Op. Dr. Orhan Coşkun
Varicose vein disease has not been considered significant by both physicians and patients for many years. Treatments with medication and compression stockings have been provided to patients to alleviate their complaints and prevent the progression of their condition. However, patients have often struggled to adhere to these treatments and stocking recommendations. Interventions aimed at eliminating the source of the disease have been consistently delayed and postponed.
As a result, inevitable progression of the disease has occurred, leading to chronic venous insufficiency. At this stage, treatment becomes more challenging, complicated, significantly impairing the patient’s quality of life. Some patients experience loss of workforce due to these reasons, and in some cases, they become unable to perform their job to the extent that they apply for disability retirement.
There are four degrees indicating the severity of venous insufficiency, which represents valve incompetence at the root of varicose veins. Starting from the 3rd degree, intervention becomes indicated for the treatment of this vein. We now treat these conditions without surgery, anesthesia, incisions, and without the need for hospitalization.
If left untreated and progresses, increased backward blood flow from valve incompetence results in pooling and accumulation of blood in the legs. The stagnation of this blood flow tends to clot in both superficial and deep veins. Consequently, diseases such as superficial thrombophlebitis in superficial veins and deep vein thrombosis (DVT) in deep veins will emerge.
Moreover, blood pooling leads to the progression and enlargement of varicose veins, resulting in the emergence of clusters of veins called varicosities. This, in turn, causes an increase in pressure within the varicose veins, leading to the formation of venous hypertension. This venous hypertension results in a brownish discoloration, thickening, edema, hardening, and itching in the subcutaneous and skin tissue of the legs. These skin manifestations are referred to as lipodermatosclerosis. As the disease progresses, impaired nourishment of the skin tissue leads to the development of venous stasis ulcers, also known as varicose ulcers.
Patients often present with prominent symptoms such as pain that increases with standing, decreases with elevating the legs above chest level, night cramps, and noticeable edema and swelling in the legs.
Unfortunately, patients frequently come to us with these ulcers or wounds that have healed but reopened. This is because treating only the wounds without addressing the underlying causes of the disease is insufficient and may lead to the recurrence of wounds.
For diagnosis, Doppler ultrasonography is performed, and in necessary cases, venography may be employed. Magnetic resonance imaging (MRI) and computed tomography (CT) are also utilized in cases where needed for diagnosis.
