Varicose veins are quite common; they’re large bulging greenish blue veins caused by a weakness in the circulation’s valve system in all our veins.
Valves help to lift the blood upwards back towards the heart ready for the arteries to pump it out again. When one of these valves fails, gravity draws the blood downwards; the lump is the site of the healthy valve below where blood forms a small pool.
Thread veins are the smaller purple or red veins which you see on your legs at the skin’s surface. These are usually caused by the back pressure created by a weak valve system. We can get thread veins without having varicose veins too.
What can we do about them?
Pick your parents more carefully next time, because these venous problems are almost always hereditary. On a slightly more helpful note, there are a number of treatments available for all types of leg veins.
Treating varicose veins
Varicose veins (VVs) must always be treated by a vascular surgeon because they are so large and contain a lot of blood. The old fashioned way – skip to the next paragraph if you’re squeamish – is to “strip” them out by making a skin incision at the top and bottom of the vessel and, quite literally, pulling the whole thing out. This leads to impressive bruising and is painful. NICE (the National Institute for Care and Excellence) has recently recommended scrapping this treatment in favour of the newer methods.
New treatments involve local aneasthetic, making a small incision in the calf and threading a small catheter up the inside of the vein, which is then heat sealed as the catheter is removed. The heating can be done with laser (EVLT) or radio frequency (VNUS) and both methods work very well. The body reabsorbs the sealed off vessel over time.
Smaller varicose veins can also be injected with a substance which has been frothed up into what I call “builder’s expanding foam”. This, while not a technically correct term, describes the process rather well. The foam displaces the blood inside the vessel and eventually shuts it down. This is called Foam Sclerotherapy.
Although these treatments tend to be a one off session VV’s can recur after all removal methods as we can grow new vessels so, like all treatment methods, we have to think about it as management rather than cure.
Treating thread veins
Thread veins (TVs) can be treated with lasers. In my view, a better treatment is to inject liquid directly into the veins using a tiny needle. It is quick, efficient and quite cost effective as fewer sessions are needed. The liquid displaces the blood and coats the inside vessel wall leading to damage and shut down and reabsorption. It’s quite environmentally friendly really, a bit like recycling for thread veins. It needs to be done by someone with professional training who has full medical back up, just in case anything goes amiss.
If the treatment is with lasers, then they need to have longer wavelengths, such as an ND Yag (neodymium-doped yttrium aluminium garnet; Nd:Y3Al5O1 crystal) and be powerful enough to damage the vessel but not cut through it. It also needs a skilful operator. Each vessel has to be sealed individually.
I do not recommend it for vessels of more than 1-2mm diameter. I know from my own experience that treating blood vessels over 2mm can lead to serious bruising, even though it’s not painful. Some laser manufacturers claim to be able to treat vessels up to 5mm in diameter which, in my view, is potentially dangerous.
Where do I go to get my veins treated?
Most vascular surgeons will treat VV’s but as always, with treatments of this kind, it is worth speaking to more than one surgeon if you do not feel completely comfortable with the first person you see. If all goes well, you may not need to see them again, but ask yourself if would you feel comfortable coming back to discuss problems with them or to say that you are not happy with the results. If not, see someone else.
A good consultation will include “the good, the bad and the ugly”. All possible side effects and complications should be discussed and, ideally, you should be given written information to take home to refresh your memory later.
Most clinics will not ask you to sign a consent form until you arrive for the procedure, and you should always be given time to think over everything you’ve talked about.
NEVER sign up for a procedure because you’re given a time limit on a special deal. This is severely frowned upon by the Keogh review and considered to be very bad practice. (Professor Sir Bruce Keogh’s review into the quality of care and treatment provided by 14 hospital trusts in England.)
Ask how many procedures the practitioner has carried out – yes even the surgeon! If she or he is experienced they won’t have a problem telling you this. Ask to see before and after pictures if they are not already on the website.
Beware of websites making outrageous claims and offers and never, ever do this sort of treatment through a special offer or coupon website.
One third of our new clients come to us following a problem at another clinic, beauty salon or private hospital.
If you are having laser treatment, ask if the practitioner is qualified. There is only one qualification, which is the BTEC in Lasers and Light.
As I run the only training school which offers this qualification I know that there are only 300 qualified practitioners in the UK, amongst over 10,000 working in the field. If they aren’t qualified, ask what training and experience they do have; a good practitioner will never mind being asked.
Most ladies over 40 have visible leg veins of one type or another but don’t have them treated because they don’t know how. They’d rather keep them hidden, even in summer when they wish they could wear shorts and swimming costumes without worrying about the blue patterns all over their thighs. Treating leg veins is one of the most rewarding parts of my job and I enjoy it tremendously because in my view, it delivers such good results in a relatively short time and at a reasonable cost.
I recommend you look into it, get it sorted, and get those legs out.
Updated September 2016