What Are Varicose Veins
Varicose veins are tortuous dilated veins often seen on the legs but can also be occur elsewhere in the body. Varicose veins can be caused by a variety of factors and often have a genetic element. Varicose veins can co-exists alongside spider veins. Spider veins are fine red or mauve veins clusters typically 1mm in size found on the skin surface
Varicose veins are not just a cosmetic problem. Although patients may seek treatments because of cosmetic concerns, varicose veins may cause health problems such as bleeding, skin pigmentation, varicose eczema and ulcers. Varicose veins also increase the risk of deep veins thrombosis. These are usually reversible by treating the varicose veins.
Normal Blood Flow In Veins
There are two main sets of large veins in the legs running alongside each other: the superficial system and the deep system. The blood flowing in the superficial system empties into the deep system before being carried out of the leg up to the heart. There are two main mechanisms which normally help the blood returning back up to the heart: the muscle contractions and the valves within the veins. The contractions of the calf muscle squeeze the blood out of the deep veins which are lying between them. However, in so doing, blood will tend to travel both up and down the veins that are being squeezed. To prevent the back flow of blood the veins have valves which, when functioning, allow blood to flow upwards only. On relaxation of the calf muscles, the pressure in the deep veins drops and blood is suctioned from the superficial into the deep system via connecting veins called perforating veins.
When the valves in the veins fail, blood flows the wrong way through the veins away from the heart. This is called reflux. The valves can fail as a result of inherited valve defects (common); hormones changes (e.g. in pregnancy), trauma, previous deep venous thrombosis (DVT) or weak calf muscles. Once one valve is damaged the resulting reflux puts more pressure on the valve immediately below it causing it to stretch and eventually fail. This domino type effect can cause more valves to fail and eventually the veins become dilated and tortuous and prominent (varicose).
Hidden dangers of varicose veins if not treated
Besides aesthetic concerns, many patients experience aching, itching, cramping and heaviness of the leg from the varicose veins. Varicose veins can also cause swelling of the leg which may predispose to recurrent infection such as cellulitis. The most dreaded complication of varicose veins is serious skin damage with consequential ulceration of the leg affected by varicose veins.
Successful treatment of the varicose veins the symptoms usually improve. Treating the veins also accelerate the healing of venous ulcers and reduces the risk of recurrent ulceration.
The build up of pressure within the veins, cause fluid from the blood can to leak into the surrounding tissues, causing swelling. Signs of swelling can include a tight sensation in your skin, or an impression left in your skin after removing your socks. In more severe cases, your shoes may not fit and your leg may become very swollen. The skin may even leak a clear or yellowish fluid. These symptoms may improve with leg elevation and special elastic socks called compression stockings. If the swelling persists, it can lead to changes in the skin, such as hardening or a change in skin colour
Blood is more likely to clot in a varicose vein. Up to 3% of people with varicose veins will develop blood clots. The segment of vein becomes painful, warm to the touch and firm. This sometimes can progress and cause a deep vein thrombiosis
Varicose veins can cause swelling, which over time can result in skin changes. When this occurs, the skin can become less likely to heal from even minor injuries. This happens because the swollen tissue can limit the flow of nutrients and oxygen to the involved tissue, both of which normally aid the healing process. The constant tension on the tissues can prevent healing as well, creating non-healing ulcers. Reducing the swelling is a key treatment for these non-healing ulcers.
Investigation of varicose veins Venous Duplex Scan
All varicose veins should be scanned before any meaningful advice can be given. We always do an ultrasound scan of the veins called a duplex scan to look at the source of the visible varicose veins. This scan is non invasive and does not involve any radiation exposure. It is therefore perfectly safe. This scan enables us to advise about the best modality of treatment for your varicose veins. Most of our treatments are performed under ultrasound guidance. Should the clinical needs dictate, we may need to do further tests such as a CT scan and some blood tests. The CT scan is non invasive but involves the use of ionising radiation. We need this investigation only if it is absolutely necessary.
Treatments of varicose veins
The treatment of varicose veins has evolved over the years. Modern treatments for varicose veins are minimally invasive treatments performed under local anaesthetic. These treatments are all walk in walk out treatments. The treatments of varicose veins are individualised based on the duplex scan findings and the preferred options of the patients.
