Varicose veins are usually caused by failure of valves within the veins, allowing blood to flow back into the leg with gravity, increasing the volume and pressure in the veins of the leg. This causes the veins near the surface to dilate and become tortuous – these are the varicose veins. The common sites of the valve failure are in the groin or behind the knee or both. There are often secondary valve failures at other points in the leg. Occasionally varicose veins can be caused by valve failures in the veins of the abdomen and pelvis.
Other causes include narrowing or blockage of the deep draining veins, but this is much less common.
Varicose veins can occur anywhere in the leg. They may present as fine 'spider' or 'thread' veins, as larger visible and palpable varicose veins, which can grow to a substantial size. In more severe cases, the venous incompetence can cause swelling, pigmentation of the lower leg and ulcers. Varicose veins can also be associated with severe bleeding on minimal trauma and episodes of superficial thrombophlebitis in which clot forms in the varicose vein subsequently causing inflammation, pain and redness.
There are a number of therapies to treat varicose veins. The best treatment depends of the anatomy, the pathology and the individual patient. Combinations of the available treatments may be combined for the best result. The available treatments may include compression therapies to help heal ulceration. Compression alone does not cure the root cause. Definitive management is usually possible with surgery, or newer minimally invasive treatments which do not require anaesthetic and surgery. The minimally invasive treatments include simple injection therapy for spider veins, ultrasound guided sclerotherapy injection therapy for deeper veins and laser therapy. I offer both surgery and minimally invasive laser and injection therapy which is as effective as surgery.
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