By: Verne Maree
It’s February, the month of romance, when we should be flushed with passion, hearts beating a little quicker and the blood coursing faster through our veins. Punnily enough, Venus was the ancient Roman goddess of love, sex and beauty – her name means “love, sexual desire” in Latin. So what better time to talk about venous health? Here’s the lowdown on problematic varicose, spider and pregnancy veins, including some expert advice from three specialist doctors in Singapore.
Strictly speaking, the term “varicose veins” includes everything from the tiniest spider veins to those bulging, grape-like lumps that often appear behind the knees. According to vascular surgeon DR IMRAN NAWAZ, the term is generally used to describe dilated and twisted veins of any size that result from a failure of the valves within them. However, there are important differences to be aware of.
How do you distinguish between various types of diseased veins?
When the deeper superficial veins or their tributaries are affected, these appear as large or truncal varicose veins. When tiny surface capillaries are affected, these become spider veins. Intermediate-sized varicose veins, which appear greenish and fairly large, but not bulging and rope-like, are referred to as reticular veins.
Two or even all three of these types of varicose vein can co-exist at the same time in the same leg, so treatment could possibly involve a variety of different methods that are used to tackle veins of different sizes.
What does your diagnosis entail?
Visible varicose veins are only the tip of the iceberg – visual inspection alone will not tell you what’s going on with the veins deeper within the l e g . F o r that, we use the state-of-the-art Color Doppler Ultrasound Scan, a specialised test to accurately locate the problem sites, document the state of the venous system and determine the extent and severity of vein disease.
I consider it the best diagnostic tool available. It’s painless and has no radiation or other risk for the patient. Also, it can be conducted in the clinic, takes only about 20 minutes and can be repeated as often as necessary.
If my superficial spider veins are left untreated, can they in time become the larger, truncal type of varicose veins?
No. The most common reason for treating spider veins is cosmetic; far less commonly, it’s to relieve discomfort in the area where these veins are. So you should not be frightened into getting treatment for this reason alone! What is the best way to treat truncal varicose veins? The best method is endovenous ablation therapy (EVA) delivered b y a n e n e r g y device using either laser (EVLT) or radiofrequency (RF). Laser and RF are equally effective and produce near equal results, in my opinion. Compared with previous methods such as surgical stripping, the advantage of EVA is that it can be done in the clinic or as a day surgery and needs only local anaesthesia. There is only a small puncture around the level of the knee, with no incisions or scars. The patient gets up and walks immediately after the procedure, and post-operative pain is minimal.
How many treatments are required?
For straightforward cases, generally only one treatment to the main reflux source (for example, the great saphenous vein). Tributary veins that are not resolved by the initial treatment can be touched up later by one or two sessions of simple injection sclerotherapy.
What if I decided simply to live with my varicose veins?
That’s not a good idea. Varicose veins should be treated early as they usually become progressively worse. Untreated, long-standing varicose veins can result in debilitating complications such as bleeding, rashes or eczema, thickened black skin around the ankles, as well as sores and venous ulcers.
What’s the Difference?
- Varicose veins are large, deeply set and protrude through the skin in lumpy formations.
- Reticular, small varicose and larger spider veins are smaller, more superficial and visible underneath the skin.
- Spider veins are small, superficial and either red or purple, forming spider weblike patterns, predominantly on the legs but also elsewhere on the body.
Spider veins aren’t generally harmful to one’s health, says DR JOHN TAN, unless they cause aches or numbness, which can affect your daily life. It would be your choice to have them removed for aesthetic reasons – particularly in our hot, exceptionally humid climate where shorts and mini-skirts are the norm year-round.
Who would be your average patient?
Many of my patients are expat women, some of whom have come to Singapore from countries with far colder climates where it is easier and more comfortable to cover up. To make things worse, some of them complain that their veins feel and look worse in the heat than they do back home.
How many of your patients report physical pain from their spider veins?
