Leg Varicose veins and superficial vein reflux can cause complications such as phlebitis, bleeding, varicose eczema, leg ulcers and deep vein thrombosis. In addition, many people suffer from ache, itch and ankle swelling. These symptoms can be distressing and aggravated by warm weather or after standing for long periods. It is generally acknowledged now that even thread veins cause symptoms in cases where they are caused by reflux. It is easy to dismiss how unsightly varicose veins and thread veins can be and many people can be so embarrassed about their veins that it affects what they can wear, what leisure activities they can peruse and even whether they enjoy a beach holiday.
Leg vein problems tend to get worse and a minority will go onto develop problems such as phlebitis, varicose eczema, deep vein thrombosis, bleeding and leg ulcers. Therefore, many vein specialists recommend early treatment. Not only will this reduce the risk of complications, but it will give better results.
Phlebitis is simply a medical term indicating that there is inflammation in the vein. Most commonly it affects the superficial leg veins and it is associated with localised swelling – a lump – which is red, tender and warm and sometimes the lump actually feels hot and painful. Usually phlebitis comes on out of the blue for no apparent reason but very occasionally we see phlebitis as a complication of cancer, intravenous arm catheters used in hospital – drips – or sometimes as a reaction to some very irritant intravenous injections such as chemotherapy. To absolutely sure that the problem is phlebitis, a duplex ultrasound scan is needed – the ultrasound appearance of phlebitis is characteristic and diagnostic. The vein wall is thickened and there is a variable amount of clot inside the vein. A scan is the only way of checking the vein directly and confirming that the vein is inflamed. Ultrasound has also revealed that a very important group of people with phlebitis either already have a DVT or they are at risk of developing a deep vein thrombosis. The inflammation in the wall of the veins affected by phlebitis activates clotting of the blood inside these veins. This clot can extend or spread from the superficial vein into the deep vein. So this is another very important reason why everyone with phlebitis should have a duplex ultrasound scan. A duplex scan is the only way to correctly identify people who already have a DVT and who need treatment to prevent that clot leaving the leg, travelling around the body and lodging in the lung – a serious sometimes fatal condition called pulmonary embolism.
Deep Vein Thrombosis (DVT)
There is now scientific evidence to confirm that varicose veins and superficial venous reflux are risk factors for DVT. This is a clot in the deep system of veins. It is potentially serious, as sometimes the clot can leave the leg and travel to the heart and lungs – an embolus. DVT is a potential problem after major surgery, illness and periods of immobility. Other risk factors include smoking, oestrogen treatment and a family history.
If you are on a long haul flight or other long journey, you may be at risk of DVT. The VeinCare Centre can advise you of your risks and on measures to minimise your chances of developing this condition. Treatment of varicose veins and superficial venous reflux reduces the risk of DVT.
Varicose eczema is a serious and common condition. It is neither an eczema – a skin problem – nor is it caused by varicose veins. The term arose before we fully understood the true nature of the problem. Varicose eczema can develop in the absence of visible varicose veins and unlike skin problems it should not be managed solely by dermatologists. Other misleading synonyms are gravitational eczema and stasis eczema. The true nature of varicose eczema is a malfunction of the veins of the legs causing inflammation and scarring of the skin and underlying fat layer. A better medical term is lipodermatosclerosis, certainly vein specialists prefer this term – often abbreviated to LDS. Varicose eczema should not be treated with steroid creams except for very brief periods when itch and pain are very troublesome. Longer term use of steroids will help the relieve symptoms and the area will look and feel better but the use of steroids will thin the skin over time making it more vulnerable to further damage. Medical stockings or socks help normalise the function of the leg veins and therefore wearing them will go a long way to improving the varicose eczema. Ideally they should be put on first thing in the morning before getting out of bed and they should be taken off last thing at night. A duplex ultrasound scan is essential in all cases of varicose eczema. It is a warning sign that the skin is being damaged by inflammation and if neglected and not treated, varicose eczema will progress to a leg ulcer.
Venous Leg Ulcers (VLU)
The medical definition of an ulcer is a break in the epithelium of a body surface or lining. If the ulcer is on the leg and has been present for more than 6 weeks it is called a chronic leg ulcer.
The National Institute for Health and Care Exellence (NICE) in its guidance CG168 recommends that patients with a Venous Leg Ulcer (VLU), an ulcer below the knee that has been present for more than 2 weeks, should be referred to a vascular team.
Four out of five ulcers are caused by a problem with the leg vein circulation and they are called venous ulcers. Problems with the deep veins such as obstruction from a deep vein thrombosis, superficial vein reflux or perforator vein problems can cause venous leg ulcers. People with a VLU usually have superficial venous reflux. The aim of treatment is to get the ulcer healed as quickly as possible.
A landmark study from 2018 has shown that a combination of early Endovenous Ablation and Compression resulted in quicker healing of VLUs that compression alone.
This usually means graduated compression either with bandages or compression stockings and Endovenous Laser Ablation. In most cases, antibiotics, creams and ointments are not necessary.
Once the ulcer is healed it is very important to avoid ulcer recurrence. We advise that people with healed VLU are kept under regular review and that they consider wearing medical grade graduated compression hosiery.
How can we avoid leg ulcers? Well there are 3 things we suggest.
- Firstly, if you are unfortunate enough to suffer a deep vein thrombosis (DVT), it should be treated promptly to limit the damage to the deep veins. Unfortunately, damage to the deep veins cannot be reliably reversed by surgery. So, prompt treatment with anticoagulants – blood thinning medication – reduces the extent of the clot and the damage to the deep veins.
- Secondly, if you have had a DVT, you should consider wearing good quality medical grade compression socks – some studies suggest that doing so may reduce the risk of leg ulcers after a big DVT.
- Thirdly, if you have superficial vein reflux have it treated early to reduce the chances of progression to varicose eczema which is itself a warning sign that the skin is damaged and liable to ulceration