Have you ever had blue lumps on your calves or felt fatigue in your legs?

Varicose veins

Human blood vessels consist of arteries that travel from the heart to the periphery and veins that return from the periphery to the heart. In the veins of the lower limbs, blood returns to the heart against gravity, thanks to the pumping action of the calf muscles and the valves in the veins. Varicose veins occur when these valves are damaged, allowing venous blood to flow backward, causing the veins to expand abnormally and become tortuous.

Natural history of varicose veins

Left: Typical varicose veins
Medium: Pigmentation
Right: Intractable skin ulcer

Symptoms

It is often seen in people who work standing up for long periods of time or who suffer from illnesses such as high blood pressure or heart failure. Some women develop the condition during pregnancy and experience gradual worsening thereafter. It typically manifests as a soft, bluish bump on the inside of the calf. Prolonged standing or walking can cause the legs to feel fatigued and require rest (intermittent claudication). As the condition worsens, dull brown pigmentation appears, and over time, sores and wounds (skin ulcers) can develop. These skin ulcers are extremely painful and do not improve easily even with ointment treatments, making them known as intractable skin ulcers. Surgery is strongly recommended for those with pigmentation or skin ulcers.

inspection

An ultrasound (echo) examination is used to check whether the venous valves that prevent blood from flowing backward are functioning properly. This examination is painless, as it simply involves applying a jelly and placing a probe called a probe. We also check the diameter of the veins and the time it takes for the blood to flow backward, which are used as indicators for selecting a treatment method. We can also check whether you have had deep vein thrombosis in the past or present. Angiography using tomography may also be performed to understand the overall condition of the blood vessels. This involves taking an MRI while an intravenous contrast agent is administered.

An ultrasound examination in action (red indicates reflux of blood)

Actual MRI angiography (arrow indicates varicose veins)

treatment method

• Varicose veins range from small to large and thick. Some people also have strong reflux while others do not. A treatment method appropriate for each individual is selected. For small veins, sclerotherapy is performed, which uses chemicals to close the veins. This can be treated on an outpatient basis. For veins with significant reflux, vein ligation is performed, and for large, thick varicose veins, partial vein removal is performed. Our department always strives to make the incisions as small as possible, with each incision being only a few millimeters in size, leaving inconspicuous scars. Treatment is primarily performed on an inpatient basis, but outpatient treatment is also possible depending on the treatment.

Partial vein removal surgery

• We also use endoscopes to treat abnormal blood vessels. Skin that has developed pigmentation or ulcers is particularly delicate, and making an incision there can make it difficult to heal. In such cases, we insert an endoscope under the fascia through an incision in the skin that appears normal, and treat the vein with abnormal reflux, called a communicating branch.
• Traditionally, the mainstream treatment was called stripping, which involves removing veins from the foot to the groin, but this can cause postoperative pain and numbness in the skin, so we are currently pursuing a less painful treatment that combines minimal ligation and removal with sclerotherapy.
• A new method that has been covered by insurance since July 2014 is the use of a high-frequency intravascular ablation device. A small hole is made in the skin, a catheter is inserted, and the blood vessels are ablated. Postoperative pain and subcutaneous bleeding are mild, allowing patients to return to their daily lives quickly.

High-frequency treatment equipment for intravascular cauterization

• We recommend wearing stockings to prevent new varicose veins from forming. There are stockings specifically designed for varicose veins, and the stockings are selected by a doctor based on the individual's leg size and the pressure required.