EVLA is a minimally invasive ultrasound guided technique for treating varicose veins using thermal energy generated by laser inside the vein. It is performed under local anaesthesia. After an initial infiltration of local anaesthetic in the skin, using ultrasound guidance, a laser fibre is placed into the vein and advanced to the highest point of reflux. After further anaesthetic infiltration, the laser is activated to start the treatment. This part of the treatment is painless. The heat generated by the laser causes the vein to contract as the laser fibre is slowly withdrawn from the vein. The laser ablation treatment is usually completed in 30-45 minutes. However, the treatment may take longer if other additional procedures are necessary
Safety and Efficacy of EVLA
EVLA is very safe in experienced hands. NICE has has approved EVLA as the gold standard for treating varicose veins. We use the latest available technology for the comfort and safety of our patients.
Recommended by NICE as the treatment of choice
Proven efficacy with a recurrence rate of less than 5%
Virtually no scarring
Local anaesthetic treatment as walking walk out treatment
Rapid return to normal activities
Venaseal™ is a minimally invasive ultrasound guided technique for treating varicose. The vein is closed by using a proprietary medical adhesive. The adhesive glues the vein shut. The blood flow is then redirected towards healthier veins. The Venaseal™ treatment is usually performed using only one small incision (2-3mm) per vein treated, and there is no need for additional injections of local anaesthetic around the vein. The treatment device delivers metered doses of adhesive to segments of the vein and under ultrasound guidance, pressure is applied to seal the vein the vein shut. The treatment is painless and is usually completed in 30 minutes to complete. However, the treatment may take longer if other additional procedures are necessary such as sclerotherapy or phlebectomy.
Safety and Efficacy of Venaseal™
The FDA has approved VenaSeal™ closure system. Its efficacy is well documented in the medical literature. The data to date suggest that the closure rate is equivalent to thermal based techniques.The major advantages of VenaSeal™ treatment is that there is no need to wear compression stocking and there is no need for tumescent anaesthetic infiltration. This treatment is therefore ideal if you have difficulty with stockings or if you are needle phobic.
Least invasive of all techniques
Immediate return to normal activities
Does not require repeated anaesthetic injection
No need to wear stocking
Ambulatory phlebectomy is a minimally invasive outpatient technique that treats visible branch varicose veins through tiny punctures in the skin. Using local anaesthesia, multiple micro incisions allow the treatment of the varicose veins branches. Segments of the branch varicose veins are removed to interrupt the continuity of flow in the branches. The remaining segments of veins will scar over, shrink and fade from view. The procedure is generally well tolerated and complications are rare. The long-term success rate of this treatment is greater than 90%. The puncture sites are usually about 2mm in size. Depending on how you heal, these will fade from view after a few months. Ambulatory phlebectomy can be a primary treatment or can be an adjunct to EVLA or VenaSeal™ closure system.
Sclerotherapy is the targeted injection of a chemical irritant into the lumen of a vein to produce inflammation, occlusion, and eventual fibrosis. The sclerotherapy solution causes the vein to scar, forcing blood to re-route through healthier veins. The collapsed vein is reabsorbed into local tissue and eventually fades from view. During the treatment, you may experience a mild discomfort and cramping for one to two minutes, especially when larger veins are injected. The procedure itself takes approximately 15 to 30 minutes. The number of veins treated in one session depends on the size and location of the veins, the volume and the strength of solution used and your general medical health. Foam sclerotherapy is a variation of liquid sclerotherapy when the liquid used is foamed by agitation with air or carbon dioxide. Sclerotherapy is best suited for treating small veins or spider veins
Our hands age faster than any other parts of the body. Although prominent hand veins are healthy veins that return blood to the heart, some may become bulgy and protrude at the back of the hand with age due to three factors:
1) Loss of skin and vein wall elasticity.
2) Loss of subcutaneous fat and collagen.
3) Water content of the tissues.
The veins at the back of the hands can be treated to give the hands a more youthful look.
Reviews And Patient Experiences
Mr Rittoo is fully registered with the General Medical Council and is on the specialist register. He is a well respected experienced vascular surgeon in Bournemouth. He has a wealth of knowledge in all aspects of venous care and specialises in minimally invasive treatments for varicose veins. He has an impeccable bed side manner that makes the most nervous patient feels at ease. He is very meticulous about his work and he always strives for perfection whenever possible.
Mr Rittoo is recognised by all major medical insurances. He also treats self-funded patients. The clinics where he practices put a strong emphasis on providing realistically priced treatment packages for self-funding patients treated under local anaesthetic.
Mr Rittoo can be consulted at his private consulting rooms as detailed below:
Nuffield Hospital , Bournemouth Tel: 07443 840 556
Royal Bournemouth Hospital (BPC) Tel: 07443 840 556
Alternatively you may request a call back by filling in the request for consultation form below. Once you have submitted the form, we will contact you about your enquiry.