Varicose veins: when the veins get tangled

Varicose veins

18 million people in France are affected by blood circulation problems. Varicose veins, for the best known of them. These are deformed and visible veins under the skin, which appear especially on the level of the legs and the thighs. How to identify, prevent or treat them?

How does our blood circulation work?

Heavy, painful legs, even burning sensations, edema of the ankles (swollen ankles)... these are the symptoms of varicose veins. A very frequent pathology which affects 25 to 30% of the active population and nearly 60% of retirees. If women are the most affected by varicose veins, men are also increasingly affected and they often consult too late, at the stage of complications.

A varicose vein is a vein that expands and becomes more and more visible, due to poor venous return. Normally, our veins are managed by a very sophisticated non-return system. Small flaps, called "valves", open under the effect of blood pressure and close mechanically in the event of reflux. An ingenious system that defies the laws of gravity but is not infallible.

When the valves don't work well, the blood pools in the veins. The vein then appears dark blue and gradually emerges from the surface of the skin. At the origin of these problems, there are several risk factors: excess weight, physical inactivity, heat or even pregnancy and of course age, because as we age, the natural anti-reflux system loses its effectiveness.

Although they are not serious in themselves, varicose veins can have serious consequences. In addition to aesthetic damage, varicose veins can cause severe pain but also complications, the best known of which are leg ulcers and phlebitis. Fortunately, the management of varicose veins has evolved a lot in recent years. Using medical imaging, it is possible to map varicose veins and make custom-made in the office and under local anesthesia.

The different anti-varicose vein treatments

Chronic disease, varicose veins must be regularly and controlled. It is a phlebologist, specialist in the veins, who must take stock of the venous state. He carries out an echo-doppler, an examination which makes it possible to evaluate the functioning of the veins.

Depending on the progress of the venous insufficiency, the doctor chooses the most suitable treatment: venous compression can be done using stockings or tights which will exert pressure on the legs to stimulate the return of blood. It is very effective, coupled with advice to limit varicose veins (see last paragraph).

The possible way is also drug: the venotonics have drugs which decrease the inflammation of the veins, and which relieve the embarrassment and the pains. If some patients feel very relieved by these drugs, they have never proven their effectiveness and are not reimbursed by health insurance.

But sometimes it is necessary to resort to surgery. The operations related to varicose veins are less and less traumatic. There are several surgical techniques: stripping involves removing the diseased vein, the Chiva method flattens the varicose vein, and cryosurgery inserts a probe that cools the varicose vein: once frozen, it can be removed.

Sclerotherapy has also proved its worth: this technique consists of injecting a product into the varicose vein that will retract and harden the diseased vein to finally sclerose it, that is to say destruction. It is particularly indicated for small caliber veins.

Varicose vein surgery: stripping, ligation, phlebectomy

The management of varicose veins has been greatly simplified. In the past, the main vein, the saphenous vein, was very often removed, as well as the small diseased collateral veins thanks to surgery. From now on, we only remove the bare minimum, that is to say just the small diseased veins. Not only is it simpler but also more effective.

The techniques are varied and the doctor chooses the most appropriate. Minimally invasive surgery is one of the most widely used methods. Performed under local anesthesia, it consists of keeping healthy veins and removing diseased veins. Patients can resume a normal life the day after the operation.

The intervention is very light and the veins removed do not modify the blood circulation in any way, quite simply because they were no longer functional. But beware, varicose veins are a chronic disease. After an operation, the patient is not immune to a recurrence. A healthy lifestyle and good follow-up are essential to avoid degradation of the remaining venous network: do not wear clothes that are too tight, avoid sources of heat in the legs, do not stay in a standing position for too long, play sports ...

Laser ablation of the saphenous vein

Men are not spared from varicose veins. Unlike women, they consult late and sometimes too late. The only remedy then is surgery.

The laser destroys the diseased vein. An optical fiber is introduced into the patient's vein to bring the laser to the heart of the vein.

Radiofrequency treatment

Another surgical technique to destroy the saphenous vein without having to extract it is radiofrequency or closure. It also acts inside the vein: a probe will burn at 120°C, every seven centimeters, the walls of the vein. It will completely retract and block traffic.

With laser and radiofrequency, the vein is not removed, it fibrosis and six months later, it will have completely disappeared. These techniques are not traumatic for patients with a low risk of complications.

The last possible, more cumbersome technique is stripping. The vein is completely torn out. Through a small incision, the surgeon has introduced a guide that hooks inside the conduit. Thanks to this device, he can turn the vein on itself like a glove.

Stripping is an operation that is performed under general anesthesia with days off work and anticoagulant treatment. Stripping is the only one of the three surgical techniques reimbursed by Social Security.

Some tips to avoid varicose veins

Women are more often than men. One in two is affected by varicose veins, while this disease affects only one in ten men. It is essentially of genetic origin, so it is often advisable to carry out a family check-up, but there are several ways to avoid varicose veins.

There are some simple tips to prevent the aggravation of varicose veins. The principle is simple: everything must be done to prevent the dilation of the veins, which interferes with blood return. It is therefore necessary to avoid clothing and boots that are too tight, heels that are too high or too flat, hot baths, the sauna and sun exposure, because heat is a factor of dilation.

Better to avoid prolonged sitting or standing. If you have no choice, simple movements of the ankle, the sole of the foot and the calf can press the blood towards the heart.

Elevating your feet to sleep is also recommended.

Regular physical activity, such as walking or swimming, is essential and must be combined with a healthy and balanced diet. In case of overweight, it is advisable to lose weight to facilitate venous return.

Finally, compression stockings provide relief for people who have a risky job (hairdressers, salespeople, etc.) or to get through painful periods, especially during pregnancy, plane or car trips lasting more than four hours. .