How to treat chronic venous insufficiency?

With classic surgery it often turns out that the expected results are achieved only when combined with each other. Conversely, endovascular procedures frequently bring the desired effect with a single procedure. Endovascular methods have been around for over 10 years and a vast majority of patients with varicose veins are now treated using these procedures. Even in countries where only classic surgery procedures are available from public providers, making endovascular procedures less common, these procedures are on the rise.

Most patients start paying attention to venous insufficiency only after the onset of pain. This might be associated with fear of invasive treatments and prolonged recovery period. Yet, awareness of less invasive procedures, which significantly reduce convalescence and minimise the need for taking time off work or limit everyday activities, seems to have the opposite effect. 

With these less invasive procedures physicians have an opportunity to encourage earlier interventions by proposing simpler solutions which can prevent the development of the condition.

The superficial aesthetic changes on the lower extremities - dilated vessels or ‘spider veins’ - may be symptomatic of a more serious problem. It is worth consulting a specialist who will perform a Doppler ultrasound examination to investigate the route of the problem, as soon as when the changes become visible . The examination will probe the condition of the veins and arteries allowing the physician to take steps, where necessary, to prevent a further development of venous insufficiency - which may lead to serious consequences.

It is not uncommon for patients to learn that they suffer from chronic venous insufficiency during their aesthetic appointment. The underlying health problem should always be addressed before any aesthetic treatment begins. Reversing the order makes little sense as in such cases the treatment results tend to be minimal and short-lived.

Larger, insufficient veins do not drain blood from smaller vessels efficiently, which causes them to widen creating ‘spider veins’. Therefore, if we treat superficial changes only, without looking at varicose veins which generate ‘spider veins’ the problem will most likely return.

The risk of varicose veins increases with age. Yet a significant proportion of patients is made out of young people with genetic predispositions towards venous insufficiency, as well as those leading a sedentary lifestyle. This sedentary lifestyle has a very significant influence on the development of venous disorders. Indeed, venous insufficiency is often referred to as the disease of the developed world.  

Modern medicine has a lot to offer when it comes to vascular problems and so it is important that patients suffering with such problems are made aware of the range of solutions available to them.

A consultation with a vein specialist, where a Doppler examination is performed, should dispel the patient’s doubts and alleviate possible concerns or anxiety associated with the treatment. If the ultrasound examination shows that the surface veins are insufficient the patient has two options. They can undergo a surgical removal of varicose veins – these procedures will usually be available from a public provider – or an endovascular procedure, which might be available from a public provider or perhaps covered under private healthcare insurance. However, in most developed countries endovascular procedures will be available from private providers in any event.

Minimally invasive procedures can be used even in patients with very advanced varicose veins. An endovascular treatment is often a far more attractive proposition than classic surgery. The main advantage of this method is the fact that it is painless and requires significantly shorter convalescence. These methods are therefore significantly different than classic surgery which requires a longer recovery period - very often spent in bed.

There are also aesthetic reasons for choosing endovascular methods as these procedures do not cause scarring. Additionally, conditions such as obesity are not absolute contraindications for the procedure. Contraindications are limited to heart defects, coagulation disorders and severe liver damage. For such patients, treatment options are effectively limited to compression therapy. Such therapy will not treat varicose veins but can arrest the progression of the condition.

Patients with convex veins and dilated blood vessels on the calves, thighs or under the knees as well as those experiencing discomfort associated with swelling, a sensation of heavy legs and pain in the lower limbs should consult a specialist without delay. Inflammatory changes around the ankles and on the calves should also be taken seriously. Venous leg ulcers, i.e. non-healing wounds, should trigger alarm bells and an immediate consultation with a vein specialist.

Similarly alarming are symptoms suggesting phlebitis - pain, redness, significant localised raised temperature and tenderness, and, in extreme cases, high fever and shortness of breath or chest pain. A consultation is also recommended when varicose bleeding occurs, or varicose veins are significantly enlarged.