What is varicose veins?

How is Varicose Veins Treated?

Varicose veins is a disease of the venous system, the veins that carry the dirty blood accumulated in the legs to the heart. In this disease, varicose veins become unable to carry dirty blood to the heart, the veins dilate and cause pain.

Varicose Veins is Vein Insufficiency!

Varicose veins are insufficiency in the superficial veins that carry the dirty blood in the legs to the lungs to be cleaned.

The dirty blood in the legs is pumped from the legs to the lungs with the help of various factors. The valves in the leg veins prevent this blood from returning back with gravity.

If the valves become unable to function as a result of various hereditary and other factors, the blood sent to the lung escapes back under the influence of gravity (reflux) and accumulates in the leg veins, causing the condition called varicose veins, which makes itself felt especially with unwanted appearance, pain, pain and swelling.

Varicose Veins Treatment, Content Map

What are the symptoms of varicose veins?

The most common symptoms of varicose veins include increased visibility of the leg veins, enlargement and swelling of the leg veins, causing pain and aching, and in advanced stages, sores on the ankles. You can review all the symptoms of varicose veins in our /varicose veins-symptoms article.

Varicose Veins Types, Types

There are basically 3 types of varicose veins. Varicose veins types are determined according to the structure of the varicose veins.

  1. Telangiectasias-Capillary varices
  2. Reticular veins-Medium size varicose veins,
  3. Varicose veins - thick varicose veins or internal varicose veins.

1- Telangiectasias-Capillary Varicose Veins

These varicose veins are the most common type of varicose veins and are seen in most people. These varicose veins do not pose a health risk most of the time, but they can cause itching and consequently venous wounds in the advanced stage.

Therefore, capillary varicose veins should be monitored. Capillary varicose veins can also be caused by internal varicose veins in the thick vein system between the muscles, called perforating veins and their failure is called perforating vein failure. The presence of this condition must be investigated. Capillary varicose veins are often desired to be treated for aesthetic reasons.

2- Reticular Veins-Medium Varicose Veins

These varicose veins are characterized by bulges on the skin surface. These varicose veins cause pain and tingling as well as visual impairment. If this varicose vein is seen, it also requires a number of measures to be taken for treatment. For this reason, it is useful for patients with medium-sized varicose veins to consult a radiology specialist for a varicose vein examination.

3- Varicose Veins - Thick Varicose Veins or Internal Varicose Veins

These varicose veins may not always be visible on the skin surface. Vena safena magna, vena safena parva, Giacomini vein insufficiency They can also be seen on the skin surface, but since they are between the muscles in the legs, it is not possible to detect varicose veins with an external visual examination. It is possible for this type of varicose veins to show symptoms such as pain, cramps, swelling and itching. This type of varicose veins must be treated.

Because when this type of varicose veins is not treated, the blood accumulated in the veins may clot and the clot may enter the circulation and go to the lung. In order to prevent such a situation, thick varicose veins or internal varicose veins must be treated.

Varicose Veins Stages

CEAP (Clinical severity, Etiology, Anatomy, Pathophysiology) Classification

It was first developed by the international committee of the American Venous Forum in 1994 and revised in 2004. The clinical component score of the disease, characterized by the letter C, ranges from 6, which describes an active ulcer in the end stage, to 0, which describes completely asymptomatic patients.

An A or S next to the C score indicates whether the patient is asymptomatic or symptomatic (such as CEAP 2S). In daily use, only the C score is often used and the E, A and P scores are often not used.

This classification is quite successful for patient examination and grading the severity of the disease. However, it is not suitable for the evaluation of response to treatment."

C (Clinical)

  • C0: No visible signs (pain may be present)
  • C1: Telangiectasia or reticular veins
  • C2: Varicose veins
  • C3: Venous edema
  • C4: Trophic changes in the skin
  • C5: Trophic changes with healed ulcer
  • C6: Active ulcer
  • A: Asymptomatic
  • S: Symptomatic

E (Etiologic)

  • EC: Congenital
  • EP: Primer
  • ES: Secondary
  • EN: Undetermined cause

A (Anatomic)

  • AS: Superficial
  • AP: Perforan
  • AD Deep
  • AN Undetectable

P (Pathologic)

  • PR Reflux
  • PO: Obstruction"

Venous Clinical Severity Score (VCSS)

In this scoring system, 9 basic features of venous disease such as skin changes, inflammation, pigmentation, induration and presence of ulcers are scored between 0 and 3. This scoring system is more suitable for the evaluation of response to treatment.

