Varicose Veins and Venous Disease
(A Guide For Patients)
PART 2 OF 3
MD FRCSC FACS
Vascular and General Surgery, Critical Care
Last time I talked about what venous disease is and how varicose veins and related issues are problems for so many people. Next up: Investigations and treatment options.
As with any medical problem, we start with getting a history, asking questions about how venous disease affects the patient and about their health in general. Some are surprised at how other health issues can be related to their venous disease. A physical examination then focuses mostly on the cardiovascular system.
Next, in most cases we need to find out whether particular veins are refluxing, allowing venous blood to pool backward down the legs instead of conducting it up toward the heart the way it’s supposed to go. Some veins that are commonly diseased this way and give rise to elevated venous pressure and varicosities are great saphenous and small saphenous veins. To check their function we do specialized ultrasound imaging in a standing position.
With all of this information in hand we can then talk about general ways to manage venous disease and what further specific procedure options are available for each individual.
Treatment measures do significantly alleviate symptoms, slow the disease process and improve appearance. For example, once we’ve taken some basic steps, often including a procedure or two, the vast majority of patients will feel better overall, varicose veins will be significantly diminished and the risk of venous ulcers or ulcer recurrence in the future will be lessened. However, I explain to patients that there is usually no “cure” for venous disease. As a chronic condition it’s important for patients to keep the health of the veins of their legs in mind life long.
The first and possibly most important measure is compression, usually in the form of compression stockings. Many are skeptical about compression stockings and have visions of heavy, ugly and uncomfortable pantyhose they remember their grandmother wearing. Both our own experience with hundreds of patients and published medical studies confirm that compression stockings are very effective in diminishing symptoms, probably lessen the disease overall and are especially important to wear after venous procedures. Modern stockings are designed to be individually fitted and come in many comfortable materials and colors. Once given a fair try (and assuming proper fit of a quality product) the vast majority of patients feel better wearing them.
Other life long interventions helpful in venous disease include regular leg exercise (muscle contractions get venous blood moving upwards) and elevating the legs as often as feasible (taking breaks and sitting with one’s legs up diminishes the pressure). There is scientific evidence that supplements such as horse chestnut seed extract can improve vein function and symptoms. Weight loss may be helpful for some. Finally, it wouldn’t be an article written by a doctor if it didn’t mention quitting smoking. You guessed it, along with all of its other terrible consequences, the toxins in cigarette smoke weaken vein walls and worsen the disease.
So far I’ve reviewed general and life long recommendations that apply to nearly everyone, whether we also undertake procedures or not. Next is consideration of surgeries and minimally invasive procedures that further help patients with venous disease