Legs without varicose veins

Many women and many doctors treat the so-called spider veins appearing on the legs only as an aesthetic problem. Meanwhile, they usually portend varicose veins.

With each contraction of the heart, oxygen-rich blood is forced into the arteries, which distribute it throughout the body. Tissues are treated with oxygen and nutrients, and the blood used in this way returns to the heart through the veins. Such work continues day and night.

Blood flows rapidly through the arteries under high pressure. With veins, it moves much slower, because it flows “uphill”. In an adult human heart is more than a meter above the ground and this distance has to be covered by circulating blood. This is not easy. After all, it has to overcome the force of gravity. In order for the blood to flow upward, he needs support. When we walk, run, our muscles contract and compress our veins rhythmically. It is as if we want to remove water from a rubber hose by squeezing it with our hands. We can do this, but as soon as we release the pressure, the water in the hose will fall to the bottom. The same would have happened in the veins if it weren’t for … the valves. They are tiny folds of the inner lining of the vessels. They close when the blood flowing upwards to the heart tries to run back downwards.

When the system fails

If we have weak muscles, little move and the valves are damaged (we may be born with damaged valves or they may “break” due to thrombophlebitis), the blood begins to regurgitate. The blood pressure rises and it presses against the veins in your legs with increasing force. The veins expand and, like a stretched spring, they do not return to their original shape. This is how varicose veins are formed, i.e. abnormal broadening of the veins. Over time, the skin above them becomes thinner, taut and shiny. Swollen varicose veins filled with hypoxic blood, visible under the skin as a bluish, sometimes mottled, tortuous line.

Some of the veins in the legs are hidden deep and form the so-called system of deep veins. Some of them run close to the skin surface and these are called superficial veins. Both of these systems connect transverse lines by specialists called perforators. Slightly more than 10 percent flows through superficial vessels. venous blood from the legs, but it is in them that varicose veins are formed. Most often on the saphenous vein, running from the inner (medial) ankle to the groin, slightly less often on the sagittal vein, extending from the outer (centrifugal) ankle to the knee.

If the valves in the deep veins are poor, the receding blood flows into the superficial veins through perforators, or transverse veins. Their blood pressure then rises, and varicose veins form over time. Specialists call them secondary. However, in about 95 percent of cases we suffer from primary varicose veins, which also form in the superficial veins, but with well-functioning valves of the deep veins.

It starts with a spider

We rarely associate the feeling of heavy, “leaden” legs and swollen ankles in the evening with varicose veins. Meanwhile, this is how, seemingly innocent, varicose disease can begin.

The so-called the pre-varicose period means that you have tired and heavy legs, at the end of the day they swell in the area of ​​the ankles (swelling increases e.g. after a warm bath, intensifies during menstruation. After greater static exercise, i.e. when you stand for a long time or for many hours) You sit in the same position, you start to feel a severe pain in your legs. Professionals call it venous claudication. More and more “spider veins” appear on your legs. This stage of the disease can last for many years.

When you look at the legs, you can see the veins clearly visible through the skin. As the varicose veins get bigger, you may experience leg pains and cramps that do not go away even after a night of rest. Sometimes, along the vein affected by the disease, there are soft protrusions, the size of which depends on the position of the legs (when you hold them up – varicose veins “disappear”, when you stand – they appear).

There are tissue disorders. There are brown discolorations on the skin, varicose eczema and inflammation of the subcutaneous tissue. There is the so-called scleroderma – the skin hardens, like the bark of a tree.

Leg ulcers are the next stage of the disease. Difficult to heal, painful wounds appear along the changed veins, usually above the inner ankles.

Oh the hormones

Every third woman in the first pregnancy and every second in the next – has varicose veins. Why is this happening? Well, varicose veins of the saphenous vein arise when the valve at its mouth in the groin does not function properly. Regurgitation of this valve allows blood to return and widen the femoral vein. This is especially the case when the pressure in the abdomen remains elevated for a long time, for example during pregnancy. In addition, future mothers also have an increase in blood volume (on average by a liter) and the venous system must contain it somehow. It should be added here that many pregnant women avoid exercise, and low physical activity promotes varicose veins. In addition, a woman’s body produces more progesterone. This hormone, which makes it easier for the uterus to stretch, also makes the veins more stretchy. When hormonal balance returns after childbirth, varicose veins usually become less visible, but this does not mean that they have completely disappeared. They often enlarge before menstruation and as the menopause approaches. So-called pregnancy varicose veins also need to be treated.

The varicose vein does not go away by itself

If varicose veins have already started to form, it is impossible to stop this process completely. They can and must be treated. An experienced surgeon will choose the method that is best for you.