Varicose veins may appear gradually with age and lifestyle, or they may appear suddenly. However, most varicose veins manifest themselves with the formation of capillary varicose veins.

When thick and medium-sized varicose veins begin to form, the first symptom is the proliferation of capillary varicose veins. For this reason, when the density of capillary varices increases, it is absolutely necessary to investigate the underlying larger varices.

If only capillary varices are seen, capillary varices should not be treated directly. If there are varicose veins in the thick veins and capillary varicose veins have started to form due to them, it is inevitable that new capillary varicose veins will appear after a short period of time even if capillary varicose veins are treated.

Varicose veins treatment should be done before it is too late!

Varicose veins complaints that are not prevented in time grow in the future and cause problems that are very difficult to treat. These complaints are seen in one out of every 4 women and one out of every 5 men. Varicose veins are often seen under the skin of the legs in the form of bluish-colored curved bulges of different diameters.

Will varicose veins go away on their own?

Varicose veins are very similar to the ballooning of the leg veins under high pressure of a plastic hose. It is not possible for ballooned or dilated veins to be restored. Therefore, if varicose veins occur, treatment is absolutely necessary.

In some cases, there is a judgment that valves can be treated. However, this is not possible in venous vessels, if the valves are enlarged, the vein is also enlarged. That vein must be canceled.

Varicose veins are not only an aesthetic problem!

Varicose veins can remain for years without causing any complaints other than appearance. However, over time, varicose veins can become painful. Swelling in the legs and after a while it may turn into chronic venous insufficiency.

A blood clot may form in the varicose vein and this condition, known as thrombophlebitis, causes pain, swelling and redness in the leg, and even embolism and death by going to the lungs. There are basically two methods adopted in the treatment of varicose veins.

Surgical Varicose Veins Treatment Since it is not possible to repair and heal the damaged leg veins, the procedure performed to remove these veins from the leg tissues is called varicose veins surgery. This treatment method is the oldest known varicose vein treatment method. Although this method has some handicaps, you can find more detailed information on our page.

EVLA-Endovenous Laser Varicose Veins Treatment is the process of closing and exiting the varicose vein with a needle like a blood collection needle, without incision and stitching. The patient arrives on foot and leaves on foot.

What causes varicose veins?

Although there are many reasons for varicose veins, the most common underlying problem is genetic predisposition. Varicose veins can occur due to the lifestyle of people with genetic predisposition, eating habits, standing work, sitting still all the time.

How does the onset of varicose veins occur?

We can say that the onset of varicose veins begins with the intensification of capillary varicose veins as we explained above. However, the absence of capillary varices does not mean that there is no varicose veins. Sometimes the onset of varicose veins can be seen only as ball-shaped protrusions or with color change without any capillary varicose veins.

How is varicose veins treated?

There is no remedy other than the closure of varicose veins. Varicose veins can be treated with sclerotherapy, foam and laser. Basically, it is not possible to treat varicose veins with external creams or medications.

In the past, varicose veins were removed during varicose vein surgery for the treatment of varicose veins, whereas now varicose veins are treated and closed with the methods we will describe below."

Before Varicose Veins Treatment

When treating varicose veins, treatment of the underlying superficial venous insufficiency (axial or truncal reflux) is the most effective method in solving the problem.

The presence of dilatation, i.e. enlargement and reflux in the truncal vein on Doppler ultrasound and the presence of symptoms caused by this venous insufficiency in the patient constitute the indication for treatment.

As a result of the removal of superficial venous insufficiency with treatment, regression of varicose veins is expected.

Sclerotherapy is often performed at the same time or in a separate session with the treatment for truncal reflux in order to completely relieve the symptoms and cosmetic problems associated with varicose veins.

Dilatation and insufficiency of the perforating veins may be caused by superficial venous insufficiency or may develop in isolation. However, perforating vein insufficiency often occurs together with truncal venous insufficiency. Therefore, treatment of varicose veins and superficial venous insufficiency may indirectly regress dilated perforating veins. However, in rare cases of isolated insufficiency, treatment of the perforating veins may also be required.

