Varicose veins are twisted, enlarged veins near the surface of the skin. They commonly develop in the legs and ankles.

What causes varicose veins?

Normally, the one-way valves in these veins keep the blood flowing efficiently against gravity up towards the heart. Varicose veins develop when you have faulty valves in your veins and weakened vein walls. When these valves do not function properly, blood pools and pressure build up, hence the veins are weakened, enlarged and twisted.

Is it serious?

Varicose veins are common and usually will not cause serious medical problem. However, in some cases, varicose veins can signal a blockage in the deeper veins that requires evaluation and possibly treatment. People with leg skin changes associated with varicose veins may develop chronic sores which are difficult to heal (as shown in Fig. B).

Your doctor will examine your legs and feet. Varicose veins are easy to see, especially when you are standing. If a problem with the deep veins or complications are suspected based on your symptoms and examination, an ultrasound study may be required.

Patients often feel no discomfort but may be concerned about the appearance of the 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 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.

How are varicose veins treated?

The goals are to reduce symptoms and prevent long term complications.

• Non-surgical: Exercise, wearing compression stockings and elevating legs
• Surgery: Ligation and Stripping (Open Surgery)
• Endovenous Laser Treatment or Radiofrequency Ablation
• Laparoscopic Perforator Surgery (Keyhole Surgery)

Ligation and stripping

Ligation is done at the main junction between deep and superficial vein with a faulty valve. Small incisions are then made over the varicose vein to remove them. If several valves along the vein are heavily damaged, the whole vein is usually removed by stripping.

Endovenous Laser Treatment and Radiofrequency Ablation

EVLT and RFA are both done under local anesthesia. It works by using laser or radiofrequency energy to heat the vein from inside which causes it to seal shut and disappear.

What to expect after surgery?

Vein ligation and stripping are done as day surgery under regional or general anesthesia. EVLT/RFA can be done under local anesthesia. The leg will be bandaged with crepe and stockings for two weeks after the operation. Most often, you can return to work within a few days. After two weeks, you can resume normal leisure and recreational activities.