Causes of pain in varicose veins
One of the most common reasons for visiting a vascular surgeon is leg pain and varicose veins. The pain is described as sharp, tearing, burning or tingling kind of pain. Moreover the patient can be affected by numbness, feel a sudden change in skin temperature, have the feeling of squeezing, stinging or have the so-called electric shock sensation in the legs. Very often you can also discover a range of small millimeter spiders or abnormally thick, widened and convex varicose veins. But how can you know if the pain is not caused by something different?
Pain of non-vascular origin
Non-vascular pain has a specific nature. It often feels like a shooting, stabbing or burning sensation. This kind of pain is called neuropathic pain and occurs when a health condition negatively affects the nerves that carry sensation to the brain. If these ailments get worse in a sitting position, at night or if it is difficult to take the first few steps after getting out of bed (but still after some activity the pain subsides or decreases significantly), these usually define a discopathic joint pain. Ailments can be caused by pressure on the nerve roots in the lumbar spine. Pain that is unrelated to either body activity nor location, can be caused by damage to peripheral nerves in neurological diseases such as polyneuropathy or diabetes.Pain of vascular origin
Chronic venous insufficiency can cause pain in the extremities, but this phenomenon occurs relatively rarely and usually in the advanced form of this disease. Small vascular spiders (called venenulectasia and telangiectasia), may be the first symptoms of venous insufficiency. However, despite the fact that they are often very visible, they do not cause any discomfort themselves and are mainly of aesthetic importance. In contrast, blood-filled, large and thick varicose veins can cause swelling, fatigue and distressing pain. These ailments are often accompanied by large swelling of the lower leg, mostly in the ankles. You can get rid of the ailments most often simply by lying down or with the legs raised above the torso level. These symptoms are describing an advanced stage of chronic venous insufficiency where you need a prompt and decisive treatment, otherwise risking serious complications. Swelling can quickly lead to inflammation of the skin and subcutaneous tissue. This condition is manifested by redness of the skin, painful thickening of the subcutaneous tissue as well as extensive swelling. The appearance of deep and non-healing ulcers can be an indicator of inflammatory complications that can be infected very quickly. In this situation not only pain is causing problems, but even symptoms such as purulent drainage and fever. Additionally, the healing process for venous ulcers takes long (from several months up to several years), they tend to recur and there is a visible scar left on the skin. After the inflammation has subsided, you can unfortunately have to deal with permanent dark pigmentation of the skin or its atrophic changes that can remain. Thrombosis and blood stasis is another frequent symptom that appears during venous insufficiency. It means that the inflamed skin area becomes hard and very painful. This condition can last a long time (up to a month) and always requires medical consultation with an ultrasound examination. Atherosclerosis is another dangerous arterial disease causing complications in the lower limbs. It leads to narrowing or total closure of arterial sections, reducing the amount of blood reaching to the muscles, nerves and skin of the limbs. In a typical course of atherosclerosis, the discomfort occurs initially after exercise, i.e. while walking. A characteristic feature is the discomfort after exercising, forcing the patient to take a break. Usually resting helps to recover so that the patient can cross a similar distance to the prior one, which then gives the opportunity to qualify the patient for an either conservative or surgical treatment based on the distance that the patient can walk without feeling any pain. If we are dealing with an advanced form of ischemia, the pain occurs even at rest. The pain can be mostly alleviated by putting the legs beneath the torso level (the patient often sleeps in a sitting position). In some extreme cases, the skin necrosis can also appear, which then requires urgent surgery so it doesn’t threaten with a limb loss. Sometimes this condition may even be life-threatening.Diagnosis and treatment
Despite characteristic features, sometimes even an experienced vascular surgeon finds it difficult to answer the question of what disease that causes the patient's discomfort. The diagnosis can be made only based on a detailed medical history, physical examination and very often non-compatible laboratory test results. Therefore in this case, the best instrument for examination is the Doppler ultrasound of vessels with its right assessment of velocity and flow spectrum. In addition, we use it for measurement of segmental pressures in atherosclerosis and for calculation of the ankle-brachial index (so-called ABI index). While most cases of spinal diseases and the initial stages of atherosclerosis can be successfully treated with appropriately selected exercises and medications, conservative treatment of chronic venous insufficiency is burdensome and often ineffective. Drugs for varicose veins are often dietary supplements with a negligible effect on varicose veins. Even if using of the compression stockings is a quite effective method to reduce the swelling and inflammation, they are uncomfortable in daily use, causing great discouragement for the patient. Therefore, whenever possible, patients should be treated in a surgical manner.Varicose vein treatment
Modern methods of interventional treatment are outpatient and minimally invasive methods. Patients can return home immediately after the procedure and in most cases immediately return to their normal physical activity. Practising large operations related to hospital stay involve administering of anesthesia to the spinal cord, and are associated with skin cuts, vein pulling and suturing. These are painful and unnecessary interventions slowly becoming a thing of the past. Currently the most effective and, above all, the safest methods of treating chronic venous insufficiency, are intravenous procedures performed by skin punctures, controlled by ultrasound guaranteeing precision and safety. There are many methods available, i.a thermal (laser and RF), chemical (tissue sclerosants), mechanical-chemical and recently even ultrasonic (HIFU). The vascular surgeon is able to choose the right method for each patient or apply several of them simultaneously, which makes all the procedures extremely safe. It should be noted that the cosmetic effect of such treatment is often excellent.Varicose vein prevention
Unfortunately, there is no ideal way to prevent varicose veins, as it is usually a genetic disease. By applying appropriate medical recommendations you can only delay its progress.
