Varicose veins are a very common health problem, especially in the female sex, which affects the veins of the legs. The function of the veins is to bring the circulating blood back to the heart. When a person suffers from varicose veins, this function may fail and circulation may slow down, with a buildup of blood in the legs and feet. The symptoms are heaviness, fatigue, pain, sometimes nocturnal cramps.
Symptoms generally worsen at the end of the day, during the menstrual cycle, with heat and tend to improve by keeping the legs raised relative to the body. In severe cases, skin changes in the legs and ulcers can occur. Heredity, hormonal dysregulation, prolonged standing during the day, obesity, pregnancy and aging are all factors that can contribute to the onset and evolution of this problem.
The impact in everyday life can be significant and influence the habits, the way of dressing and therefore the quality of life as a whole.
In the established cases, the main therapy is the use of elastic stockings. These special elastocompressive socks allow a rapid improvement of the symptoms and are able to slow down the evolution of the disease. When, however, in addition to the disorders, a significant aesthetic problem coexists, it is advisable to resort to surgical treatment.
The most effective treatment to eliminate varicose veins both large and small, both a source of disorders and simple aesthetic problems, is their surgical excision in the clinic, using local anesthesia (the same used by the dentist). The operation is called ambulatory phlebectomy and consists in the removal of the diseased vein through small holes (rarely over a millimeter) made on the skin with a simple needle, along the entire course of the vein. The wounds are so small that they do not need stitches and, usually after two months, they are barely visible and after six months they are invisible. The patient can immediately return to his usual activity, taking care to take a compressive bandage for a week in the treated area.
Once the varices have been removed, any remaining capillaries can be eliminated with sclerosing injections, which will be performed starting from the second post-operative week.
Capillaries of the Legs
On the legs often appear, even at a young age, the unsightly capillaries in the lower limbs. The telangiectasia (the so-called capillaries) are small dilated blood vessels (diameter varying between 0.1 and 1 mm), located in the dermis and unfortunately clearly visible through the epidermis. Their clinical importance is not limited to the aesthetic discomfort, mainly concerning (but not only) the female sex, since they can be accompanied by a symptomatology characterized by burning, heaviness up to the actual puncture pain. The discomfort can intensify during the pre-menstrual phase of the cycle.
In many cases the dilated and visible capillaries are fed by diseased veins (called nourishing veins) from which the blood flows. However, the nourishing veins, unlike the capillaries, are often invisible to the naked eye and difficult to locate.
Using near infrared (NIR) technology, the precise placement of the subcutaneous venous tissue can be visualized and projected in real time onto the skin. Thanks to Vein Viewer (Luminetx Corp., Memphis, TN, USA), it is possible to easily locate the nourishing veins and make capillary treatment faster and more effective.
Sclerosis is considered the reference therapy for eliminating the capillaries in the lower limbs. By injecting small amounts of low concentration sclerosing substances, with the help of fine needles, a progressive attenuation can be achieved until the definitive or partial disappearance of the problem. The number of sessions required varies from individual to individual and is related to the extent of the phenomenon and the individual response to therapy.
The treatment is preferably carried out in the winter months and during the spring, before the warm season arrives because solar exposure is contraindicated during treatment. The sessions are performed weekly. The patient can return to his usual activities immediately with the caution to bring, for a few days, a small elastocompressive band, in addition to the elastic stockings of adequate gradation that will be prescribed after the initial visit.
In patients with an obvious venous problem or complaining of discomfort in the legs, before any treatment, it is advisable to perform a complete Eco-Doppler examination of the superficial and deep veins of the lower limbs. This examination, completely painless, is performed by placing a small handpiece (probe) on the skin, interposed by a layer of gel.
The examination is performed with the patient standing and allows the doctor to visualize the flow of blood in the veins.
No blood chemistry is required, except in those patients with a history of phlebitis or deep vein thrombosis.
Prof. Stefano Ricci Physician Surgeon is one of the world’s leading experts in Phlebology. Honorary member of the American College of Phlebology. Founder and Editor in Chief of Veins & Lymphatics magazine. Honorary member of the American Society of Ambulatory Phlebectomy. Member of the Société Française de Phlébologie and Italian representative of the Société Européenne de Phlébectomie.
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