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| Do varicose veins need treatment? |
Additional Reading:
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In the past, many people have said that varicose veins are “just cosmetic” and can be left alone safely. This, however, has shown to be nonsense.
Although thread veins (also known as spider veins or broken veins) by themselves can be cosmetically damaging, and some small varicose veins which are not connected to any deep problems can also be cosmetic only, the vast majority of people with true varicose veins have lost their valves in one of their major veins.
The major veins in the legs are the Great Saphenous Vein (GSV), which travels from the ankle up the inside part of the leg to the groin, and the Small Saphenous Vein (GSV), which travels from the Achilles tendon just above the heel, up to the back of the knee. Both of these veins then drain into the deeper system from where blood goes up through the pelvis, abdomen and into the heart.
The Great Saphenous Vein (GSV) and Small Saphenous Vein (GSV)s are both known as venous trunks. However, there are also another group of veins that are very important in vein disease and these are called perforators. In the leg, all blood tries to go inwards and upwards. Blood from the near the skin needs to travel in through the muscles into the deep veins and up to the heart. Valves that perforate through from the skin, through the muscle and into the deep veins are called perforating veins. Occasionally, valves in these can give way. In this case, when the muscles contract in walking, and the deep veins are squeezed at high pressure, the blood shoots out through these perforating veins, damaging the skin and causing varicose veins.
It has been well shown that people who have lost the valves in the truncal veins and some people who have lost valves in the perforators, can go on to get the complications of long term varicose vein disease – a condition that, at The Whiteley Clinic, we call vein pump failure (see www.veins.co.uk).
In the long term, blood falling down one of the venous trunks or at high pressure out of the perforating veins, causes inflammation in the tissues surrounding the veins in the lower leg. If this inflammation is allowed to continue, slowly the tissue becomes hardened. The first sign of this is itchiness of the skin or redness of the skin – a condition known as venous eczema. Unfortunately, many doctors and nurses think that this is due to other causes and give creams for this rather than send the patient to a varicose vein expert where treating the veins would cure the patient.
If the inflammation if allowed to continue (ie: by leaving the veins untreated), the skin gets further hardened – a condition known as lipodermatosclerosis. The skin then discolours, going brown – a condition called haemosiderin. If this is allowed to continue, eventually the skin breaks down and a venous ulcer occurs.
As such, once the major valves have gone in the truncal veins or in the perforating veins, the varicose veins are clearly not a cosmetic problem at all but a true medical condition. However, this can only be determined by having a duplex ultrasound scan.
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