Varicose veins are a condition in which the veins in our legs become elongated, widened, tortuous, and their valves become insufficient. Varicose veins can occur in all superficial veins in the body, but the term varicose veins is used only for the veins in the legs.
The leg veins consist of superficial and deep venous systems, and communicating veins that connect these two systems. Veins are a system that ensures the return of blood to the heart. Clean blood is easily distributed throughout the body via arteries by the pumping action of our heart, but the collection of deoxygenated blood occurs through a more passive system, and this system is most strained in our legs. The most important element of this system is the contraction of the leg muscles. In addition, the valve system within the veins and the reflection of arterial pressure on the capillaries also facilitate the return of blood. Therefore, movement is the most important factor in the emptying of the veins.
Causes of varicose veins
Although the exact cause is unknown, the following factors are believed to play a role in the formation of varicose veins.
Age:
Varicose veins become more common with age, especially after 40, due to weakening of the veins and valves.
Gender:
It is more common in women due to factors such as the structure of the lower abdominal organs and veins, and the increased blood return during menstruation.
Heredity:
Children of parents with varicose veins have a higher probability of developing them. This suggests that the veins were congenitally underdeveloped.
Pregnancy:
This condition occurs particularly in the first months of pregnancy. While the exact cause is unknown, it is thought to be a result of hormonal changes, the growth of the uterus, and the excessive backflow of blood from the veins, leading to pooling in that area.
Obesity:
In obese individuals, the increased intra-abdominal pressure and the resulting pressure on the veins make varicose veins more likely to occur, especially if there is a personal predisposition.
Job:
Varicose veins are more common in people who have to stand for long periods of time.
It is also said that various factors such as infection, trauma, and sock elastics can facilitate the development of varicose veins in people who are predisposed to them.
The explanations given so far summarize the main topic: primary varicose veins, which only affect the superficial veins. Secondary varicose veins arise from the blockage of deep veins by blood clots and the resulting malfunction of the valve system.
Symptoms seen in varicose veins
Varicose veins are easily recognizable by their distinctive appearance: twisted, elongated, worm-like veins of varying sizes beneath the skin. Sometimes, they can also appear as very small, spiderweb-like dilated veins.
A feeling of heaviness in the legs occurs in severely enlarged varicose veins due to excessive blood accumulation in the legs.
Localized leg pain may be due to stretching of small veins; other types of pain should be investigated to rule out underlying causes (arterial problems, rheumatism, herniated disc, etc.).
Night cramps are attributed to the accumulation of deoxygenated blood in the veins, the release of certain substances, and insufficient blood supply to the muscle tissue.
Leg edema is generally mild swelling. It appears towards evening in those who stand all day and disappears when the legs are elevated.
Symptoms may include a burning sensation and itching in the legs; allergic reactions may also cause red rashes, spots, and itchy lesions on the legs.
Varicose vein bleeding can occur when severely enlarged varicose veins are located just under the skin and have very weak walls, causing bleeding even with simple movements or during sleep. If left unnoticed, it can lead to serious bleeding.
Non-healing wounds; wounds that open spontaneously after trauma, impact, or advanced venous insufficiency can be very difficult to heal in varicose legs and require special treatment.
Psychological disorders; the unsightly appearance of varicose veins and the need to constantly wear compression stockings can lead to psychological problems.
Treatment Methods
Sclerotherapy
Sclerotherapy is a treatment method that can be applied in cases where varicose veins are few and small in diameter, and it is based on the principle of injecting a constricting substance into the veins with a syringe. Sclerotherapy works by injecting substances called sclerosants, which have a vasoconstricting effect, into the varicose vein using very fine-tipped syringes.
Sclerotherapy is recommended in sessions, each lasting approximately 20 minutes. If varicose veins are present in both legs, treatment is applied to a different leg in each session. The number of sessions varies depending on the extent of varicose veins in the leg. After each session, compression is applied to the leg with high-pressure stockings or elastic bandages. Wearing lower-pressure stockings for about a month after the sessions are complete is recommended.
