Sclerotherapy of varicose veins
- General information
- How can I prevent varicose veins?
- Useful tips
- The aesthetic leg
- Possible treatments
- The procedure of shrinking the vessels (sclerotherapy)
- After sclerotherapy
- Are there side effects to sclerotherapy?
General information
Varicose veins are not a cosmetic problem alone: they can cause serious discomfort in the form of itchy, aching, restless legs, swelling of your ankles, cramps in the calves – the medical condition may even progress to total occlusion of the deep venous system ('phlegmasia alba dolens' also colloquially known as 'white leg', 'milk leg'). Other serious discomfort is festering wounds and venous ulcers (an area of skin has broken down and you can see the underlying flesh).
Treatments like wearing support stockings, taking special medicine do not help any more once the varicose veins have become larger.
We can only perform surgery if the deep venous system is still intact. To be sure about that, closer examination is necessary, such as plethysmography, where an x-ray of the veins is taken = a venogram (also called phlebography).
Your veins carry your blood back your heart. In your legs, this normally happens when you lie down. However, when you are sitting or standing, the muscle pump of the leg comes into action. That is at least the case in a healthy human being. But when the small valves inside the veins stop working properly, the blood doesn't flow smoothly to your, because the valves cannot prevent them from flowing backwards any more. Now, the blood can flow backwards and can collect in your veins, eventually causing varicose veins.
Blood brings oxygen and nutrients to your body. Via the veins your 'old' blood is taken back to the heart. This old blood is full of carbon dioxide and needs to be cleaned. Only if the circulatory system works well you can stay healthy.
How can I prevent varicose veins?
- Take regular exercise
- Don't stand still for too long
- Raise your legs higher than your chest after standing for a long period of time
- Wear compression stockings
Useful tips
There is so much you can do yourself, it is in your very own hands to prevent varicose veins. This is true much more than for any other ailment. Take therefore the following advice:
- Avoid temperatures above 28°C, i.e. no sun, no sauna, no hot-water bottles and no hot bathing
- Shower your legs, feet and especially your lower legs twice a day. The temperature of the water doesn't have to be ice cold - you should still feel comfortable (16-18°). The cold water showering should take five to ten minutes. But beware: in case of heart failure or osteoarthritis you've got to turn to a doctor first.
- Don't sit or stand still longer than one hour. If that's not possible try at least to move a little, like standing on your toes
- Take exercise, for example: jogging, swimming, bicycling
- When your legs are swollen at night raise them higher than your chest by putting up the foot end of your bed
- FIGHT OVERWEIGHT – overweight puts pressure on your hart, the arteries and the blood vessels. Avoid heavy heaving or anything that has to do with pressing (e.g. weight training). Make sure that your stool is soft, that means that you drink a lot, especially in between meals, at least two litres a day
- Wear appropriate shoes: the lower the heels, the better. Heals that are higher than 6-8 cm are bad for your legs and vessels. Try to walk bare footed as often as possible!
- Take the pill only after having consulted your gynaecologist first. If new troubles arise, such as aching muscles or an extraordinary swelling of the legs, or cough, or breathlessness, vertigo of several days' duration, than you've got to inform your GP immediately
The aesthetic leg
Young people have varicose veins as well. In the beginning it's only the veins that lie under the skin. Over the intervening years, however, they can lead to pigmentary abnormality or phlebitis even.
Varicose veins increase the chance of thrombosis and embolism. With tiny, low varicose veins, such as the so called spider the risk is remarkably lower - they are rather a cosmetic problem.
Possible treatments
Varicose veins can be removed by ambulatory phlebectomy (according to Robert Müller), by sclerotherapy, or by laser treatment. Varicose veins can return after a while. To smooth the discomfort of varicose veins there are compression stockings.
Nowadays there is an alternative to the classic surgery according to Müller: 'endovascular' methods, for example laser and foam sclerotherapy - a medicine is injected into the vessels, which causes the thickening of the vessel walls and seals off the blood flow. A current treatment is the VNUS closure-method. This minor operation takes place at the clinic under local anaesthesia.
The procedure of shrinking the vessels (sclerotherapy)
A kind of glue is injected into the vessels. The veins are blocked and compressed. Finally the body removes the dead veins itself.
The injection into the veins causes the veins to be pressed together. It's possible that you have an unpleasant sensation in your legs while the sclerotherapy is going. Immediately after sclerotherapy we'll apply pressure bandages to the legs that you are to wear for up to seven days. Usually we apply compression stockings above the bandages. The veins are strongly compressed that way. They waste away and change into scar tissue. This tissue dissolves in the course of two months.
After sclerotherapy
You have got to walk after the operation. You may have a burning sensation in your legs. This is totally normal and means that the therapy goes according to plan.
You can soon return to work, if you wish – you aren't limited at all, as a matter of fact. We even advise you to be on your feet rather than sitting around and twiddling your thumbs. We need you to be active in moderation though, since you have to avoid taking exercise or any other heavy exertions. You can contact us at any time of course if the bandage causes any discomfort. You may remove it yourself though when the time has come.
Our advice:
- Bring someone with who can drive you home: you are not allowed to drive after the treatment
- Don't wear to to tight trousers, there must be enough space for the bandages
- The same goes for your shoes: they've still got to fit with bandages
- Regular exercise (bicycling, going for a walk, swimming)
- Wearing support stockings
- No hot bathing, sauna, etcetera
Are there side effects to sclerotherapy?
There can be localised swellings and bruising or tenderness or itch. Occasionally a darkening of the skin occurs which may take up to 12 months to resolve. The skin may turn yellow but this is a temporary phenomenon as well. Tight pressure bandages may cause blisters.
Especially large varicose veins can return. In this case follow up-treatments are necessary.
Sclerotherapy is the most popular treatment of varicose veins at the moment. The future might bring more advanced techniques to treat varicose veins even better.
How much does sclerotherapy of varicose veins cost?
© Dr. Darius Alamouti, MD — www.dariusalamouti.de
