Doing the legwork: Varicose veins

After years of discomfort and itching in her right leg, Sally (not her real name) developed an ulcer on her right ankle.

The ulcer, 6cm in diameter, became infected. The 47-year-old teacher had to be hospitalised to be on intravenous antibiotics.

All this grief because of varicose veins, which are often thought of as a cosmetic problem.

Varicose veins usually occur in the legs and are a result of weakened or damaged valves in the legs, said Dr Edward Choke.

Usually, blood flows upwards from the legs towards the heart. Valves help to prevent blood from flowing backwards to the legs.

In the case of varicose veins, blood flows backwards to pool in the veins because of the damaged valves, said the consultant at Sengkang Health's vascular and general surgery department.

This causes the veins to become enlarged and twisted.

A common symptom is the sensation of heaviness and discomfort in the legs, especially after prolonged periods of standing. Other symptoms include itching and swelling of the legs, said Dr Choke.

Over time, the skin over the ankles can become dark, thick and scaly. If left untreated, ulcers can develop. As in Sally's case, they can be difficult to heal.

Women who are pregnant or people who have to stand for prolonged periods are more likely to develop varicose veins.

Obesity, too, is closely linked to varicose veins, said Dr Choke.

"Extra pounds put extra pressure on your veins, and as the blood pools in the leg veins, these veins will enlarge even more.

"The vein valve failure is made even worse by the extra weight, and this worsens the stagnation of the trapped blood in the leg veins," he said.

While weight loss can prevent the worsening of varicose veins, it cannot make them disappear.

Said Dr Choke: "In fact, losing weight can give the impression that underlying varicose veins have become more obvious, by unmasking the problem."

Not all varicose veins need treatment, unless they are causing pain or discomfort.

Doctors may first recommend lifestyle measures, such as using compression stockings.

These stockings, which are tightest at the ankle and gradually looser as they go further up your leg, are designed to improve circulation by squeezing your legs and encouraging blood to flow upwards towards the heart.

Other lifestyle measures include:

• regular exercise
• avoiding standing for long periods and
• elevating the affected area when resting.

Patients can opt for procedures to remove the unhealthy veins if the lifestyle measures do not work after six months. These include:

• endothermal ablation, where energy from radio waves or lasers is used to destroy affected veins
• sclerotherapy, which uses special foam to close the veins
• Clarivein, which closes the veins with a combination of mechanical and chemical means and
• Venaseal, which uses biological glue to seal the veins.

These involve only a small puncture in the skin, which means patients can return to work with less downtime, said Dr Choke.

"These can usually be done under local anaesthesia as a day case," he added.

Sally recovered after compression bandage therapy, followed by Venaseal glue ablation.

"With successful intervention, it is anticipated that she will no longer be troubled by any recurrence of right leg ulcers," said Dr Choke.