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Q&A varicose vein of legs
What’s varicose vein of legs?
Varicose vein makes blue pipes in a foot swollen and they become puffy like a bump. They are large and small, various ones. Since They look bad, varicose vein is among the diseases that women wish to avoid. Varicose vein itself doesn’t cause harm, it is the stagnation of blue pipes that triggers symptoms such as lassitude and edema. It is developed from eczema to ulceration when it gets worse. Unless it is awfully severe varicose vein, bleeding is rare and varicose vein itself is not life-threatening. Even so, we rely on feet throughout our lives and they are necessary parts of the body that enable us to walk. Chronic issues such as prolonged symptoms of laziness are what we hope to overcome and that is the varicose vein of legs.
What kinds of blue pipes are there in the lower extremity?
There are 3 kinds of blue pipes; superficial vein, deep vein and communicating ramus(penetrating branch).
There are 2 kinds of superficial veins: great saphenous vein and small saphenous vein. Deep vein runs inside the muscle and there are 6 deep veins in a lower leg.
Communicating ramus is a blood vessel that connects the surface with the deep part. There are said to be more than 100 of them.
As for the valve of blue pipes, unlike artery, they have valve structure. This is to prevent blood from flowing backward.
What causes varicose vein of legs?
In case of women, they say, it is mostly caused by delivering a baby. Other than that, there are various factors such as standing for a long time at work and heredity. Recently, the number of men being diagnosed with varicose vein has been on the increase. The direct cause of varicose vein is generally backflow of the valve. When the valve working against backflow of blood vessel that runs on the surface(superficial vein) becomes ruined, the blood of blue pipes starts flowing back and gradually blood vessel becomes swollen and lump-formed.
What would happens if I varicose vein were left untreated?
The initial symptoms of varicose vein are swollen blue pipes looking like a lump or slightly plumped blood vessel appeared in most cases there are no symptoms at all. Gradually, the stagnation in blue pipes progress and lassitude, swelling and fatigue etc. are generated. it starts causing a cramp in the leg (Charley horse),too. Additionally when it becomes more advanced, sensations of burning and skin alteration(itch and eczema) are experienced. and if they are not treated appropriately, skin irritation and pigmentation develop into hardening of skin, erosion and ulcer, leading to severe condition that is difficult to treat.
What kinds of varicose veins are there?
As the cause of varicose veins lies in the backflow of non-return valves, these listed below can be categorized in the similar types of varicose veins.
  1. Large saphenous vein: caused by large saphenous vein.
  2. Small saphenous vein: caused by small saphenous vein.
  3. Collateral varicose vein: caused by the branch and communicating ramus.
  4. Cancellate varicose vein: even smaller and the diameter of vein is roughly 3mm.
  5. Araneose varicose vein: accompanied by enlarged capillaries.
What examination methods are there for varicose vein of legs?
In past days, painful examinations such as phlebography were most commonly performed. Recently, with the advancement of echography, the examination of varicose vein of legs has been capable of performing in a way that doesn’t accompany pain.
What treatment approaches are there for varicose vein of legs?
Today, there are treatment methods such as surgical treatment(selective stripping, high ligation, removal of failing communicating ramus, cirsectomy), intravascular surgery(laser procedure) and sclerotherapy.
The symptoms of varicose vein of legs vary one person to another and they are never the same as bumps are formed by various expanded blood vessels. However, since the cause lies in the backflow of non-return valves, the similar types of varicose veins can be treated in the same way. The followings are the example of them. Each treatment method is performed by appropriately combining with various treatment methods according to its condition of the bulk.
Large saphenous vein, Stripping, laser procedure, high ligation etc.
Small saphenous vein High ligation, laser procedure
Collateral varicose vein High ligation, removal of failing communicating ramus, cirsectomy, sclerotherapy
Cancellate varicose vein Removal of failing communicating ramus, cirsectomy, sclerotherapy
Araneose varicose vein Sclerotherapy
Of course, there are cases where we conservatively monitor course of the diseases. Using the methods listed below, we may aim to alleviate symptoms and prevent its development. However, please note that although they improve symptoms, they don’t cure varicose vein.
  1. Avoid standing and sitting in a chair for a prolonged time
  2. Avoid sitting on your heels for a prolonged time
  3. Do ankle exercise (walking etc.)
  4. Don’t warm it up too much.
  5. Sleep with legs elevated
  6. Undergo compression therapy like wearing compression stockings etc.
Start with weakly-compressible ones which give pressure of 10-20mm Hg to the ankle. Hospital-use stockings are so tight that it may take time to get used to them.
Basically, High-socks are recommended.
If it occurs during pregnancy, we recommend that you prevent it from worsening by wearing compression stockings etc.
What kind of surgery is required?

Cirsectomy/ Removal of failing communicating ramus

We extirpate and litigate the varicose vein itself by incising the skin slightly (5mm-10mm), and apply treatment to the partial varicose vein and failing communicating ramus.
There is no need of suture removal as we use dissolvable stitches.
We may perform treatment in conjunction with the surgeries listed below, laser procedure and sclerotherapy.

High ligation

It’s the method applied to large saphenous vein and small saphenous vein with roots which have back-flow. It extirpates and litigates the blue pipe at its root. We extirpate and litigate the blue pipe by incising the skin(roughly10mm) at the groin or at the back of the knee. As there are many branched blue pipes that, we prevent relapses by serving the treatment in the proper way. This treatment is applied for a part of large saphenous vein(with mild symptoms) and small saphenous vein.

