Veins 101:
Treating the unsightly
ften appearing as twisted or swollen blood vessels that bulge from the skin’s surface, varicose veins occur when valves in the veins of the lower legs no longer function properly. This causes blood to flow back downwards, resulting in enlarged veins, says general and vascular surgeon DR JOHN TAN. Contributing factors may include pregnancy, obesity, standing for long periods of time and a family history of varicose veins.
The Big Fixes
Thanks to medical breakthroughs in vascular health, no one these days has to live with the unsightliness of varicose and spider veins. And thank goodness for that – especially in Singapore’s year-round swelter, where leg-baring shorts and skirts are the daily norm.
As important as the aesthetics are, however, vascular surgeons like Dr Tan agree that varicose veins are not merely a cosmetic matter. In fact, they’re a sign of an underlying problem – chronic venous insufficiency – that causes the characteristic bulging and pain.
What’s more, they tend to worsen over time. Left untreated, they can lead to serious complications such as bleeding from a ruptured vein, phlebitis (inflammation), and also a higher risk of deep vein thrombosis (DVT) – a life-threatening condition where part of a clot can break free, travel to the lungs and obstruct essential blood flow. That’s why it’s best to get your varicose veins treated, even if they aren’t troubling you now.
Spider veins – smaller, superficial veins that often make their ugly appearance on a woman’s thighs – may not be a hazard to your health. Leave them be, then? Not so fast, the doctors warn. Any numbness, heaviness, tiredness or aches may point to an association with more deeply located varicose veins, in which case they definitely should be treated.
In all cases, an ultrasound examination will be used to check the condition of the underlying feeder veins and to make an accurate diagnosis.
The Options
A range of technologies can be used to eradicate diseased blood vessels, after which the vascular system naturally redirects the blood to flow through other, healthy veins in the legs.
“Seeking early treatment for varicose veins that have become troublesome is the best way to prevent some of these risks associated with them,” says Dr Tan. “Depending on the severity, there are various treatment options available, many of which are non-invasive, needle-based procedures that don’t require any incisions or anaesthetics, and can be easily performed in the clinic.”
Minimally invasive treatment can include the following four options.
#1 Endovenous laser therapy (EVLT)
According to Dr Tan, EVLT is one of the most popular picks for treatment because it eliminates all the veins without any surgery, general anaesthesia or hospitalisation, and the patient can walk immediately after the procedure. There are no visible scars once the needle marks have healed, he says. A one-time outpatient procedure under local anaesthesia, EVLT involves inserting a fibre optic wire into the vein to deliver heat, thus shrinking the varicose veins.
#2 VNUS Closure
This is another endovenous technique, though one that uses radiofrequency (RF) instead. Dr Tan describes it as somewhat gentler than laser, yet equally effective in treating the vein. While there has been a move to RF all over the world, he explains that there is still an important place for laser – specifically, for ablating short segments of veins. The reason for this is that the RF version employs something called sectional ablation, which treats the vein in segments measuring 7cm. While laser burns the vein from the tip of the application head, sectional ablation heats it evenly across these segments. As a result, the RF option can sometimes mean quicker recovery. Treatment is typically tailored to meet the unique needs of each individual patient, and may involve a combination of EVLT and VNUS Closure.
#3 Venaseal
Another non-surgical treatment is Venaseal, a superglue-like closure of the veins. This non-heat-based treatment promises less post-procedural bruising and significantly less risk of nerve injury. According to Dr Tan, this method quickly and effectively closes varicose veins by coating and sealing them with a medical “superglue” that’s introduced through a tiny catheter. Once the diseased vein is sealed, blood is redirected through other healthy veins in the leg.
#4 Ultrasound-guided foam sclerotherapy
This non-surgical, minimally invasive procedure involves the injection of a strong chemical in the form of foam into the varicose veins, ultimately closing and eliminating them. The use of ultrasound imaging makes it possible to treat deep veins that aren’t visible to the naked eye, helping to guide the needle into the vein accurately, says Dr Tan.
“As the fine needle is not much bigger than an acupuncture needle, there’s no pain and therefore no anaesthesia is required.”