Ugur Bengisun, MD Professor of General Surgery
İbn-i Sina Hospital of Ankara University, Ankara/Turkey
Private Office : Tunalı Hilmi Caddesi Yaprak Apartmanı 94/14 Kavaklıdere 06680 ANKARA
Telephone: +90 312 466 1656
Fax: +90 312 466 1658
e-mail:  info@ugurbengisun.com
www.ugurbengisun.com

VARICOSE VEINS  AND CAUSES,
Chronic venous disease (CVD) of lower extremities is a major   socio-economic burden with high health care expenditures in many countries. The spectrum of clinical manifestations of CVD ranges from telengiectasias to varicose veins (vv) and severe venous skin changes ie lipodermatosclerosis and venous ulcer. Epidemiological studies have demonstrated that the prevalence of   vv   as the most common clinical form CVD is around 25-33% in women and 10-20 % in men.

Although the pathogenesis of CVD is not fully or clearly understood, sustained venous hypertension is the result of symptoms or signs of vv   which are due to valvular incompetence and venous obstruction. Venous disease is often inherited and is associated with pregnancy, obesity and standing for long periods.

In contrast to wide variety lower limb symptoms including aching, heaviness, pruritis, swelling and restless legs many patients with   CVD   are asymptomatic. Moreover patients with venous aching or swelling cannot be associated with apparent vv during examination. Interestingly similar patients who have minimal or no varicosities can show major venous reflux by duplex scanning. Therefore symptomatic patients should be assessed with great attention starting from history taking and physical examination points in search of characteristic features of alternate ischemic, arthritic or neuralgic causes for pain. This will lead to appropriate diagnostic investigations and treatment modalities.

Majority of patients (70-80%) with vv have great saphenous vein incompetence while 15-20% of  patients have lesser saphenous vein incompetence and the remaining nearly 10% have incompetence in the non-saphenous veins. After clinical assessment including history taking and physical examination of the patient, the next step is the application of various diagnostic tests in order to  better assess the pathophysiology, severity, distribution and extent of underlying abnormalities.  These tests reveal the presence or absence of reflux, obstruction or both. In this way we can diagnose and classify precisely (CEAP classification) the underlying venous problem which gives us the guidelines for correct treatment .  Currently duplex ultrasound is the gold standard to determine underlying venous abnormalities. Color flow duplex provides more precise mapping of the refluxing veins and helps identification of the possible causes.

TREATMENT OPTIONS

The most applicable treatment depends on the type, severity and location of the problem, its effect on the patient, patient age and the patient's medical history. The first treatment option is conservative and in milder conditions certain medications will help with aching or restless legs.

Treatment that is more "active" includes:

Appropriate Surgical Compression Stockings that can help to alleviate the effects of high venous pressure including swelling, aching and cramping.

Microinjection treatment or sclerotherapy, a treatment that is mainly for cosmetic problems. This treatment removes very small surface veins and is performed in a doctor's surgery or clinic. A solution (sclerosant) is injected into the vein that irritates the vessel walls. When combined with compression it glues the vein, and the resultant tissue is eventually absorbed by your body.

Ultrasound Guided FOAM Sclerotherapy. This can sometimes be used to treat larger diseased veins, and is similar in principle to micro-sclerotherapy, except that "sclerosing foam" is used .

Endovenous Laser : a newest  attractive minimal invasive procedure. Usually under local anesthesia and mostly office-based is performed. Varicose vein is ablated by thermal injury under ultrasound guidance without any incision.