Vein Conditions

Abnormalities of the veins, such as varicose veins and spider veins, are a common concern for many individuals. At Veincare Cornwall, we understand that not everyone has access to treatment through the National Health Service (NHS), which is why we offer private treatment options for those in need. We are dedicated to providing our patients with trusted information and the latest, clinically-proven treatments. Let us help you regain your confidence and improve your quality of life.

Varicose Veins

Varicose veins are a common condition in which the superficial veins in the legs become enlarged and twisted. These veins, which are located just under the skin, are responsible for carrying a small portion of the blood flow back to the heart.

The main cause of varicose veins is a problem with the valves within the veins, also known as superficial venous reflux. Normally, the valves in the veins work to ensure that blood flows in only one direction – toward the heart. However, when these valves become damaged or weak, blood can begin to flow backward and pool in the superficial veins, leading to the characteristic bulging and twisting of varicose veins. Superficial venous reflux progresses over time and if left untreated this can cause serious complications such as phlebitis, varicose eczema, bleeding, and leg ulceration. Unfortunately, only patients with these serious complications can be offered treatment for their vein condition on the NHS.

In the UK, it is estimated that around 20-30% of adults have varicose veins. The condition is more common in women and those over the age of 50. Factors such as obesity, pregnancy, and prolonged periods of standing or sitting can increase the risk of developing varicose veins. Additionally, having a family history of varicose veins increases the likelihood of developing the condition.

It is important to note that varicose veins can be a sign of an underlying issue with the circulatory system, and it is important to seek expert advice to determine the exact cause of the condition.

NHS information about Varicose Veins can be found here

The circulatory system in the body has two parts: arterial circulation and venous circulation. The venous circulation in the legs is divided into two main systems: the deep veins and the superficial veins. The deep veins are responsible for carrying the majority of the blood back to the heart, about 90-95% of the total volume. These veins play a critical role in the circulatory system and can be affected by conditions such as deep vein thrombosis (DVT). The superficial vein system drains the skin and superficial tissues and is the system where varicose veins can occur. The arterial circulation carries blood from the heart to the rest of the body under high pressure, typically 140 mmHg. This means that if a surgeon were to make a hole in an artery, there would be enough pressure for the blood to shoot out nearly 2 metres in the air.

Once the blood reaches the end of the arteries, it enters the capillary bed, which is a vast network of tiny blood vessels with a surface area almost equal to half a tennis court. The walls of these capillaries have tiny holes called fenestrations that allow fluid, oxygen, and nutrients to move into the tissues while keeping blood and protein within the capillary. It is the circulation of all these essential nutrients that keeps the tissues healthy and strong.

As the blood moves from the capillaries towards the veins, there is another set of fenestrations, but this time the blood is concentrated. The proteins in the blood create a pulling pressure called oncotic pressure, which brings fluid back into the bloodstream carrying waste products and completing the circulation of nutrients in the tissues. However, about 10% of the fluid is not reabsorbed in this way and is instead taken up by the lymphatic system.

By the time the blood reaches the veins, all the pump force (hydrostatic pressure) has been used up and there is barely enough pressure to pump the blood out of a coffee cup let alone circulate blood all the way back to the heart. To make up for this, the veins have tiny, paper-thin valves that open and close to gradually move blood back to the heart every time a muscle moves. Unfortunately, these valves are susceptible to failure and one in four people experience this. This leads to a condition called superficial venous reflux, which is the root cause of varicose veins.

Studies have shown that one in four people with leaking valves goes on to develop varicose veins. Environmental factors like height, occupation, weight, smoking, and pregnancy determine whether the reflux will lead to varicose veins. Some evidence even suggests that this process may start early in life, as one in four 12–13-year-olds already have leaking valves and signs of superficial venous reflux.

Varicose veins are a common condition that can affect up to 30% of adults. Women are more likely to develop them compared to men. As people age, the risk of developing varicose veins increases, with those over 50 being particularly susceptible.

Obesity and pregnancy also increase the risk of developing varicose veins as they put extra pressure on the veins in the legs. People with a family history of varicose veins are more likely to develop them too.

Sedentary lifestyles and prolonged periods of standing or sitting can also increase the risk of developing varicose veins. If you have any of these risk factors, it is important to take steps to prevent the development of varicose veins.

In summary, anyone can develop varicose veins, but women, older people, those who are overweight or obese, pregnant women, and those with a family history of varicose veins are more likely to get them.

Varicose veins are caused by weakened valves in the veins. The veins have tiny one-way valves that prevent blood from flowing backward. When the walls of the veins stretch and become less elastic, the valves can weaken.

If the valves are not working properly, blood leaks and flows backward. The medical term for this is Superficial Venous Reflux. As with any elastic tube that is put under pressure, the veins swell and enlarge, both in diameter and length, creating the characteristic twisted and bulging look of varicose veins.

Unfortunately, superficial venous reflux progresses over time and if left untreated this can cause serious complications such as phlebitis, varicose eczema, bleeding and leg ulceration. Currently, as NHS vein treatment is tightly rationed, only patients with these serious complications can be offered treatment for their vein condition on the NHS.

