Is vein stripping always the right solution to varicose veins?

Circulation | Healthy legs – varicose veins


Owen Wiseman
@AVogel_ca


20 June 2019

What is vein stripping?

This minor surgery is a means of removing a damaged vein for the purpose of preventing potential complication as a result. An incision is made below and above the damaged part of the vein with an instrument then threaded through the vessel at the top incision. The damaged vein is then pulled out through the bottom incision

What are the symptoms of varicose veins?

As mentioned, colour changes and bulging of the veins are obvious to the observer.

The condition may also result in a sense of itchiness and burning, especially if you're on your feet all day allowing a great volume of blood to pool in the lower extremities.

There may also be skin changes such as dryness and flaking, almost like eczema, better known as venous stasis dermatitis. This term indicates that due to a lack of circulation, the skin becomes irritated and inflamed. It can begin to change colours, shifting between red and blues. If you begin to notice black tissue or the formation of open wounds, it's critical that you seek medical attention as soon as possible. Black tissue usually indicates cell death, known as necrosis, while the open wounds are known as ulcerations that form as the tissue disintegrates.

What are the complications that could occur if the vein were left alone?

Due to the elevation of the varicose vein away from the skin, this makes them more prone to damage and subsequent bleeding if you were to fall or damage the tissue. Due to the damage, it's possible for clots to form within the vein which can result in severe pain and swelling, a condition known as deep vein thrombosis. This carries the potentially deadly risk of a pulmonary embolism, a blood vessel in the lungs blocked by a clot, typically one that has traveled from an area such as the legs.

When the veins are chronically deprived of proper blood flow, this can lead to manifestations in the skin such as having it become hardened and thicker, a condition known as lipodermatosclerosis.

Chronic venous insufficiency can also lead to an eczema like picture where it becomes red and flaky. One final complication worth mentioning is the formation of ulcers, open wounds that are incredibly slow to heal due to the poor circulation of blood through nearby tissues.

What are the potential risks associated with vein ligation?

As with many surgical procedures, scarring is a potential risk and there is a possibility that the varicose veins return. While surgeons are careful to avoid damaging aspects of the deep vein structures, an incident occurring to these tissues may lead to a worsening of blood flow and potentially numbness if nearby nerves are damaged.

Who should not have vein stripping?

It's always important to consult a vascular specialist to determine whether the surgical route is your only option.

Those with chronic venous insufficiency, as discussed earlier, seldom undergo venous stripping.

Those who are pregnant are often advised against venous stripping as the varicose veins may spontaneously regress in the weeks following delivery. Finally, those with an acute deep vein thrombosis may be advised against the procedure as well.

Additionally, those with small varicose veins may be treated with a minor procedure known as sclerotherapy. A chemical irritant is injected into the vein, causing it to seal shut. You may be wondering what happens to the blood that's supposed to flow through the vessel. The nearby veins will compensate for the increased flow through their tissues.

Would compression stockings help?

While stockings are not a cure and will not reverse the damage done, they have been shown to be effective in reducing symptoms and slowing the progression of the condition. They provide constant pressure to the tissues of the legs. Pressures between 18-21mmHg for a one-week period reduced associated pain. It's important to discuss with your primary care provider to determine the appropriate pressure for your own body.

Are there any other options for me?

For some herbal help, one could try the herb Aesculus hippocastanum, more commonly known as horse chestnut. This potent herb has historically been used for toning the blood vessels throughout the body and controlling the build-up of fluid that could result in varicose veins. The herb contains flavonoids and the coumarin, esculin, which are active in capillary fragility. Products such as Venaforce come in tablet, liquid, and gel form. The gel can be massaged into the legs in an upward motion to follow the natural flow of blood. Always check with your primary care provider when adding a new product to your regime as it may interact with your medication.

Finally, a simple 15 minutes spent on your back with your legs elevated against the wall can alleviate the effects of gravity on the lower extremities, allowing the blood to circulate without resistance. This can reduce the stress on the varicose veins and potentially alleviate symptoms temporarily, especially those where the tissues have swollen.

References

https://www.bmj.com/content/362/bmj.k3115
https://www.ema.europa.eu/en/documents/herbal-report/final-assessment-report-aesculus-hippocastanum-l-cortex_en.pdf
https://www.ncbi.nlm.nih.gov/books/NBK279246/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4144244/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4144250/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4301287/
https://www.ncbi.nlm.nih.gov/pubmed/18692348
https://www.ncbi.nlm.nih.gov/pubmed/24323411
https://www.ncbi.nlm.nih.gov/pubmed/29129457
https://www.nhs.uk/conditions/varicose-veins/complications/