Mr C. Kyriakides MBChB, MD, FRCS, FRCSEd, FRCS(Gen)
Consultant Vascular and Endovascular Surgeon

1. Varicose veins and chronic venous insufficiency:

Varicose veins are large distended superficial veins which are not properly returning blood from the lower leg to the heart. Normally veins have valves that open to allow the flow of blood to the heart and close to prevent backflow or reflux of blood to the foot. When these valves fail to function properly and become “leaky”, blood overfills and distends these veins which can be seen bulging under the skin, otherwise known as varicose veins. They affect 50% of people aged 50 and over. Varicose veins are commoner in women, particularly during pregnancy and can be hereditary. Symptoms include, aching pain, heaviness and itching which are wore towards the end of the day. Chronic venous insufficiency is a term used when varicose veins become severe, and if left untreated can cause skin ulceration that can be very difficult to manage. Ultrasound assessment of varicose veins know as venous duplex scan can be useful in assessing the levels of valve reflux which can help in planning surgery. Standard surgery for varicose veins is performed under general anaesthesia and involves stripping of the affected vein and its complete removal from the leg. Newer techniques have been developed including endovenous laser therapy or EVLT. This procedure can be performed under local anaesthetic. Through a small puncture in the leg a laser fibre is passed up the affected varicose vein. Laser energy is passed through the fibre and into the vein causing the vein to close thus negating the need to remove the vein. Other treatment options for varicose veins include radiofrequency ablation and foam injection sclerotherapy.

2. Deep vein thrombosis:

Deep vein thrombosis (DVT) is the development of a blood clot known as thrombus in the deep veins of primarily the legs and pelvis. This is different from clots forming in the superficial veins referred to as superficial thrombophlebitis, also commonly known as "phlebitis". This distinction is important as blood clots in superficial veins rarely cause serious problems whereas clots in deep veins require immediate medical attention. DVT tends to present with localised pain or tenderness within a calf or thigh muscle, usually associated with ankle and calf swelling. Blood clots in deep veins can grow in size, break loose, and then travel through the bloodstream to the lungs resulting in life-threatening pulmonary embolism (PE). Symptoms relating to PE include breathlessness, chest pain, palpitations, increased heart rate and coughing. Risk factors for DVT include smoking, obesity, the contraceptive pill, having had a DVT before and pregnancy. In addition, there are a few rare medical and inherited conditions that are associated with an increased tendency of the blood to clot. Long-haul flights can predispose to DVT because of dehydration and lack of activity, both of which cause the blood in the circulation to become more sluggish and form clot in the vein. It is therefore important to drink adequate quantities of non-alcoholic fluids and exercise the feet either while sitting or by getting up and walking in the cabin of the plane. Elastic compression stockings also improve the circulation in the legs thus protecting from DVT. The most commonly used test to diagnose DVT is an ultrasound scan of the veins in the affected limb (venous duplex scan). Occasionally a special X-ray test, known as a venogram may be required. Treatment of this condition is mainly by drugs that thin out the blood known as anticoagulants, such as heparin and warfarin. Rarely if the clot is too extensive, it may have to be dissolved with other drugs or even surgically removed.

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