Treatment of Truncal (Vena Safena Magna and Vena Safena Parva) Reflux: Currently, the most preferred treatment options for VSM, VSP, ALTD and PMTD reflux are conservative treatment, thermal ablation, surgical treatment and sclerotherapy.

Conservative Treatment

Conservative treatment of venous insufficiency is basically the use of compression stockings. Generally, grade 1 (18-23 mmHg) haf pressure stockings are sufficient. In addition to stockings, leg elevation, exercise and weight loss are beneficial in these patients. However, since this treatment does not correct the underlying underlying problem, it is only a supportive treatment; it is not sufficient as a basic treatment method. It does not provide regression of reflux, but it provides regression in the patient's complaints. Therefore, in patients who require saphenous vein treatment and are suitable for VSM or VSP ablation, compression therapy alone or with the addition of medication is not sufficient.

Surgical Treatment

High ligation and saphenous stripping, mini phlebectomy are performed. It has been the standard treatment method for about 90-100 years for dilatation and insufficiency of the vena saphena parva and magna. It involves making a very large incision in the groin or behind the knee, ligating the proximal saphenous vein and severing and removing the distal part. Today, surgical treatment has been replaced by thermal ablation. In general, the aim is to ablate the saphenous vein, but complication rates, long postoperative bed rest (approximately 1 month),prolonged wound healing, recovery time and recurrence rates are higher in surgical treatment."

Varicose Veins Treatment Methods

  • Sclerotherapy
  • Foam Therapy
  • Sclerotherapy for Varicose Veins
  • Laser Varicose Veins Treatment (EVLA) Endovenous Laser Ablation

Varicose Veins Treatment with Sclerotherapy

Sclerotherapy is a treatment method that has been in use for more than 80 years.

In varicose vein treatment with sclerotherapy, a sclerosing substance is injected into the varicose veins with very fine needles and the inner surface of the varicose vein is damaged by the drug. This damage is done consciously. After this damage, the varicose vein adheres and closes.

This method, which is widely used in the treatment of varicose veins, provides treatment of varicose veins at an early stage in a large part of varicose vein patients. Since the vein that has undergone sclerotherapy is adhered, blood flow through it stops and thus it is not possible for varicose veins to form again in this vein. The closed veins are then absorbed and destroyed by the body.

Another curious issue in the treatment of varicose veins with sclerotherapy is whether there are any drawbacks for the body of this vein that disappears or closes. The answer is actually very simple. Varicose veins are veins that do not do their job and their closure brings benefit to the body, not harm. In addition, the deep veins continue to function.

How long sclerotherapy lasts is another curious issue. The sclerotherapy session applied in our clinic lasts approximately 30-45 minutes. After the session, the treated patient can walk from our clinic and go to work and home.

After varicose veins treatment with sclerotherapy, low-pressure compression stockings should be worn to ensure that the veins adhere and close. The patient is advised to wear the stockings for about 3 days after the treatment. There is no harm in bathing the next day after the treatment.

After sclerotherapy, mild burning may be seen in the treated areas. It is possible to see redness. All necessary precautions are taken to prevent the drug used in the treatment from leaking between the tissues. However, some leakage may occur during the treatment. Accordingly, it is possible to open a wound. Although this possibility is very low, these wounds will disappear afterwards. Sclerotherapy sessions are usually performed between 1 day and 1 week.

Laser treatment of varicose veins is a convenient and safe way to treat varicose veins. Scientifically, this procedure is called endovenous laser ablation (EVLA) and consists in the fact that under the influence of a laser, the vessel wall of the affected vein ""sticks together"" and the vein disappears without a trace. This procedure does not damage the blood supply to the legs because the deeper veins ensure normal blood flow. Thus, you not only get rid of an aesthetic defect in a short time, but also treat a disease fraught with major complications in the future.

How is Varicose Veins Treatment with Laser?

Laser varicose veins treatment is applied in a sterile environment. The patient lies on the operating table, the intervention site is prepared by cleaning with antiseptic. After that, the radiologist doctor makes a mark indicating the place where the laser is placed and the course of the varicose vein. The procedure follows a certain algorithm:

The doctor punctures the vein with a special needle under the control of an ultrasound machine. The sensations are no different from a normal intravenous injection. With the help of this needle, a catheter is inserted into the vein.