The doctor first conducts an interview and then has to carefully examine the entire legs. Then he assesses the size of varicose veins and tracks the course of the superficial veins. It pays attention to the condition of the skin, whether it is healthy, warm or changed – red or pale with discoloration. He looks for puffiness. While running his fingers along the veins, he feels, for example, hardening or thickening in them. He can also sense the rush of blood flowing in and see if the valves are working properly and not letting the blood flow back. However, this is only a preliminary diagnosis. The doctor may also carry out additional, simple tests in his office.

Opaskow-Trendelenburg test. The patient is lying down with the leg raised. The doctor massages his leg as if he wanted to “squeeze” all the blood into his abdomen. Then he puts a tourniquet high on his thigh. After a while, the patient gets up. The leg is smooth, varicose veins are not visible. The specialist releases the band, the blood draws back and varicose veins appear immediately. This proves the insufficiency of the valves at the exit of the examined vein.

The march rehearsal – Perthes. While the patient is standing, the doctor places a rubber tourniquet high on the patient’s thigh. The patient has to walk for 20-30 minutes. During this time, the blood from the superficial veins is pressed into the deep veins by the working muscles. If the varicose veins “disappear” after these several dozen minutes, it will mean that the valves of the deep veins are efficient, because they retain blood. This is important, because if during the operation the trunk and branches of the superficial vein are removed, its tasks will have to be taken over by the deep vein. So it must be in good condition.

Duplex-Doppler examination. This modern ultrasound examination is extremely precise. While the patient is standing, sitting and lying down, the doctor runs the Doppler head over the skin. On the monitor, he can see if the valves are functional, healthy and there are no blood clots in the veins. It can also check if the blood is flowing smoothly and under good pressure – the right colors on the screen indicate if the flow in the vein is correct. For example, when the graph in the monitor shows red, it means that the blood is flowing quickly without obstruction; when blue appears – the blood is barely squeezing through the vein (perhaps there are clots in this place).

Thanks to the duplex-Doppler examination, the condition of deep and superficial veins can be assessed.

Before the surgeon decides which method to treat varicose veins, he also orders a blood count and blood clotting test. Large varicose veins are removed surgically, slightly smaller ones are obliterated (the middle that closes them is injected into the diseased vessels), and quite small ones – so-called spider veins can be destroyed with laser or photo-derm method (irradiation and destroying the diseased vessel).

What treatment?

At each stage of the development of varicose veins, surgery can be performed to remove the diseased vein. There are not many contraindications for the operation. However, the treatments are not performed when:

– deep veins are blocked, which should take over their work after removing the superficial veins,

– during the tests, thromboembolism was detected; breakage of a clot during surgery could lead to serious complications such as a heart attack or stroke,

– general health does not allow it, e.g. a recent heart attack, advanced diabetes, hyperthyroidism.

Surgeons usually choose one of three surgical methods. Their purpose is to remove varicose veins. The differences lie in the use of different tools or a different technique for performing the procedure.

Stripping, i.e. the Babcock method

The main venous trunk and the departing venous branches are removed. When removing the saphenous vein, the surgeon first makes two 5-cm incisions on the leg: in the groin and at the ankle (when removing the saphenous vein, the incisions are made just below the knee and around the ankle). Then he introduces into the diseased vein – usually from the ankle side – a soft, metal rope, the so-called the stripper cuts and ties the vein and pulls it out with one jerk. In order to remove the venous branches, he has to make a few, a dozen or so 1-2 cm incisions on the leg along the course of the venous trunk, through which he will pull out the branches of the removed trunk in a similar way. Stitches are placed on the cuts and are usually removed after 10 days. Stripping takes about an hour.

The procedure is performed in a hospital under general or epidural anesthesia (feeling blocked from the waist down). You can get up and walk the very next day after the surgery. The incisions hurt for several days, but can be relieved with painkillers. For a month, hematomas are visible. During this time, the diseased leg is wrapped with an elastic bandage from the groin to the toes. Special compression tights must be worn for the next 3 weeks. Unfortunately, scars remain after numerous large incisions.

Treatment price: 1,3 – 4 thousand. zloty

Miniphlebectomy, or the Miller and Varady method

It’s a bit like stripping. The first stage of the operation – removal of the venous trunk – follows the same course as in the Babcock method. The second stage – removal of venous branches, can be performed under local anesthesia. A minimum of 2-3 mm incisions are made along the course of the venous trunk, through which small branches are pulled out with a crochet hook-like tool. There are no sutures, and the incisions are sealed with a special plaster for several days. Later, there is almost no trace of them. You can go home after the surgery. After the procedure performed with this method, the principles of convalescence are similar to those after stripping.

Price of the procedure: approx. 1,5 – 2 thousand. zloty.