There's no need to take a break from work while the sessions are ongoing; you can continue with your normal daily life as long as you have a bandage or compression stocking on your leg.
Drug treatment
In patients experiencing leg swelling, pain, and night cramps due to varicose veins, medications that strengthen the vein walls can be beneficial for certain periods.
Laser treatment
It successfully eliminates various types of varicose veins. With more than 10 different laser systems developed today, varicose veins of varying degrees and depths can be treated without causing any damage or side effects. The variety of lasers developed for varicose vein treatment is one of the broadest fields of laser technology in medicine, leaving almost no gaps in this area. Short-wavelength "KTP" and "Flash lamp pulsed dye laser" systems are the first choice for thinner veins located in the more superficial layers of the skin, with diameters between 0.1 and 1 mm, while other laser systems with longer wavelengths, such as Nd:YAG and 808 nm Diode, eliminate deeper, thicker varicose veins with diameters between 0.3 and 5 mm. Treatment duration and sessions may vary depending on the patient's skin type, vein diameter, depth, and extent. While a single treatment session is often sufficient, 3-5 sessions may be required for deeper and thicker varicose veins. The application is quick and takes only a few minutes. No preparation is required before the procedure, however, as with all procedures, blood-thinning medications should not be taken for at least one week prior to the procedure. Sun exposure should be avoided for up to one week before and after the procedure, and appropriate sunscreen should be used.
Surgical treatment
In the surgical treatment of varicose veins, a method called stripping, which was previously recommended as a must-do, is no longer preferred today unless there is insufficiency in the great saphenous vein. In the stripping method, the great saphenous vein (vena saphena magna) was removed by pulling it out through incisions made in the groin and ankle using a steel wire inserted into the vein. Due to its rather crude surgical technique, the increased hospital stays, the fact that it is more convenient to perform under general anesthesia, and the lack of additional benefit in the treatment of varicose veins except in certain specific cases, it has been abandoned over time, except for certain necessary conditions.
Timing
Regarding timing, while it can generally be performed in any season, it is not recommended during the hot summer months due to the need for elastic bandages or high-compression stockings in the post-operative period.
It is absolutely necessary to wear an elastic bandage or compression stocking for 10 days after the operation. For operations that do not require hospitalization, 3-4 days of home rest after the operation is generally sufficient. After this rest, if necessary, you can return to work, provided you wear compression stockings. However, in cases where many large varicose veins are removed, the operation is performed under general anesthesia, or stripping (see paragraph above) is required, an overnight hospital stay and 1 week of home rest, including the first two days in bed, is appropriate. In this case, it is beneficial to rest in bed for the first two days after the operation, keeping your legs slightly elevated.
Bathing is allowed on the second day after the operation. For the first week, showering should be limited to regular showers and should not be done with excessively hot water.
Post-operative
If there are no complications after the operation, we recommend a follow-up schedule that includes a doctor's check-up on the 2nd day, a second check-up and stitches removal in the 1st week, and a final check-up on the 10th day to remove compression stockings or elastic bandages, as well as a discussion of what needs to be done afterwards.
Compression Stockings
For patients with varicose veins, wearing a good compression stocking at all times is crucial for preventing varicose vein-related symptoms and as an adjunct to the described treatment methods. The stocking should be worn whenever possible, and the following points are important when wearing them:
• To be worn before getting out of bed in the morning,
• While lying in bed, keep your feet elevated for 3-4 minutes (they can be placed on two pillows) to allow the veins to partially drain.
• The socks will be put on in this position, and then you will stand up.
• Socks that are left on all day should be taken off at night and placed by the bedside.
Compression stockings are produced in various textures, colors, and pressure levels; now, thin-textured and specially colored stockings suitable for everyday wear are available. Stockings are divided into 4 groups according to their pressure level.
• Class 1, 20-30 mmHg pressure, mild surface application.
• Class 2, 30-40 mmHg pressure, medium impact.
• Class 3, 40-50 mmHg pressure, combined superficial and deep acting.
• Class 4, >50 mmHg, very deep impact socks.
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