Varicose veins are a very common problem – about 30% of the population will suffer from them at some stage in life. In some quarters, varicose veins are regarded as a purely cosmetic problem – and to a certain extent they are because no one especially not ladies is keen to have bulging blue veins all over their legs.
However, untreated varicose veins can cause a serious medical problem called a venous ulcer on the lower part of the leg.
An ulcer is basically a sore that does not heal. There are many reasons why ulcers can happen on the lower leg, but in the UK the commonest reason by far is untreated varicose veins. This is unfortunate, as prompt treatment of varicose veins can reduce the risk of a venous ulcer developing very significantly.
The basic problem in varicose veins is a leaking valve somewhere in the vein system. If one thinks of the vein system as a set of pipes that take the blood back out of the leg to the heart, one can readily appreciate that the pipes need some valves within them, as the blood has to travel against gravity to get back to the chest.
The valves in the veins are very delicate – if you actually seem them, they are so delicate you can see through them! For this reason, they commonly fail and start to leak. There are lots of valves in the vein system, but some valves in key locations are more important than others. All the veins in the leg eventually meet up together at main junction points – one of the main places is at the top of the leg in the groin crease, where lots of the superficial veins join the main deep vein of the leg called the femoral vein – it is basically like a venous spaghetti junction!
If the valve at that point fails, blood starts to flow the wrong way down the veins. The veins under the skin then start to bulge out as the pressure in them rises. In the early stages, they just look unsightly and lumpy, then they may become achy and sore. Finally, after a long period of time they start to damage the skin. There are lots of theories about how the skin damage happens, but in essence we think it is because the pressure inside the vein forces components of the blood out of the pipe and into the space under the skin. This sets up an inflammation in the skin, which damages it. The first signs are usually a darkening of the skin just above the ankle on the inside of the leg. The skin may become itchy and dry. Eventually the skin damage causes it to break down into an ulcer – usually after a trivial injury, which would otherwise heal up quickly in a normal leg.
Once an ulcer has formed, it is really difficult to get it to heal. It usually requires a prolonged period of time in compression bandages and then subsequent surgery on the leaky veins. Some ulcers defy all attempts to get them to heal and patients can spend literally years in bandaging for chronic ulcers.
Venous ulcers are a major source of unhappiness and pain in elderly people. They frequently get infected, they limit mobility and they can lead to patients becoming housebound and socially isolated. The financial cost alone of looking after venous ulcers is estimated at 1 billion pounds per year in the UK!
A more sensible way of treating the problem is to treat the veins before the skin damage starts and an ulcer develops. Fortunately, this is a lot easier and more effective in 2012 than it used to be 10 years ago. In the last decade, surgery for varicose veins has changed beyond all recognition. The old style â€˜high tie and strip’ operation has been superseded by a variety of minimally invasive techniques, most of which are not just more effective and less painful than the old style surgery, but can be done under local anaesthetic, without needing to put the patient to sleep. This is particularly important in older people who may well have several other medical problems, which can make a general anaesthetic more hazardous than in a fit and well younger patient. Minimally invasive surgery with lasers can even be performed on patients who take warfarin (a blood thinning drug often used to reduce the risk of strokes in patients with irregular heart beats). So the best treatment for a venous ulcer is simple – you don’t have to get one in the first place if you get your varicose veins fixed early on!