Varicose veins can pose some risks if left untreated, the medical term used for these problems is complications. Although most people with varicose veins do not develop complications, it is possible that some may experience them several years after the veins first appear. Some of the possible complications of varicose veins are:

Bleeding

Surface veins that are varicose may bleed if the skin is cut or bumped. The bleeding may be difficult to stop, and it is important to seek medical help immediately if direct pressure on the wound does not stop the bleeding.

Blood clots

Blood clots in superficial veins can lead to conditions such as thrombophlebitis or deep vein thrombosis.

Image showing acute superficial thrombophlebitis on patients medial left leg

Thrombophlebitis

This is swelling and inflammation of the veins in your leg caused by blood clots. It can be painful, look red, and feel warm to the touch. Thrombophlebitis can be treated with compression stockings and in some cases with non-steroidal anti-inflammatories such as ibuprofen.

Deep vein thrombosis

This can develop in up to 20% of people who have a blood clot in superficial veins. It can cause pain, swelling, and serious complications such as pulmonary embolism.

The classic early appearances of varicose eczema and lipodermatosclerosis with brown skin staining known as haemosiderin deposition

Chronic venous insufficiency

This occurs when the blood in the veins does not flow properly, disrupting the exchange of oxygen, nutrients, and waste products with the blood. Over time, this can cause skin conditions such as varicose eczema, lipodermatosclerosis, and venous ulcers.

Varicose eczema

This causes the skin to become red, scaly, and flaky and may develop blisters and crusting.

Lipodermatosclerosis

This causes the skin to become hardened, tight, and red or brown in color, usually affecting the calf area.

Here we see progression of the skin changes with early skin breakdown and the start of ulcer formation

Venous ulcers

These develop due to increased pressure in the veins of the lower leg and result in fluid seepage and skin breakdown to form an ulcer, most commonly in the ankle area.

It is important to seek help from a vein specialist or your GP immediately if any unusual changes in the skin are noticed, as these conditions can usually be easily treated with prompt medical attention.

In the UK, it is estimated that around 20-30% of adults have varicose veins. The condition is more common in women and those over the age of 50. The exact cause of why the valves in the veins weaken is not fully understood. However, a number of factors can contribute to the development of varicose veins. These include:

Gender

Women are more likely to be affected by varicose veins than men. Research suggests that this may be because female hormones tend to relax the walls of veins, making the valves more prone to leaking.

Genetics

Over 25% of the adult population will develop varicose veins during their lifetime, with heredity being the primary cause. This means that you are more likely to develop varicose veins if a close family member has them.

Age

Varicose veins are more common with increasing age. As we get older, the veins start to lose their elasticity, and the valves within them stop working as well.

Weight

Being overweight puts extra pressure on the veins, which means that they have to work harder in order to send the blood back to the heart. This can put increased pressure on the valves, making them more prone to leaking.

Environmental Factors

Environmental factors also play a large part, for example, prolonged standing in various occupations and our Western diet with high fat, refined sugar, and low fiber content may also contribute.

Pregnancy

During pregnancy, the amount of blood in the body increases to help support the growing baby. This puts an extra strain on the circulatory system. Increased hormone levels during pregnancy also cause the muscular walls of the blood vessels to relax. Both of these factors may increase the risk of developing varicose veins.

Varicose veins may also develop during pregnancy as the uterus (womb) starts to grow. The expanding uterus puts pressure on the veins in the pelvic area, which can sometimes cause them to become varicose.

Although being pregnant may increase the risk of developing varicose veins, in 60-70% of women the veins improve considerably after their pregnancy. You can find out much more about varicose veins in pregnancy in a blog that Rob has written. You can find the blog here on our blog page.

Getting an accurate diagnosis is important to determine the best course of treatment. Here’s a step-by-step guide to help you understand how varicose veins are diagnosed.

Step 1: Clinical Examination

Your healthcare provider will start by examining your legs to see if you have visible signs of varicose veins. They will look for swelling, redness, or discoloration, and check to determine the location and extent of the veins. They may also ask you about your symptoms and medical history to identify any risk factors for varicose veins.

Step 2: Ultrasound Venous Duplex

The next step is an ultrasound venous duplex, a non-invasive test that uses sound waves to create images of your veins and blood flow. It is performed by Rob Windhaber himself as part of the outpatient consultation. This test provides a definitive diagnosis and information about the underlying cause, severity, and extent of your condition. The images from the test are crucial in determining the best course of treatment for you.

Why an Ultrasound Venous Duplex Scan is the Key to Effective Veincare?

The ultrasound venous duplex uses sound waves to create detailed images of your veins and accurate information about blood flow and valve function. This information is critical in determining the underlying cause of your vein condition and the most appropriate course of treatment. The test is quick, painless, and non-invasive, and does not involve any radiation exposure or risks associated with invasive procedures. The information obtained from the test allows your healthcare provider to determine the most effective course of treatment for your varicose veins. Additionally, the test is cost-effective and provides accurate results.

