Relieving the pain of varicose veins

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Varicose veins affect 20 per cent of people in the western world but new procedures have replaced the old painful “stripping” operation, so they are easier to treat, writes MICHELLE MCDONAGH

IF YOU suffer from varicose veins, you can count yourself as a member of a very large club. One in five people face a daily struggle with the familiar swollen, ropey veins that can cause throbbing pain, severe swelling and heavy, tired legs.

Varicose veins are caused by a condition known as venous insufficiency or venous reflux in which blood circulating through the lower limbs does not properly return to the heart, but instead pools up in the distended legs.

If your parents or siblings have had varicose veins, youre more likely to develop them - as heredity is a major factor in venous reflux disease. People who are obese and women who have had multiple pregnancies are particularly susceptible as the extra weight puts extra strain on the veins. Women are more vulnerable to the problem than men, partly because the hormonal changes brought on by menstruation, menopause and hormone-based drug therapy can relax vein walls and cause venous reflux.

Lifestyle and particularly physical activity can also affect your odds of developing varicose veins. People whose careers require them to stand in place for long periods of time – nurses, teachers, waitresses, flight attendants and other service personnel, for example – have a higher-than-average risk of venous disease as do people who do a lot of heavy lifting.

Symptoms of venous reflux disease can include pain and fatigue in the legs, swollen ankles and calves, burning or itching skin, skin discolouration and leg ulcers. In less severe cases, thin, discoloured vessels – spider veins – may be the only symptom.

About 4,000 varicose vein operations are carried out annually in Ireland. One in 200 Irish people will suffer the devastating, painful and socially isolating complication of a varicose leg ulcer.

Although many people do not experience problems until they are older, venous reflux disease can occur in teenagers and is a progressive disease that worsens without treatment. Since valves cannot be repaired, the only alternative is to re-route blood flow through healthy veins.

Traditionally, this has been done by surgically removing or “stripping” the troublesome vein from the leg. During a stripping procedure, which is usually performed under general anaesthetic, the surgeon makes an incision in the patient’s groin and ties off the main vein, after which a stripper tool is threaded through the vein and used to pull the vein out of the leg through a second incision just above the calf.

However, a new, cutting-edge, minimally-invasive procedure now available in Ireland, VNUS Closure, uses ultrasound to close off diseased veins and allows patients to get back on their feet much quicker than traditional treatments. The “walk-in, walk-out” procedure, which is covered for the treatment of varicose veins by all of the insurance companies in the Irish market and is available at a number of hospitals around the country (see vnus.iefor more details), involves little or no pain and minimal scarring.

A thin catheter is inserted into the vein through a small opening to deliver radio-frequency energy to the vein wall, causing it to heat, collapse, and seal shut. The vein simply becomes fibrous tissue after treatment and, over time, will gradually incorporate into the surrounding tissue.

Prof Austin Leahy, general and vascular surgeon at the Bon Secours Hospital in Dublin, treats two main categories of varicose vein patients – younger people in their 20s and 30s who are concerned about the cosmetic appearance of their legs and people over 50 who are suffering from varicose vein disability such as skin rashes, cellulitis and leg ulcers.

“We no longer need to cut, strip or sew varicose veins and patients no longer need a general anaesthetic. The procedure can all be performed under local anaesthetic on a walk-in, walkout basis using VNUS Closure. There are no stitches involved and the pain in minimal,” he explains.

Kevin O’Malley, general and vascular surgeon at the Mater Hospital in Dublin points out that varicose veins affect 20 per cent of the western world and there “will never be a pill to treat them”. Although vein stripping is a well established operation that stood the test of time over the years, he says the technology has now moved on.

The standard treatment for varicose veins in more recent years has been laser which involves burning off the main vein from the groin down to the knee.

“Laser has been around for five to 10 years now and is another minimally invasive procedure compared to more traditional treatments,” explains Mr O’Malley.

“To my mind, the advantage of VNUS over laser is that it is even less painful and patients are fully mobilised and back to work even quicker. In many people’s views, this technology is the way forward in the treatment of varicose veins over the next number of years.”

While the VNUS procedure is not yet available in the public hospitals in Ireland, Mr O’Malley says he hopes this situation will change within the next year as obviously it is not equitable to have it available only in the private sector.

PATIENT CASE STUDY: GERRY CUMMINS (44)

AS A theatre nurse in the Mater Private Hospital, Gerry Cummins is on his feet most of the day at work. Although he has had varicose veins in both legs since his mid-20s, he did not do anything about them for 20 years until they began to cause him pain and irritation.

“They became a problem about nine years ago, they were throbbing and sore at work. I was aware of varicose vein surgery from working in the hospital and in 2009, I had a stripping and ligation done on my right leg. The surgery was fairly OK although it involved making a series of small incisions in my leg from groin to ankle. I had some pain and numbness after the operation and the recovery time was about 10 days,” he says.

By the time Gerry went back in to have the vein in his left leg treated earlier this year, the newer, minimally invasive VNUS Closure procedure had become available in Ireland.

“The second procedure was totally painless, I could barely see the incision and my recovery time was very quick. I had the bandages off the next day and was walking about and driving the day after that. On top of this, the throbbing and pain was all gone. It was so simple. People really don’t need to be nervous about getting their veins done anymore with the new treatments”.

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