02.03.2024

Beware of the outdated surgery that makes varicose veins worse

Maxi dresses and linen trousers have been my uniform since my 20s when summer kicks in — it’s the best way to hide my lower legs, spattered with ugly raised veins.

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

At their worst, they are often painful, especially during summer months when heat causes the blood vessels to dilate, making it even harder 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 lead to thickened, inflamed skin and ulceration, as well as unsightly brown ‘hemosiderin’ staining, caused by blood leaking.

Varicose veins affect more than a third of us, and they get worse over time. At their worst, they are often painful, especially during summer months when heat causes the blood vessels to dilate (File image)

Varicose veins affect more than a third of us, and they get worse over time. At their worst, they are often painful, especially during summer months when heat causes the blood vessels to dilate (File image)

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

The result is that patients who thought the problem had gone face more complicated treatment the next time round. That’s 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 dropped 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 anyone with ‘symptomatic or recurrent varicose veins involving pain, aching, discomfort, swelling, heaviness and itching’ be referred to a vascular service.

Thousands aren’t getting the treatment they need, forcing some to live with painful open sores, in some cases for years, said a 2019 Parliamentary report.

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

I was 28, and, as I learned quickly, varicose veins can occur at any age, as they’re largely genetic. If one of your parents had them — and my mother did —  you are likely to get them, too.

Mine got steadily more problematic, affecting both legs, with each pregnancy. After baby number four in 2003, my GP referred me for vein ‘stripping’ — this involves making small cuts along the leg under general anaesthetic; 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 per cent of patients, a few years later the problem returned.

Thousands aren’t getting the treatment they need, forcing some to live with painful open sores, in some cases for years, said a 2019 Parliamentary report (File image)

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

‘Instead of growing back straight, these new immature vessels grow back twisty or torturous and with no valves,’ says Nung Rudarakanchana, a consultant vascular surgeon at London North West University NHS Trust. As a result, the varicose veins can recur.

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

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

Other treatments recommended by NICE when laser treatment isn’t possible — for instance, in very twisty veins — include foam sclerotherapy, where a chemical detergent mixed with air is injected directly into each vein, irritating the lining and closing it.

However, the 2019 Parliamentary report found there is huge 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 Miss Rudarakanchana.

‘But if you’re suffering, ask for a referral to a vascular surgeon or interventional radiologist, quoting NICE guidelines.’

She adds: ‘Treatment not only resolves the physical problem, but the psychological benefits are often transformative.’

Recently, my varicose veins became more than ‘just’ a cosmetic problem; I began to get pins and needles in my left foot and my leg throbbed from thigh to toe.

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

My GP was sympathetic but not hopeful that I’d get NHS treatment and asked if I had private health insurance. I don’t.

When I went to see Miss Rudarakanchana privately at the Veincentre clinic in London, I was shocked to learn my previous vein stripping had not just been painful, but had resulted in neovascularisation — my great saphenous vein had grown back ‘torturously’ in both legs, while in my left leg it had dilated, measuring 1cm in diameter at my knee — it should be 2-3mm.

‘That’s why you are feeling so much pressure in your leg and ankle,’ she told me.

I had an hour-long session of EVLA (treatment costs £2,500 for both legs: full disclosure, I did not pay) which, while not painless, was tolerable.

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

Within another six weeks, the ugly purple splashes had gone, and I no longer feel self-conscious. I’m also now reassured I won’t be an early candidate for leg ulcers.

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