10 things you didn’t know about varicose veins

Summertime and those ugly veins on your legs are stopping you wearing shorts and skirts. Ignoring them can be more than just a cosmetic problem, as they can ultimately lead to skin problems, eczema and even skin ulcers. But there may be things you may not know about varicose veins.

1) Giraffes don't get varicose veins, only humans do. Varicose veins are a result of human evolution. The combination of standing on two legs, which creates pressure in our ankle veins, and loose skin, leads to varicose veins. Giraffes have the highest ankle pressure in the animal kingdom (150 mmHg), but their tight skin prevents varicose veins.

2) Severe pain is not a symptom of varicose veins, unless the veins are inflamed. Ache after standing or itch due to skin damage are the common symptoms. Most people have few symptoms, but want treatment for cosmetic reasons. It is always worth treating varicose veins to prevent the development of skin damage including eczema and ulceration.

3) They are more common than you think – 30 per cent of woman and 20 per cent of men have large varicose veins. However, the incidence increases with age and, by 60 years old, 50 per cent of us will have some manifestation of varicose veins.

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4) Genetic influences and childbirth do increase your risk. This is well known. Children blame their mothers and mothers blame their children, which creates a nice symmetry. However, standing and occupations where people are on their feet a lot surprisingly have not been shown to increase risk.

5) Not all varicose veins have to be treated by surgery. Broken veins in the skin, in the absence of ultrasound evidence of major varicose veins, can be treated on an outpatient basis by injection or laser sclerotherapy. This involves walk in/walk out treatment where the veins are destroyed usually by injecting a chemical into them.

6) Open surgery, including stripping of varicose veins, is not necessary any more. Evidence-based research supports minimally invasive treatment as first line and it has thankfully replaced cutting and stripping. At Vein Clinics of Ireland we have not performed open surgery for many years.

7) Thermal ablation using either radio-frequency or laser to destroy the veins with heat has revolutionised varicose vein treatment. It is the minimally invasive treatment of choice, delivered through tiny incisions on a day-case basis. Most people return to full activities 48 hours later and the cosmetic results are excellent.

8) Where does the blood go when varicose veins are ablated? Fortunately there is an over provision of veins in our legs. The varicose veins that we treat are not working properly, and their function has already been taken over by healthy veins.

9) Non-thermal treatment using glue to destroy the veins (VenaSeal) is a new, much-talked about treatment. It has potential benefits, however, these have yet to be proved beyond three years' follow up. Consequently it is not covered by any health insurers in Ireland, unlike the previously mentioned treatments which are. VenaSeal is available for those who are prepared to pay for it.

10) The ultimate aim of varicose vein surgery is to prevent leg ulcers developing in later life. The skin damage which starts as dry scaly, itchy skin can progress to ulceration which is painful, socially isolating and often resistant to treatment. Surprisingly, treatment of leg ulceration accounts for 2 per cent of the health budget and is therefore more than just a problem for the individual. It is also a problem for the health budget.

Hopefully, what you do know is that there has been a revolution in the treatment of varicose veins which allows minimally invasive therapy, excellent results and early return to full activities.

– Prof Austin Leahy is consultant vascular surgeon at the Beacon Hospital, and Director of Vein Clinics of Ireland.