Most of them don’t complain of any significant discomfort – but some do experience feelings of tiredness or heaviness in their legs, numbness or tingling around the veins, or cramps and aching during the night. Generally, they find that these symptoms tend to be worse at the end of the day, especially if they’ve been standing for hours at a time.
When is it necessary to treat spider veins?
Spider veins absolutely should be treated when they’re associated with varicose veins that are located at a deeper level, which is the case in about five to 10 percent of patients with spider veins. We use ultrasound assessment to check on the condition of the deeper veins. It’s essential for us to do that first, because treating a vein is only effective when that vein is the source or feeder vein.
How would you treat spider veins on the thighs?
I’d use injection sclerotherapy, which takes only around 30 minutes and is relatively painless. (Though laser and other light therapies are useful in treating pigmentation or skin spots, they are less effective for spider veins.) While every patient is different, I find that most cases require from three to six treatments to clear the veins completely.
If the sluggish blood flow is due to a deeper superficial vein malfunction, I would first treat that vein with Vnus Closure, a radiofrequency-powered endovenous laser technique, before treating the more superficial veins with injection sclerotherapy.
What about spider veins on the body, or on the face?
Injection sclerotherapy is not only for the legs: it’s just as useful for getting rid of spider veins on the body and face, too.
What can I do to avoid developing spider veins, and does heredity play a role?
A family history of vein disease does predispose you to both varicose and spider veins, yes. What’s more, although both sexes can get them, women are generally more prone to do so – especially during pregnancy.
Other risk factors include obesity, prolonged standing, and living or working in a hot climate. Prolonged standing or sitting exerts extra pressure on the leg veins, so that they have to work harder. The same goes for wearing high-heeled shoes, which tend to restrict calf muscle function and circulation in the lower legs.
There’s no denying that the job of pregnancy is hard on the body, or that someone’s got to do it. So, you’ve put in for maternity leave, you’re resigned to your inevitable increase in curviness and you’re shopping for nursery furniture. But what’s that you see, just as you’re about to lose sight of your toes – surely, surely, not spider veins on your previously perfect pins?
Hang in there for a while, advises consultant vascular and endovascular surgeon DR CHENG SHIN CHUEN: around 50 percent of all pregnancy-related varicose vein problems disappear within a month or two of giving birth.
What’s going on?
Various factors come into play during pregnancy. Firstly, the volume of blood in your body increases, exerting more pressure on the walls of the veins. Secondly, the physical strain of having a baby growing in the pelvic region can cause varicosity – not only in the legs, but also in the genital area. Thirdly, hormonal changes can make the veins less efficient at moving blood back to the heart, which causes the blood to pool.
What if my varicose or spider veins don’t go away of their own accord?
With new technology, they are now easily treatable and there’s no longer a need to cover up to hide unsightly veins on your legs. Venaseal, for example, is a very efficient option for treating varicose veins, and I find that it causes the least bruising of all treatment modalities. That said, each modality has its strengths and weaknesses, so treatment should be selected on the basis of the individual patient’s anatomy and the extent of the disease.
Can we do anything to avoid unsightly vein problems developing in the first place?
Even though the tendency to develop spider and varicose veins is inherited, your occupation and lifestyle can put you more at risk. If at all possible, a good suggestion is to avoid standing for longer than 15 minutes at a time. If your work requires you to stand for prolonged periods, it’s a good idea to wear compression stockings; the non-prescription grade of stockings can be bought from a pharmacy.
Can pregnancy also cause fine spider veins to appear on the face?
No, thankfully – they usually appear on the thighs, calves and ankles. Occurring particularly during the first and second trimester, this is caused by sensitivity to higher levels of hormones such as oestrogen; in only 20 percent of cases are they caused by underlying venous insufficiency.
- Whenever you can, elevate your legs to give the veins a break from their continuous fight against gravity.
- Avoid constipation by drinking sufficient water and eating plenty of fibre-rich food, including fresh fruit and vegetables and whole-grain cereals.
This article appeared in the February 2017 edition of Expat Living. Head to the Shop to get your copy!
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