Expert Care for Accurate Results

To ensure accurate results, it’s important that the ultrasound venous duplex is performed by an experienced and fully trained healthcare professional. Rob Windhaber, has undertaken extensive training in ultrasound scanning and performs all scans himself. This provides additional information and helps him fully understand the underlying vein condition and gives additional information about how the veins may respond to the different types of treatment. Only with the right treatment, you can find effective and long-term relief from the discomfort and swelling of varicose veins.

While it’s challenging to completely stop varicose veins from getting worse or prevent new ones from developing, there are some measures you can take to ease symptoms, including:

  • Maintaining a healthy weight through a balanced diet to reduce pressure on your leg veins
  • Wearing compression stockings to improve blood flow and relieve discomfort
  • Avoiding high heels that put extra pressure on leg veins
  • Quitting smoking, which can harm veins and increase the risk of varicose veins
  • Staying active improves blood flow and lowers the risk of varicose veins.

Treatment for Varicose Veins: The Permanent Solution

The only way to completely get rid of varicose veins or prevent their progression is through modern, minimally invasive techniques such as endovenous laser ablation. This method effectively treats problematic veins, offering a permanent solution.

Compression stockings are designed to improve circulation by applying graduated pressure on the legs. The pressure is tightest at the ankle and becomes gradually looser up the leg, encouraging blood flow towards the heart. While compression stockings may relieve pain and swelling caused by varicose veins, their ability to prevent their progression or occurrence is not clear. NICE recommends compression stockings only as a long-term treatment option when other treatments are unsuitable. Pregnant individuals with varicose veins may also use them during pregnancy.

Classification of compression stockings depends on the level of compression they provide, ranging from light (Class 1) to extra-firm (Class 3). Class 2 (20-30mmHg) stockings are commonly prescribed for individuals with varicose veins. Compression stockings come in various types including knee-high, thigh-high, and pantyhose, and are available in different colours, lengths, and foot styles. Some compression stockings come with stocking liners for added comfort and others have zippers for easy wearing and removal.

Proper measurement of compression stockings is important for a correct fit and optimal compression. The measurement should be taken around the widest part of the calf, ankle, and leg. Made-to-measure compression stockings are also available for individuals with non-standard leg shapes.

Wearing compression stockings requires a normal arterial supply. Individuals with poor arterial circulation or other conditions affecting the blood supply to their legs should not use compression stockings without medical advice. The ankle-brachial pressure index (ABPI) or Doppler test can determine the arterial supply by measuring the blood pressure at the ankle and comparing it to the blood pressure in the arm. If the blood pressure in the ankle is lower than that in the arm, it may indicate poor arterial circulation and contraindicate the use of compression stockings.

It is important to seek medical advice and check circulation concerns before using compression stockings to ensure their safety and suitability. The ABPI test is a simple way to check the arterial supply and determine the appropriateness of compression stockings.

In summary, compression stockings come in various types, classes, lengths, and colours, and a proper fit is essential for effective compression and comfort. Before use, it is important to seek medical advice and have any concerns about circulation checked. The ABPI test can be used to determine the arterial supply and appropriateness of compression stockings.

Top Tips for Wearing Compression Hosiery

  • Put them on in the morning and take them off at night.
  • Pull up fully to ensure proper compression.
  • If uncomfortable, ask GP about custom-fit stockings.
  • Use a stocking applicator for ease of use.
  • Two types: knee-high (ankle & calf compression) and thigh-high (full leg compression).
  • Wash regularly for hygiene and longevity.
  • Apply moisturizing cream to prevent dry skin.
  • Watch for signs of skin irritation.
  • Compression stockings usually have to be replaced every three to six months otherwise the elastic wears and they do not provide the correct level of support (old stockings are often more comfortable for that exact reason)

Top Tips for Caring for Compression Stockings

It is essential to keep your compression stockings in good condition to ensure their effectiveness. Here are some guidelines for caring for your compression stockings:

  • Replacement: Compression stockings typically need to be replaced every 3 to 6 months. If you notice any holes, tears, or other damage, it is best to speak to your GP or vein specialist to order replacements as they may no longer be effective in providing the compression you need.
  • Prescription: Your healthcare provider should prescribe two stockings (or two sets of stockings if you are wearing one on each leg) so that you always have a clean pair ready to wear.
  • Washing: Compression stockings should be hand washed in warm water, using a gentle detergent. Avoid using fabric softeners, bleach, or other harsh chemicals that can damage the compression material.
  • Drying: After washing, air dry your compression stockings away from direct heat, such as a radiator or hair dryer. Do not tumble dry, iron, or dry clean your stockings, as this can damage the compression material and affect their effectiveness.

By following these simple care instructions, you can ensure your compression stockings are always in good condition and working effectively.

Further Information

You can book your consultation via our contact page, you can email us at: info@windhaber.co.uk or you can call the Duchy Hospital Directly at 01872 438983.