In the evening your legs get fuller and fuller, you wake up with cramps or you see these twisted, swollen veins in the mirror... This condition is called varicose veins (venous insufficiency) and can lead to serious health problems if not treated.
In this article, we will go into all the details you’re curious about, modern varicose vein treatments, and the diagnostic process, to help you get back to the health of your leg.
What is a varicose vein?
Veins are like highways that bring blood to the heart. In the veins of our legs there are one-way valves that allow blood to flow upwards against gravity and prevent it from flowing downwards. When these valves are damaged or become weak, blood flows backward and pools in the legs. This condition is known as venous reflux. The veins widen, lengthen and twist as the pressure increases and are visible on the surface of the skin.
Varicose vein symptoms: What’s your body telling you?
What you see in the mirror or how your legs feel are actually important messages from your body about your vascular health. Varicose veins (venous insufficiency) are not only a cosmetic problem but also a medical problem that can progress if not treated.
Before we look at the symptoms of varicose veins, to understand what your body is trying to tell you:
What do you feel? (Subjective symptoms)
While varicose veins may not seem to be very prominent on the outside, you may experience the following physical sensations in your legs:
- • Heaviness and fatigue in the legs: Particularly in the later hours of the day, you may feel an ineffable sense of fullness and fatigue in your legs.
- • Pain and ache: It is common to feel a dull ache, burning or throbbing in the areas where the veins are.
- • Nite cramps and restlessness: Sudden cramps in sleep or an urge to constantly move your legs (restless leg syndrome) can be signs of venous insufficiency.
- • Itching and tingling – You may experience a feeling of intense itching, tingling or prickling sensations on the skin over the veins.
What do you see?
The appearance of your legs depends on the severity of the vein dilation:
- • Capillaries (Spider veins): These are fine lines on the skin surface which are red or purple in colour and look like a spider web.
- • Reticular veins: These are veins 1-3 mm in diameter, slightly deeper and usually blue-green in colour.
- • Prominent varicose veins: These are veins greater than 3 mm in size, raised above the surface of the skin, twisted, and look like “bunches of grapes”.
- • Oedema (Swelling): Swelling, particularly in the ankles, that gets worse after standing for a long time or travelling indicates increased venous pressure.
The body's "Help" signal: Symptoms of advanced disease
As the disease progresses, symptoms become more severe, and the risk of permanent damage increases:
- • Skin discolouration (pigmentation): The skin around the ankle will begin to turn brown or dark as blood leaks out into the tissues.
- • Skin hardening (lipodermatosclerosis): This is caused by inflammation of the fat layer under the skin, leaving the skin feeling hard and wood-like.
Venous ulcers are the most advanced stage of varicose vein disease. They are open wounds that form around the ankle and are very difficult to heal.
- • Bleeding from varicose veins: The bleeding can be profuse and is sometimes caused by trauma or spontaneous rupture of the dilated and thinned vessels.
- • Corona phlebectatica: The fan-shaped cluster of small blood vessels around the ankle is an early visual warning of advanced vascular disease.
When do symptoms appear?
These complaints tend to worsen when standing or sitting for prolonged periods; they tend to improve with elevation and rest of the legs. If you have one or more of these symptoms in your legs, it is important that you see an expert like Prof. Dr Cenk Eray Yıldız and get a Veins Doppler Ultrasound for vein mapping.
Who is at greater risk?
- • Genetic predisposition: If you have a family history of varicose veins, you are much more likely to develop them yourself.
- • Gender: It is seen twice as often in women as in men with the assistance of hormones and processes of pregnancy.
- • Lifestyle: Obesity, smoking, and sitting or standing still for extended periods may affect the structure of blood vessels.
- • Age : The older you are, the greater the risk, particularly after age 50-60, when the walls of blood vessels lose their elasticity.
Varicose vein treatment
Modern and minimally invasive treatment options: In the treatment of varicose veins (venous insufficiency), modern medicine has almost completely abandoned the traditional method of “stripping” with large surgical incisions and long recovery periods and switched to minimally invasive (closed) methods which allow the patient to return to his daily life on the same day. These methods work from inside the vein instead of removing the vein from the body. The vein is sealed off, and the body absorbs it over time.
Here are the modern and minimally invasive options for treatment of varicose veins:
Thermal (heat) ablation methods
In these methods high heat energy is used to seal the vein. The procedure is usually performed using tumescent anaesthesia, a numbing and cooling fluid, which is injected around the vein with a needle under ultrasound guidance.
- • Endovenous laser ablation (EVLA): A thin laser fibre is inserted into the vein under ultrasound guidance, heating the wall of the vein so that the blood clots and the vein closes.
