (chemical, detergent, osmotic), sclerosing agents can change strength depending on their form: liquid or foam.

Sclerosing foam is just as efficient in experienced hands as surgery for controlling the disease’s development. It is mostly used on huge dysfunctional vessels. It requires wearing an elastic hose for a few weeks. 

Lasers and phototherapy

They are an alternative to sclerotherapy for isolated thin vessels that are used more at the face level than the extremities.

Surgical treatments

Treatments like crossectomy, stripping, endovenous laser and phlebectomy consist in removing diseased superficial veins.

Surgical treatments like ligatures, stripping, phlebectomy and cryotherapy consist in removing diseased superficial veins. The endoveinous laser can also be used for performing this type of procedure.

What Can You Expect after the Injections?

  • Small balls of cotton wool will be put on the injection sites, which will be removed after 30 minutes.
  • The larger veins will form small green hard cords which will disappear after a few months. A small puncture performed by Dr. Bernier will help accelerate the healing process.
  • The smaller veins do not form cords and disappear in the subsequent weeks.
  • Ecchymoses (bruises) can occur due to the fragility of varicose veins. They will disappear after 1 to 3 weeks.
  • Elastic hose can be prescribed for the treatment of bigger vessels. Walking is recommended. In fact, nothing needs to be changed in your daily activities.

Are There Complications after the Injections?

Usually, complications are insignificant and temporary. You may notice the occurrence of: 

  • Ecchymoses,
  • Dyschromia (discolouration),
  • Chemical venites (local inflammation),
  • Neuritis (trauma of a superficial cutaneous nerve).

You will notice less frequently: 

  • Cutaneous eschar (blackish crust) ,
  • Deep phlebitis.

Prevention

How can you protect your venous circulation?

  • Avoid the prolonged standing position and sitting with your legs crossed.
  • Avoid traumas such as blows, fractures, excessive massaging with a bristle glove.
  • Adopt the habit of postural drainage by raising your legs on an elevated support in order to rest the venous walls.
  • Adopt the habit of alternating warm-cold showers, especially in summer.
  • Avoid applying local heat, which promotes blood vessel dilation. The same applies to tanning booths, electric blankets, hot wax and warm baths.
  • End your sun bathing 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 into your daily life beneficial activities like walking, cycling and swimming.

Answers to Frequently Asked Questions about Varicose Veins

  • Varicosis is a chronic disease that develops independently and subsists. Other veins can also become varicose. A maintenance treatment is then required.
  • Varicosis is hereditary, which means that if your father and/or mother have varicose veins, you are likely to develop them also.
  • Varicose veins can appear as soon as the adolescent years and are not always painful.
  • Surgery or sclerotherapy does not increase the risk of varicose veins reappearing several years after the procedure. On the contrary, this will avoid deteriorating your venous system.
  • It is preferable to undergo the procedure before pregnancy.
  • Treating regularly your varicose veins can help avoid surgery or its equivalent.Sclerotherapy can take place anytime during the year. Sunbathing is not a contraindication except if there are bandage marks.
  • Exposure of your legs to the sun after surgery is not recommended as long as the scar tissue is still red and visible. A total-protection sunscreen provides ample protection.
  • Varicose veins can also occur in other areas: breasts, arms, back. Your physician can determine if they are treatable.

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