Selective stripping (according to Invagination Stripping)

This is the surgery generally performed for the treatment of saphenous vein. The treatment method is as described in the illustration, we incise approx.1 cm at the groin, and 1cm at the knee about 3/1 down from the lower thigh, then remove the blue pipe by inserting a specific wire into it. This has enabled us to minimize the neural damage, and since the method is less invasive compared to the conventional stripping which involved the entire body down to the ankles, day surgery has become possible too. After the surgery, patients are required to immobilize the part with an elastic wrap for one day and wear elastic stocking for the following 1-2 weeks. They are able to go back to their normal life-style from the following day of the surgery.

What’s Laser procedure(Intravenous laser treatment, Laser stripping) ?

In Shonan Kamakura General Hospital, 1-day course of laser procedure has been performed since April of 2005. And recently we introduced the know-how into Shonan Atsugi Hospital to provide the same treatment. This laser procedure is a treatment method in which we incinerate and collapse the intravenous by inserting a laser-fiber into the blue pipe using pulse YAG laser with the wavelength of 1320nm. Since it doesn’t require incision of the skin, the aesthetic effect is as superior as stripping.
And there are few complications including internal bleeding that are frequently experienced in the conventional stripping.
It is minimally invasive and starting to attract attention from people as a treatment that will replace stripping with in the days to come.
In the US, it is said that half of the treatment for large saphenous vein are already provided with less-invasive intravascular treatment.
The medical treatment provided is at your own expense as it is not covered by insurance. In Shonan Atsugi Hospital, We charge 150,000 yen(tax excluded) for the treatment.
Treatment method : please refer to the illustration.
Postoperative course: After the laser procedure, the treatment continues as following, 1 day of immobilizing the part with an elastic wrap, and 3 continuous days of wearing compression stockings, then 2 weeks of wearing these stockings during the day time.

Comparison of selective stripping with laser procedure

  Conventional method Laser procedure
learning curve
Degree of complication
Rate of relapse ○ medium-term
Aesthetic condition
Social rehabilitation
Cost,Duration of procedure
Employment cost
Cost of material expensive
Medication cost
Please tell me about complications of the surgery.
  1. It is accompanied by bleeding and procedure performed with blood vessels, and blood transfusion is not involved in the treatment.
  2. Hematoma formation, internal bleeding
  3. There is reportedly 0.1-0.6 % chance of developing blood vessel impairment and deep thrombophlebitis.
  4. Injury to lymphatic vessel
  5. Nerve damage,most are improved conservatively
  6. Aching pain after the surgery, it is recovered by taking drug for pain.
  7. postoperative wound infection etc.
  8. Postoperative skin inflammation, may develop skin inflammation associated with hardening of skin.
  9. Recurrence of varicose vein the risk of recurrence is not a zero.
  10. Residual bump there is a possibility of small bumps being left, should that occur, we treat it with sclerosing therapy.
  11. Skin irritation it is developed by the use of tapes and stockings.
  12. Complications accompanied by anesthesia
What’s sclerosing therapy?
It’s a treatment method where hardener is used to crush a blue pipe. We use a method of injecting hardener (polidocanol is mainly used in our hospital) for the therapy. And today, we provide foam sclerosing therapy in which hardener is combined with the air.

Method

Advantage
  1. We ask a patient to lie down on their side then inject medicinal solution by using a 30G needle into the blood vessel .
  2. We compress it with swabs etc. then wrap it in elastic bandages to immobilize it.
  3. The patient goes back home after moving feet for 30 minutes or so.
  4. The following day, the patient unwraps the elastic bandages on their own and put on compression stockings.
  5. Spend 3 days continuously wearing them including night time and make the shift to wear them only during day time for roughly another 4 weeks.
Disadvantage
  1. The treatment is suited for relatively small varicose veins such as araneose varicose vein and cancellate varicose vein.
  2. As for large varicose veins, since there is a high risk of relapses, sclerosing therapy is not performed independently, it is introduced in combination with surgery/ laser procedure etc. However, It is not to say that sclerosing therapy can be applied to all the treatment.

Complications

Thrombus inside the bump, pigmentation, edema at injection site, drug-induced skin inflammation, skin ulcer, necrosis
Most can be treated conservatively.

Advantages and Disadvantages

Advantages
  1. Free of scars, (minimally-invasive)
  2. Aesthetically good
  3. Can be treated in a short time
  4. Treatment is provided on an out-patient basis
  5. It doesn’t affect patients’ work
Disadvantages
  1. Risk of complications
  2. Hospital visit is required
  3. If a patient has a fear about injection, they may feel uncomfortable
  4. Problems of wearing compression stockings
For people who are concerned about varicose vein of legs・・
Varicose vein of legs is basically not life-threatening unless it is not arising from secondary cause( meaning, it is caused by deep vein).
However, it is a chronic disease and the symptoms follow a protracted course developing into troublesome ones such as skin inflammation, hardening of skin and development of ulcer. Today, with the development of less-invasive examinations(human body-friendly, free of pain) it has become easily-diagnosed. As for the treatment, it is also becoming simple, enabling patients to quickly re-adjust to society by minimizing the pain with laser procedure and such. Rather than put off treatment until it gets worse, it is necessary to be prevented and treated while it is still in the early stages.
If you are concerned, I would advice you to visit the department of varicose veins of legs, Shonan Atsugi Hospital once.
Shonan Atsugi Hospital Deputy director of the hospital Taro Kozeni