- • Radiofrequency ablation (RFA): Similar to laser, but radiofrequency waves are used as the energy source. It causes the collagen in the vessel wall to contract at about 120°C and so close the vessel. Pain and bruising rates after the procedure are relatively low.
Cold techniques
The major advantage of these methods is that there is no risk of damaging the nerves surrounding the blood vessels, as heat is not used and tumescent anaesthesia (a large number of injections) is not required.
- • VenaSeal (Medical Adhesive): This is one of the newest technologies. A tiny amount of a medical adhesive, called "varicose vein glue", is placed into the vein with a catheter and makes the vein walls stick together. Most patients do not require compression stockings after the procedure and can return to their normal activities immediately.
- • Mecano-chemical ablation (MOCA - ClariVein): Mechanical damage of the inner surface of the vein is induced by a rotating wire tip while injecting a drying agent (sclerosant) at the same time. This double-action method removes the risk of burns from heat.
Sclerotherapy (injection therapy)
It is direct injection of a sclerosing agent into the vein. The medicine irritates the wall of the blood vessel. This causes the vessel to constrict and close.
- • Foam sclerotherapy: this is the preparation of the medication by mixing it with air or gas to make foam. Foam is also effective in the treatment of larger vessels, as it is in contact with the vessel wall for a longer period.
- • Microsclerotherapy: An aesthetic procedure performed with very fine needles for capillaries and very small varicose veins.
Ambulatory phlebectomy (microphlebectomy)
It is the process of removing the tortuous veins which are clearly bulging on the skin surface using special hooks through very small holes (tip of needle or mini incision) of just 1-2 mm. Usually it is a stitch-free procedure and is done as an adjunctive procedure in the same session with laser/RFA.
Why prefer the minimally invasive methods?
- • Quick recovery: Patients can discharge from the hospital after 30-60 minutes of the procedure and resume work in 1-2 days.
- • Fewer complications: No large surgical wounds, marks of stitches, or severe bruising.
- • Ease of anaesthesia: Usually only local or tumescent anaesthesia is needed, as opposed to general anaesthesia.
Prof. Dr Cenk Eray Yıldız, who has been working in the surgical field for over 25 years, applies these modern techniques within a personalised treatment plan considering the type of varicose vein and the patient's needs.
How is the VenaSeal method different from other closed methods?
The VenaSeal method (medical adhesive/varicose vein glue) is different from other closed (minimally invasive) methods used in the treatment of varicose veins, especially in terms of its application principle and the comfort it provides to the patient. The following are key differences:
- • Heat use (non-thermal approach): Closed procedures such as Endovenous Laser Ablation (EVLA) and Radiofrequency Ablation (RFA) use heat from lasers or radiofrequency energy to close the vein. VenaSeal uses a special medical adhesive called cyanoacrylate that bonds and closes the vein mechanically by applying it inside the vein.
- • Need for tumescent anaesthesia: For heat-based methods (laser and radiofrequency), "tumescent anaesthesia" (injection of cooling and anaesthetic fluid) is needed along the leg with multiple needle punctures to protect surrounding tissues from heat damage and to numb the vein. VenaSeal is a non-thermal method and therefore does not require this number of needle insertions; usually only a single local anaesthesia at the entry point of the vein is enough.
- • Use of compression stockings: Following almost all other methods, such as laser, radiofrequency and sclerotherapy (needle treatment), patients are usually required to wear compression stockings for at least 1-2 weeks. One of the biggest advantages of the VenaSeal procedure is that it typically eliminates the need for wearing compression stockings after the procedure.
- • Risk of nerve damage: There is a risk (about 7%) with the heat-based procedures that nerves close to the vein will be damaged by thermal energy. Because VenaSeal is a non-thermal procedure, it reduces the risk of nerve injury from thermal damage.
- • Recovery and back to normal life: Although recovery is also fast with other minimally invasive methods, VenaSeal patients can get up and walk immediately after the procedure without any bandages or stockings on their legs and can go back to their normal physical activities or work without any restrictions.
Recovery process after varicose vein treatment
The recovery process after varicose vein treatment varies depending on the type of method used (laser, radiofrequency, adhesive, or surgical), but thanks to modern techniques, it is generally a quick, comfortable process in which the patient can return to their daily routine in a short time.
The key stages of the recovery period and the points to pay attention to are as follows:
Immediately after the procedure: Movement and mobilisation
- • Immediate movement: The patient is asked to move their leg as soon as they get off the table after the interventional procedures.
- • Mandatory walking: A walk of at least 30 minutes before leaving the clinic is critical for the success of the treatment and the revitalisation of blood flow.
- • Same-day discharge: In minimally invasive procedures (EVLA, RFA, VenaSeal), patients can typically "walk in and walk out" and return home the same day.
