Prof. from the Department of Cardiovascular Surgery at Memorial Bahçelievler Hospital. Dr. Askin Ali Korkmaz gave important information about the treatment options in varicose disease
Varicose veins are caused by the deterioration of the valve system in the veins, causing the blood that should normally go up, escaping down, leading to vein formations of different diameters and appearances in the superficial veins. Varicose veins, contrary to what is known, are not only seen in the legs. For example, hemorrhoids are also a type of varicose because it is an enlargement of a vein. Likewise, a varicocele seen in the testicles in men is an enlargement of the veins. Esophageal varices can be seen around the esophagus. These are all types of varicose veins. However, when varicose disease is mentioned, it is not these, but the vein enlargements that occur in the legs.
Varicose veins are divided into 3 groups according to their severity.
Varicose veins on the leg can be of different sizes and appearances. If they are 1-2 mm thick, they are called “telangiectatic varices”. Sometimes it can be seen on our face as reddish, thin veins. It can occur in different parts of the body.
If the diameter of varicose has reached 3-4 mm, it is called “reticular varicose”. These are in the form of bluish veins under the skin that are not very puffy from the skin. It can be alone or in a spider web style.
More advanced varicose veins are large varicose veins that are about the thickness of a pinky finger, have started to swell outward on the skin, and have worm-like appearances called “packs”. It can occur in different parts of the superficial vein system in general, as well as below the knee.
Confused with restless legs syndrome
Due to the accumulation of venous blood in the legs, complaints such as fullness, swelling and pain felt under the knee especially in the evenings. In the very advanced stage, it wakes the patients with night cramps. This discomfort is confused with restless legs syndrome, since varicose veins also have the feeling of being unable to keep their feet stable and constantly lifting. Patients may refer to health care providers by mistaking the discomfort they feel in their legs for restless legs syndrome due to varicose veins.
Thin and superficial varicose veins can be treated practically
The treatment method varies according to the diameter of the varicose veins. Telangiectatic varices, that is, thin capillary varices, do not usually cause severe pain, fullness, and discomfort. It is generally a cosmetic problem. Rapid weight gain can be seen frequently during pregnancy and postpartum. Its treatment is a method called “sclerotherapy”. The drug, which causes a reaction on the vessel wall, is injected into the vessels with capillary needles. If there are small formations that cannot be entered with a needle in telangiectatic varices and this situation makes the patient cosmetically uncomfortable, superficial laser treatments can be performed by a dermatologist.
Moderate complaints begin
Complaints begin to occur in patients with reticular varices of 3-4 mm in moderate severity, bluish, not very puffy. There is a feeling of pain, fullness and restlessness. However, night cramps are not uncommon in these patients. Especially towards the evening, there is a desire to extend the foot to a high place.
If there is a leak in the vein, an "endovenous laser" is required.
When reticular varices begin to form, patients may experience serious leaks in the superficial veins. Therefore, first of all, venous Doppler ultrasound is performed. Leaks can occur in the great saphenous vein starting from the inner face of the ankle to the groin or in the small saphenous vein starting from the outer edge of the ankle and going up to the knee pit. Or, there may be perforating vascular leaks that combine the superficial system and the deep vein system. These problems are checked with Doppler. If there is a leak, an "endovenous laser" procedure is performed. However, if there is no leakage, foam sclerotherapy is applied. In foam sclerotherapy, it is aimed to reach more surface with less medicine by mixing the medicine normally used in sclerotherapy with air. A white foam is obtained and injected into the vein.
Large varicose veins require surgery
The treatment of larger varicose veins is surgery. If there are leaks in the main vein as a result of Doppler and the pachyderms are visible, these varicose veins are cleaned with small incisions. This procedure is called “miniflebectomy”. In this method, no sutures are made. After the location of the vein is detected by ultrasound, the leakage in the main vein is treated by entering through a needle hole with endovenous laser treatment, and by sending a special catheter along the vein, by gluing the vein with laser or radiofrequency rays, and sometimes by a method called glue or gum treatment. These procedures take place in the operating room environment. The treatment method to be applied varies according to the diameter of the vessel.
Compression stockings are the most important part of the treatment of varicose veins.
An important part of the treatment of varicose veins in all patients is to wear appropriate compression stockings. They are socks with varying pressures according to the severity of varicose veins. Sometimes, protective stockings should be preferred in daily life for patients with only telangiectatic varicose veins, for patients who do not have leakage in the main vessels, who only require cosmetic procedures, or for patients who have occupational risk factors. Compression stockings are a very important part of the treatment of varicose veins. The important thing is to reduce the pressure in the ankle and facilitate the upward return of the blood.
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