Varicose veins are largely hereditary; however, there are other precipitant factors. In women, pregnancy and taking contraceptives may cause varicose veins. In the general population, remaining in a standing or sitting position for long periods of time may also cause varicose veins.
A usual complaint is pain in the lower limbs associated with a feeling of heaviness and fatigue, which worsens in hot weather or when standing for long periods of time. In women these symptoms tend to get worse in the premenstrual period and during pregnancy. There are also other associated complaints such as itching, tingling, heat, cramps and oedema (swelling), of the ankles and legs especially at the end of the day. These symptoms are proportional to the severity and size of the varicose veins.
Prevention of this disease is crucial not only in preventing its appearance but also its progression:
- Remaining in a standing or sitting position for long periods of time or sitting cross-legged, should be avoided. When it is necessary to remain seated or standing for long periods, it is important to change position and take small walks;
- Practicing regular exercise causes muscle contraction and promotes return blood flow, especially gymnastics, swimming, cycling and dancing. Sports which demand sudden movements should be avoided eg basketball and tennis, as they cause pressure variations in the veins causing these to dilate decreasing the return blood flow;
- Hot places should also be avoided as they cause the veins to dilate. On the other hand, cold water baths provide pain relief and a decrease in heavy leg sensation;
- Constipation and excessive weight gain increase venous blood pressure and should be avoided;
- Very tight clothing causes compression of the veins and hampers circulation. Shoes with very high heels or flat shoes have the same effect. Shoes with 3-4 cm heals are advised.
- Sleeping with the legs raised about 10 to 15cm provides relief, as well as performing leg movements before falling asleep;
- Massaging legs with movements from bottom-up may relieve symptoms.
Minimally invasive techniques have provided very good results, including thermal radiofrequency ablation or laser and sclerotherapy. At the Vascular Surgery Unit of the Hospital Particular do Algarve radiofrequency has been widely used. It consists in the introduction of a catheter with an electrode that discharges a radiofrequency current onto the wall of the vein resulting in its ablation. Due to the safety and efficiency of this technique it has progressively gained advantage over other techniques. In addition, as it is a minimally invasive procedure, performed under local anaesthetic, resulting in an easier post-operative recovery, less painful, less bruising with much less complications.
Varicose veins are not only a cosmetic problem they are especially a health problem, a chronic problem and almost always with a tendency to worsen.
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