Use of compression (Varicose vein stockings and bandages)
- • Duration of application: The use of bandages or varicose vein stockings after treatment is very important to support the sealing of the veins and reduce bruising. Socks should generally be worn continuously day and night for the first 3 to 5 days and then during the day for a total of 2 weeks.
- • VenaSeal exception: In the medical adhesive (VenaSeal) method, unlike other techniques, there is generally no requirement to wear compression stockings after the procedure.
Physical activity and daily life
- • Back to work: Patients can usually return to work in 0 to 2 days after treatment with laser, radiofrequency, or sclerotherapy. In traditional methods of surgery (stripping), this period may be as long as 5 to 10 days.
- • Restrictions: For the first 3 to 7 days you should avoid heavy lifting, sports that will strain your legs too much (running, jumping) and exercises that will increase your intra-abdominal pressure.
- • Elevate legs: Rest with your legs raised above heart level to help decrease swelling and pressure.
- • Travel: Short flights are usually acceptable 2 weeks after treatment, but long flights (over 4 hours) are usually recommended to be postponed for 4 weeks.
Anticipated temporary conditions and side effects
Normal symptoms during the recovery process include:
- • Bruising and tenderness Mild bruising, tenderness and colour changes may be seen along the treated vein line; they usually disappear completely within 2 to 6 weeks.
- • Hard lumps: Hardness under the skin (clot remnants/coagulum) is a sign that the vein has closed. Over time these hard lumps dissolve by themselves, but if they are very sensitive, they can be drained by your doctor with a small needle intervention (microthrombectomy).
- • Numbness: Infrequently, temporary numbness or tingling in the skin can occur due to involvement of nerves near the vessel.
Follow-ups
- • Follow-up visits: Doppler ultrasound is usually done at 1 week, 4-6 weeks and 3 months after the procedure to assess the effectiveness of the treatment.
- • Additional sessions: A few weeks after the main treatment, additional sclerotherapy sessions might be required to achieve a complete aesthetic result and to eliminate any residual small vessels.
F.A.Q:
Will I feel pain during the procedure?
Modern techniques are performed under local anaesthesia so that only slight pressure is normally experienced and the procedure is almost painless.
Will the veins come back after varicose vein treatment?
The treated vein closes completely, but the genetic predisposition that causes varicose veins continues, and new varicose veins may develop in other veins in the future.
Are compression stockings a treatment for varicose veins?
No, stockings do not eliminate existing varicose veins and slow the course of the disease, but they reduce complaints.
Are capillaries just giant varicose veins?
Capillaries (spider veins) are normally cosmetic; "true" varicosities are dilated vessels larger than 3 mm and require medical treatment.
What are the non-surgical treatments for varicose veins?
Yes, procedures like laser, radiofrequency, and VenaSeal are performed without any surgical incisions.
When can I get back to work after the treatment?
“Yes, in most of the closed methods, patients are able to go back to their work and normal activities the same day or next day.
What happens if varicose veins are left untreated?
As the disease progresses, you may get blood clots in the veins, bleeding, changes in skin, and ankle wounds that don't heal.
Do cigarets cause varicose veins?
"Smoking does affect the structure of the blood vessels, causing insufficiency, and also affects the healing process.
When is the best time of year to get treated for varicose veins?
The months of winter and spring are generally preferred. Because after the treatment it is more comfortable to protect from the sun for a while and (in some methods) to wear varicose vein stockings.
Is varicose vein treatment done in pregnancy?
Treatment is not recommended during pregnancy, unless it is an emergency situation (e.g., bleeding). Usually it is recommended to wait 3-6 months after delivery.
Does losing weight cure varicose veins?
It doesn’t get rid of existing varicose veins but helps alleviate symptoms by taking pressure off the veins.
How to stop varicose vein bleeding?
Lift your leg above the level of your heart and put the finger right on the bleeding point and go on to the nearest healthcare facility.
What is deep vein thrombosis (DVT)?
It is the formation of a clot in the deep veins. It causes sudden swelling and pain and can carry a life-threatening risk (pulmonary embolism).
Can herbal supplements cure varicose veins?
Some herbal extracts (such as horse chestnut) can decrease pain and swelling, but they cannot repair the physically damaged vein valve.
Does the VenaSeal (glue) technique use a stitch?
No, it doesn't need stitches. It's just a little hole. The size of a needle hole. You need a band-aid."
Are men at greater risk from varicose veins?
It is not dangerous, but men usually go to a doctor later (in advanced stages), so there is a higher risk of complications.
Can the varicose vein creams take out the veins?
No, no cream can be applied to the skin that will physically remove the enlarged vein in the skin.
What is the cost of treatment?
Cost will vary depending on the size of the vein, technology used, and number of sessions.
