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What Causes Varicose veins?

There are two systems of veins in the leg. One that lies just under the skin is called superficial system and the one that lies deep in the muscle is called the deep venous system.

Blood is directed from the superficial to the deep venous system, which then takes the blood back to the heart for purification. There are two main valves linking the two systems. The main one is in the groin and it is called the sapheno-femoral junction and another large one is behind the knee called the sapheno-popliteal junction. There are also other links between the systems along the leg called perforators. All these links have valves as well. The valves normally only allow blood to go from superficial to deep. When the valves do not work (they become incompetent), blood is allowed to reflux back from the higher-pressure deep system to the superficial system. This makes the veins under the skin bulge and stick out. These are called varicose veins. The higher pressure in the varicose veins causes the symptoms of varicose veins.

Thread veins are extremely common and sometimes embarrassing, mostly affecting the face and legs. The causes of thread veins are unknown although they may be caused by changes in temperature, smoking, hormonal changes, alcohol and prolonged standing as well as being a possible inherited condition.

Varicose veins are veins that have become enlarged and twisted. The term commonly refers to the veins on the leg

• Cosmetically unsightly
• Aching, heavy legs (often worse at night and after exercise).
• Appearance of spider veins (telangiectasia) in the affected leg.
• Ankle swelling.
• A brownish-blue shiny skin discoloration near the affected veins.
• Redness, dryness, and itchiness of areas of skin - termed stasis dermatitis or venous eczema, because of waste products building up in the leg.
• Minor injuries to the area may bleed more than normal and/or take a long time to heal.
• In some people the skin above the ankle may shrink (lipodermatosclerosis) because the fat underneath the skin becomes hard.
• Restless legs syndrome appears to be a common overlapping clinical syndrome in patients with varicose veins and other chronic venous insufficiency.
• Whitened irregular "scar-like" patches can appear, especially at the ankles, "atrophie blanche".

Complications from Variouse Veins

Most varicose veins are relatively benign, but severe varicosities can lead to major complications, due to the poor circulation through the affected limb.

Symptoms

Surgical:
Ligation of the SFJ or the SPJ
Recurrence still occurs and it is advised to remove the long saphenous as well as ligation.
Long Saphenous Vein (LSV) Surgery (Trendelenburg Procedure).  Higher chances of neurologic pain at site of the saphenouse vein.

Non-surgical treatment

Sclerotherapy

A commonly performed non-surgical treatment for varicose and "spider" leg veins is sclerotherapy in which medicine is injected into the veins to make them shrink. It has been used in the treatment of varicose veins for over 150 years. Sclerotherapy is often used for telangiectasias (spider veins) and varicose veins that persist or recur after vein stripping [ Sclerotherapy can also be performed using microfoam sclerosants under ultrasound guidance to treat larger varicose veins, including the great and short saphenous veins. A study by Kanter and Thibault in 1996 reported a 76% success rate at 24 months in treating saphenofemoral junction and great saphenous vein incompetence with STS 3% solution.  Complications of sclerotherapy are rare but can include blood clots and ulceration.  

Radiofrequency

Radiofrequency endovenous ablation works by thermal destruction of venous tissues. Electrical energy passes through the tissues in the form of high-frequency alternating current and is converted into heat, which causes irreversible localised tissue damage. Radiofrequency energy is delivered through a special catheter with deployable electrodes at the tip; the electrodes touch the vein walls and deliver energy directly into the tissues without coagulating blood.