Cryostripping, or La Piverte’s method

Several 2-3 mm incisions are made along the course of the venous trunk. A special probe, covered with 24 carat gold at the end, is inserted into the vein through the incision. The probe is connected with a wire with a special apparatus containing nitrous oxide. When the probe reaches the place designated by the doctor, its tip is rapidly cooled down to minus 80-100 degrees C. A piece of the vein sticks to it and is pulled out. For the next microvision, the probe is re-inserted into the vein and the procedure is repeated. Piece by piece, the main venous trunk is removed. Venous branches can be removed through the same small incisions. If the varicose vein is tortuous and the probe is difficult to enter the diseased vein, individual pieces of it can be “glued” to the frozen tip of the probe and pulled out. General or local anesthesia is used for the procedure. The operation takes about an hour. After the procedure, the patient returns home. For about 2 weeks, he should wear a pressure bandage (elastic bandage) and then special compression tights.

Price of the procedure: approx. 2-2,5 thousand. zloty.

Sclerotherapy (obliteration)

This is an inoperable method of treating varicose veins. This procedure is used on veins with a small cross-section (also when there are so-called spider veins on the legs). The doctor injects into the diseased vein (sometimes several times, at intervals of 7-10 days), an agent that causes its walls to fuse together. Then he bandages the leg. The squeezed vein becomes overgrown with the given preparation. The blood takes a new path without damaging circulation. The procedure is short, 10-30 minutes, and can be performed on an outpatient basis. After the procedure, the patient should walk, but the pressure dressing must be worn for up to 2 weeks.

Treatment price: approx. PLN 100-150.

A way to deal with spider veins

Laser therapy

Sick vessels can also be destroyed with a laser. In various places, the doctor illuminates the points of connection of the vessels and several places along the course of the vessels. In this way, diseased vessels are destroyed. The laser emits a wavelength of light that is selectively absorbed by hemoglobin. Therefore, there is no need to be afraid of laser therapy, because the surrounding tissues are slightly exposed to high temperature (although there are micro-burns to tissues). After laser therapy, you should not sunbathe for 6 weeks to avoid permanent discoloration on the skin.

Price of the procedure: approx. 1 thousand. zloty

Photo-Derm

A special device creates a pulsed beam of light (different from a laser), which heats the tissue to a high temperature, destroying diseased vessels. First, the patient’s skin is smeared with anesthetic cream, then with a cold cooling gel (as before the ultrasound examination), and then a rectangular tip made of crystal is applied to a specific place on the patient’s leg. The special wavelength of light goes only into the vessels, and not into the skin or surrounding tissues, and closes them. Photo Derm is suitable for the treatment of small “spider veins”, benign vascular lesions and smaller varicose veins. Before the procedure, the skin should not be tanned, and after the procedure, just like after laser therapy, one should not sunbathe for 6 weeks. No pressure bandages are applied. After the procedure, the patient can go home. All he has to do is care for the irritated skin for a while to prevent bacterial contamination. But the same tip applies to any method of removing varicose veins.

Price of the procedure: approx. 1 thousand. zloty.

What favors varicose veins

The tendency to develop varicose veins is genetic; you can inherit them not only from your mother, but even from your grandmother or great-grandmother. Their appearance is also influenced by:

– race – white; Black women don’t have varicose veins,

– gender: women are affected 5 times more often than men,

– past pregnancies,

– hormonal disorders and the use of oral contraceptives and hormone replacement therapy,

– little active lifestyle: no exercise, sitting for several or several hours a day (especially with the leg crossed),

– performing a profession related to long-term standing, e.g. hairdresser, surgeon, waiter,

– wearing tight clothes, especially knee-length socks, stockings or socks with a tight welt,

– walking in high-heeled shoes or boots that put pressure on the ankle,

– overweight and obesity,

– diet low in fiber and vitamin C deficiency,

– chronic constipation,

– smoking, alcohol abuse.

After the treatments

The main rule of procedure is: follow all the instructions of the operating physician conscientiously. Some of them are general and apply to all patients.

– To avoid blood clots in the veins, start walking as soon as possible.

– Usually, for 4-14 days you need to wear a compression dressing, which can be replaced with specially selected stockings or compression tights over time.

– You will need to take medicines to prevent blood clots for a while on your doctor’s orders.

– 1-2 weeks after the surgery, it is worth choosing massages (including hydro massages) to improve blood circulation in the venous system.

– During the convalescence period (approx. 6 weeks), you should not sunbathe intensively. You do not have to completely avoid the sun, but you cannot lie flat on a beach as hot as a frying pan.

– Since veins do not like high temperatures, both those who have a tendency to varicose veins, suffer from varicose veins or have surgery to remove them, should not go to the sauna.

– After the treatments, you should not wear heavy weights, stand too long or sit and wear high heels.

– With skin changes that accompany varicose veins, e.g. discoloration, scars after treatments with scleroderma residues, you must visit a dermatologist.

Text: Anna Jarosz

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