An anesthetic is injected into the tissue around the catheter. This prevents pain and limits the area of exposure to the laser radiation. The laser fiber is inserted through the catheter into the varicose vein. Under the control of an ultrasound probe, the doctor advances a laser fiber to the saphenofemoral junction or the saphenopopliteal junction. This allows maximum control over the procedure. Tumescent anesthesia is given around the vessel so that the tissues are not burned by the laser. The procedure is done by pulling the fiber back as the laser fiber burns the vessel.

The laser fiber and catheter are removed from the puncture site. The puncture site is cleaned with an antiseptic solution and closed. Compression stockings or bandages are applied to the leg. Immediately after the intervention, the patient should get up and walk for at least 40-60 minutes. This redistributes blood from healthy vessels and stimulates blood circulation through the deep veins.

How to Treat Capillary Varicose Veins?

Capillary varicose veins are spider web-like vein condensation seen on the skin surface of the legs. This is called telangiectasia. Foam therapy and sclerotherapy methods are used in the treatment of capillary varices.

How can we prevent varicose veins?

We can prevent varicose veins by taking good care of our legs. This can be done by doing sports, eating right, not gaining excess weight, not standing for long periods of time, or not standing still for long periods of time. Varicose veins like inactivity and are very common in sedentary and overweight people. That's why being active is a big help.

Varicose veins are not treated in beauty centers!

Capillary varicose veins seen from the skin surface are often considered as an aesthetic problem in the legs and are tried to be eliminated in beauty centers. However, doing this does more harm than good. For this reason, in case of capillary varicose veins, it is definitely useful to see a radiology specialist doctor and undergo a varicose vein examination.

Which doctors treat varicose veins?

Today, interventional radiology specialist doctors perform varicose veins treatment without surgery with the help of ultrasound. In the past, varicose vein surgery was performed by cardiovascular surgeons, but with the methods developed by interventional radiology specialists, varicose vein surgery is no longer necessary. Therefore, when you decide between having varicose vein surgery or non-surgical varicose vein treatment, you should consult an interventional radiology specialist for non-surgical varicose vein treatment.

Do compression stockings work for treatment?

As we explained above, varicose veins are defined as the inability of the veins, which resemble an enlarged plastic hose under pressure, to carry blood to the heart. Compression stockings are a tool that compresses these enlarged veins with external pressure and helps to carry dirty blood to the heart. Compression stockings do not cure varicose veins, but they can alleviate varicose vein-related complaints. Compression stockings do not cure varicose veins.

Can varicose veins be treated with medication?

Unfortunately, varicose veins is a disease that cannot be treated with medication. Most of the products sold on the market as varicose vein medication are drugs that help to shrink varicose veins. However, the effectiveness of these drugs does not allow the varicose veins to shrink permanently or to be restored. Therefore, there should not be too high expectations from varicose veins medications.

Can varicose veins be treated with cream?

Varicose veins cream is one of the most frequently asked products. However, varicose veins cannot be treated with cream as it cannot be treated with medication. Most of our patients who come to us for treatment are people who have used varicose veins cream before coming to us for treatment. Although varicose vein cream is a very available product on the market, it has no therapeutic properties. None of the products sold under the name of horse chestnut cream, red vine leaf cream, Varicose Vein Defense Cream, herbal varicose cream are scientifically proven drugs.

What happens if varicose veins are not treated?

If varicose veins are left untreated, venous wounds may form on the legs, clots may form, and the clots may be thrown to the heart and then to the lungs. This can cause bigger problems than thought. For these reasons, varicose veins should be treated.

  • When the pain started, I reached you over the internet.

    Dear teacher, I had varicose vein surgery in 2018 with anesthesia in the general external center. Foam treatment and laser continued for 2 years afterwards. However, it occurred again. Afterwards, when the pain started, I reached you over the internet. My pain was over in one session. I ...

  • I have neither pain nor vascular prominence

    Before I came to the clinic, I was very nervous and had hesitations about both the pandemic and the procedure to be performed. However, the hygiene of your examination was very reassuring when I first arrived. Then the examination and then the intervention... I had previously been trea ...

  • I got rid of varicose veins in just 2 sessions.

    Dear colleague Ms. Rengin, thank you for your unwavering support for my varicose veins, which I could not take care of because I could not find time to take care of myself due to our profession. I had radiology shots taken in 3 hospitals before. In all these measurements, it was stated ...

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Md. Rengin TürkgülerMd. Rengin TURKGULERInterventional Radiologist
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