Beware of the outdated surgery that makes varicose veins worse

Long dresses and linen pants have been my uniform since I was 20, come summer: it’s the best way to hide my lower legs, dotted with ugly raised veins.

Varicose veins affect more than a third of us and get worse over time. All leg veins contain tiny one-way valves, and when they don’t work properly, blood that needs to be pumped back to the heart flows backwards and pools, stretching the walls of the veins and causing them to bulge.

At their worst, they are often painful, especially during the summer months when the heat causes blood vessels to dilate, making it even more difficult for the valves to work properly.

Pain can also be a sign of serious complications, including inflammation of the underlying fat.

Untreated varicose veins can cause thickening and inflammation of the skin and ulceration, as well as unsightly brown ‘haemosiderin’ spots, caused by blood leakage.

Exacerbating all this, the standard treatment for years, the ‘strip’, invariably leads to the problem recurring.

The result is that patients who thought the problem was gone are faced with a more complicated treatment the next time. That is if they can even get treatment.

Analysis of NHS hospital statistics, published last year in the British Journal of Surgery, found that treatment rates have fallen over the past 20 years in all but the oldest age groups (over 75s). ), despite the National Institute for Health and Care Excellence (NICE) recommending that anyone with ‘recurrent or symptomatic varicose veins presenting with pain, discomfort, swelling, heaviness and itching’ be referred to a vascular service.

Thousands go without the treatment they need, forcing some to live with painful open sores, in some cases for years, according to a 2019 parliamentary report.

My first small, raised vein appeared when I was pregnant with my first child 27 years ago.

I was 28 years old, and as I quickly learned, varicose veins can strike at any age, as they are largely genetic. If one of your parents had them, and my mother had them, chances are you have them too.

Mine became more and more problematic, affecting both legs with each pregnancy. After baby number four in 2003, my GP referred me for vein ‘stripping’, which involves making small cuts down the length of the leg under general anesthesia; A wire ‘stripper’ is then used to pull the vein out through these incisions.

It was brutal and painful, and I had to take weeks off work. It also left scars, and as with up to 70 percent of patients, a few years later the problem returned.

Thousands go without the treatment they need, forcing some to live with painful open sores, in some cases for years, according to a 2019 parliamentary report (File Image)

The removal usually involves the great saphenous vein, a superficial vein that runs from the thigh to the foot; But in many people, the body’s natural healing process causes new blood vessels to form (a process called neovascularization).

“Instead of growing back straight, these new immature vessels grow back crooked or tortuous and valveless,” says Nung Rudarakanchana, a consultant vascular surgeon at London North West University NHS Trust. As a result, varicose veins can recur.

In 2013, NICE stopped recommending stripping procedures in favor of endovenous laser ablation (EVLA), where, under local anesthesia, a fine needle is placed into the vein and laser heat is used to destroy the vein wall, that the body absorbs.

A review in The European Journal of Vascular and Endovascular Surgery in 2019 showed that the overall success rate for EVLA, which usually takes about an hour, was 92 percent after three years. There were also far fewer recurrences.

Other treatments recommended by NICE when laser treatment is not possible, for example in severely crooked veins, include foam sclerotherapy, where a chemical detergent mixed with air is injected directly into each vein, irritating the lining and closing it off.

However, the 2019 parliamentary report found that there is wide variation in access to treatment.

“Patients have heard that the NHS won’t treat their varicose veins, so they don’t go to their GP,” says Ms Rudarakanchana.

“But if you are suffering, ask for a referral to a vascular surgeon or interventional radiologist, citing NICE guidelines.”

She adds: “The treatment not only solves the physical problem, but the psychological benefits are often transformative.”

Recently, my varicose veins have become more than just a cosmetic problem; My left foot started to tingle and my leg ached from thigh to toe.

Then my foot started to feel like it was bursting and I started to worry about the risk of leg ulcers.

My GP was sympathetic but did not trust that I would receive treatment from the NHS and asked if I had private health insurance. No.

When I went to see Miss Rudarakanchana in private at the Veincentre clinic in London, I was shocked to learn that the removal of my anterior vein had not only been painful, but had resulted in neovascularization – my great saphenous vein had grown back.” tortuously” on both legs. while on my left leg it had dilated, measuring 1 cm in diameter at my knee, it should be 2-3 mm.

‘That’s why you feel so much pressure on your leg and ankle,’ he told me.

I had an hour long session of EVLA (treatment costs £2500 for both legs – full disclosure, I didn’t pay) which, while not painless, was tolerable.

This was followed by (painless) injections of foam sclerotherapy to treat sections too crooked to be reached by the laser. Six weeks later, I had more sclerotherapy injections for the small veins.

In another six weeks, the ugly purple spots were gone and I no longer feel self conscious. I am also now confident that I will not be an early candidate for leg ulcers.