When valves in the veins become faulty, the result is poor blood circulation which can lead to painful bulging veins in your legs. STACEY CHIA reports

Varicose veins are not just a cosmetic issue for the vain: there can be complications if they are left untreated.
 
These abnormally dilated veins appear as bulging and worm-like swellings, typically under the skin of the lower limbs.

About 50 per cent of Singaporeans, mostly women, have some degree of varicose veins.
 
A milder variation are spider veins, also found in the lower limbs.

This web of red and blue veins that form close to the skin’s surface are more of a cosmetic problem compared to varicose veins, said Dr Imran Nawaz, the director of the Singapore Vein Centre.

Source of the problem Dr John Tan, a consultant vascular surgeon at The Vein Clinic, said varicose and spider veins occur when there is a
malfunction in the veins.
 
He said that blood that travels from the legs to the heart has to work against gravity. It is the job of valves in the veins to ensure that there is no backflow.

“Varicose veins form when the valves become faulty and the resulting backflow of blood applies pressure on the vein below,” he explained.

Dr Nawaz said that varicose veins are more serious than spider veins as they can cause an impairment in the venous circulation and, if left untreated, can lead to leg ulcers.

However, Dr Tan said there is a possibility that spider veins can progress to varicose veins. “When you have abnormally dilated veins, the problem will  never go away. Even if it does not progress to varicose veins, more spider veins will develop with time,” he said.

People at risk
There are three main groups of people who have a higher chance of developing abnormally dilated veins, said Dr Tan.

One group are people with a family history of varicose veins or spider veins.

“As they are born with a weaker set of veins and valves, there is a higher chance of them malfunctioning,” he said.

A second group are pregnant women. If the uterus distends onto the veins and presses against them, a result can be poorer circulation of blood leading to failure of the valves. For this reason, varicose veins and spider veins are seen more in women.

Finally, if your job requires you to stand or sit for prolonged periods of time, you too may be at risk.

“Your blood does not flow well if you are in the same position for a long time,” said Dr Tan.

Also, people with varicose veins have a higher chance of getting deep vein thrombosis.
 
Dr Nawaz said that apart from being an eyesore, varicose veins can be painful.

Agreeing, Dr Tan said: “When patients see me with complaints of pain in the leg, the first thing I do is look at their veins. Many don’t know there may be a correlation.”

Treatment methods
Ever since 2001, removing varicose or spider veins has become much easier and is fairly risk free.

Prior to the improved surgical methods, the stripping method was used. It involved making several incisions, after which a wire was inserted and attached to the faulty vein to enable it to be pulled out.

Dr Tan said that at times, only part of the vein was removed and the problem remained.

“That method led to a lot of wound complications, extensive bleeding and it could even result in nerve injury,” he said.

Today, endovenous laser therapy (EVLT) is used to remove varicose veins. It is a minimally invasive therapy and can be done under local anaesthesia within a day.

Dr Nawaz explained that it involves delivering laser beams directly into the varicose veins via an optic wire that is inserted through a tiny puncture. The laser shuts off the vein and causes it to shrink.

Over time, the vein will disappear. A similar therapy, for spider veins,
called microsclerotherapy involves finer needles and more dilute solutions.

“There is very little pain involved and almost no scars for both treatments,” he said.
 
Dr Tan said these methods do not guarantee that varicose or spider veins will not return. If the patient spends much time on his feet and subjects himself to further stress, it can come back after a few years.

He said some of his patients put off surgery and opt to wear graduated
compression stockings. These stockings, which apply different degrees of pressure on different parts of the leg, help the blood
to flow more efficiently.

This helps to improve the condition but the stockings have to be worn every day to be effective or the problem will recur.

Unfortunately, Dr Nawaz said, many of the risk factors of varicose veins are difficult, if not impossible, to reduce.

Dr Tan suggested doing ankle rotation exercises, which can aid blood circulation, for those who wish to reduce this occupational hazard.
 
Also, while varicose veins may be unsightly, he said that at least they are not indicative of any other health ailment other than a vascular problem.