Each week, the ​​Department of Vascular Surgery​ at Singapore General Hospital (SGH), a member of the SingHealth​ group, sees up to 10 new cases of varicose veins per clinic. 

Although these visibly enlarged and twisted veins do not usually pose serious health problems, more patients are seeking treatment for the condition, said Associate Professor Tan Seck Guan, a Senior Consultant.

Varicose veins are a common condition. Some people may be more likely to develop varicose veins because of inherited characteristics (genetics), ageing and hormonal changes. 

Varicose veins may also result from conditions that increase pressure on the leg veins, such as being overweight or pregnant, or having an occupation that requires standing for long periods of time.

Are your legs aching, heavy and veins bulging out? Watch this video to learn about the causes, symptoms and treatments.

Treatment for varicose veins

Treatment depends on patient choice, severity and fitness. 

Non-surgical treatments

Options include:

• No treatment – not a life-threatening condition especially for varicose veins

• Conservative treatment – In patients who are considering or unsure about surgery, a trial of compression treatment can be employed. Recommendations include:
  
  - (20-30mmHg) for C2- C4 disease of the CEAP classification
  - (30-40mmHg) compression therapy with garment for C6 ulcer disease
  
  Most chronic discomfort and skin changes can be ameliorated by judicious use of compression garments, skin care, lifestyle changes and topical dressings.

Surgical treatments

1. Stripping (early surgical procedure)
   One early surgical procedure to treat varicose veins is known as stripping, which involves general or half-body anaesthesia. The faulty veins are removed and blood flow directed through functioning veins.
   Stripping requires incisions to be made at the groin, inner thigh and calf. Patients typically are given up to two weeks of leave for recovery, during which they are encouraged to walk.

2. Endovenous laser therapy
   Endovenous laser therapy uses a laser to burn the vein under local anaesthesia, allowing patients to literally walk home immediately after treatment.

3. Injection of foamed sclerosants
   Another popular alternative is the injection of foamed sclerosants – liquid chemicals in bubble form – into the inner thigh to harden the vein. 
   This minimally invasive procedure, performed under local anaesthesia, is usually prescribed for small reticular “spider veins”

All the patient needs to do after undergoing either endovenous laser therapy or sclerosant injection is to take a few painkillers and wear graduated compression stockings for 30 days to aid recovery. 

These prescription tight-fitting below-the-knee, above-the-knee or pantyhose stockings create a gentle pressure on the legs which prevents blood from pooling in the veins and improves the results of minimally invasive treatments.

Treatment outcomes

Results for surgical treatments have been encouraging. Post-treatment, most patients will find their varicose veins reduced in size and symptoms relieved. 

In 25 per cent of cases, varicose veins eventually completely disappear, said Assoc Prof Tan.

Symptoms of varicose veins

Varicose veins are visible through the skin and appear dark blue, swollen and twisted. Some may experience distending discomfort, tiredness, swelling and pain in the leg. Symptoms include:

• Aches and cramps in the legs
  

• Affected area may also ve swollen, itchy
  

• Tired, heavy legs after a long day of standing
  

• Inflamed legs may be tender to touch
  

• Itchy, swollen ankles
  

Symptoms may worsen after standing or sitting for long periods of time. Varicose veins can also cause darkening of skin, dry, thickened skin, open sores (ulcerations), inflammation (thrombophlebitis) or bleeding.

“Although many are bothered by varicose veins and find them unsightly, they should not affect self-confidence,” said Assoc Prof Tan. “There is no need to be resigned to them as they can be easily treated.”

Ref: G25 (ed)

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Venous Insufficiency Can Cause Varicose Veins

Quick, Painless Treatment for Venous Insufficiency