Welcome to Penang Adventist Hospital...   A Passion To Heal, A Heart To Care Visitors: Site Meter






Outpatient Registration Hours

Mon-Thu: 8am-4:30pm
Fri & Sun: 8am-12:30pm

Pediatric Night Clinic Registration Hours

Mon-Thu: 7pm-8:30pm
Sun: 7pm-8:30pm

Visiting Hours

12pm-2pm
5pm-8:30pm

Address

465, Burma Road,
10350 Pulau Pinang,
Malaysia

Contact

Tel: (604) 222-7200
Fax: (604) 226-3366

Your Veins and Your Legs

What is Varicose Veins and How Does it Develop?

Veins are blood vessels which carry blood from the peripheral tissues, such as the limbs, to the heart. In the veins of the leg, the flow of blood is always upwards.

This unidirectional flow is mainly controlled by leg muscle contractions and valves located in the veins. Muscle contraction ensures flow of blood in an upward direction, while venous valves prevent venous blood from flowing downwards (venous reflux).

When valves in the veins of the legs are not functioning properly or are destroyed, they can no longer prevent the blood from flowing downwards. The venous blood then flows in a backward direction; this is called venous reflux. Thus, the pressure in the veins increases, and the veins become dilated and distorted. They now become what are called varicose veins, a condition which develops, into, in most cases, chronic venous insufficiency. Varicose veins are dilated tortuous veins, with valves which are usually poorly functioning. "Spiders", minute veins radiating from a single feeding vein are also abnormal.

Who Suffers from Varicose Veins?

Varicose veins affect adult women more commonly than adult men. The risk of acquiring varicose veins, in the case of women increases with the number of pregnancies. Obesity, genetic history & lifestyle (eg. standing all day) may also play a role in the development of varicose veins.

What is the Connection Between Long Distance Travel and Vein Thrombosis (Economy Class Syndrome)?

People who have varicose veins or who have had deep vein thrombosis (DVT) should be extra careful during long distance travel by car or specially by plane. The motionless sitting position and possible concomitant  dehydration could facilitate blood clots as it stagnates in the leg veins by gravitation and by absence of calf pump activity. As a measure of prevention, gradient surgical stocking up to the knee should be worn during the flight. Get up every 45-60 minutes and walk in the aisle. In between, move your feet up and down. Fluids should be consumed in large amounts. In airplanes the air is dry favouring fluid loss through our breathing and perspiration making the blood more viscous. One should refrain from alcoholic beverages as these promote vasodilation and further fluid loss through the skin.

Symptoms and Diagnosis

Many abnormal veins are unsightly but cause no symptoms.

The most common problems of varicose veins are pain in the legs, weariness, aching, a sensation of heat, [blood clots in the veins (thrombophlebitis)], burning, itching and cramps. These symptoms may worsen with heat or as the day progresses, reaching a peak in the evening.

The bursting of small veins can cause permanent brown stains in the skin. This is common.

The most severe complications of varicose veins are skin disorders, such as oedema (swelling); skin rashes (cezema) or ultimately leg ulcers.

By examining your legs, the surgeon will determine the type and extent of abnormal veins. Your surgeon may do an ultrasound test (doppler or duplex scan), which uses sound waves and colour to give a picture of the veins. The test causes no pain or discomfort.

Your Legs and Your Veins: Management

How will your doctor treat your chronic venous insufficiency (Varicose Veins).

Your doctor decides on the types of treatment according to:

  • Signs and symptoms you have
  • Clinical examination
  • Ultrasound tests (Duplex Scan)
  • Risk of complication

Treatment of Chronic Venous Insufficiency

  1. Diet and Lifestyle Rules
    • Avoid hot baths, saunas, prolonged immobile exposure to the sun and hot wax depilatories.
    • Sleep with your legs slightly raised.
    • Finish washing with a cool shower directed at your legs.
    • Wear heels approximately 3 to 4 cm high
    • Avoid clothes that are too tight
    • Move your legs about while sitting, and get up and walk around from time to time when sitting (or standing) for prolonged periods especially at work.
  2. Drug Treatment
    • Phlebotronic drugs improve your venous circulation and protect your veins
    • Phlebotronic drugs also reduce symptoms such as heaviness, pain, night cramps and paraethesia (numbness and tingling)
  3. Graduated Pressure Elastic Stocking
    • Thin elastic stockings are used during the early stages and thick elastic stockings for later stages; they must be worn all day long except when in bed.
    • Elastic stocking must be avoided if you have leg arterial problems.
    • Your doctor will be able to choose he stockings appropriate for your venous problems based on certain measurements of your leg.
    • Bandages can give more compression than stockings alone and may be required for problems such as thrombophlelitis, eczema or skin ulcers.
  4. Elimination of Varicose Veins
    1. Injection treatment is suitable for:
      • Spider veins
      • Isolated varicose veins
      • Varicose veins which appear again after surgery
      • Occasional early varicose vein
    2. Injection therapy is usually not recommended for people who:
      • have many varicose veins
      • have obese legs
      • are not able to walk very much
      • have had asthma or bad allergies
    3. Injection therapy has the advantages of:
      • avoiding surgery
      • avoiding a general anaesthetic
      • little or no time off work, home duties or sports
      • However, a disadvantage is that treatment is longer
    4. Preparing for injection treatment

      5. The procedure is done in the surgeon's rooms. On the day of treatment:
      • wear loose slacks or trousers
      • wear comfortable, low-heeled shoes or sandals
    5. Procedure of injection treatment

      6. The surgeon will mark out the vein while the patient stands. The veins are injection with the patient lying down. The bandages and elastic stockings at first feel tight but soon loosen slightly, becoming more comfortable.

    6. Care after treatment
      7. Do not take off bandages and stocking
      • Walk about half hour every day (not including walking about in the house) to reduce swelling in the treated leg. This is important.
      • While taking a shower or bath, put the leg in a plastic bag out of water. The bandages must be kept dry.
      • It is usually not necessary to take more than one day off work.
      • The legs are re-bandaged every 7-10 days, if needed. Other veins may then be treated.
      • Even if the veins seem to have closed off, a follow-up visit is needed a few months later so the surgeon can see if new veins have appeared which must be treated.
    7. Relief of pain or discomfort

      8. The best treatment is to do more walking. Sometimes paracetomol tablets may be required.

    8. Side effects
      • Brown stains along treated veins are common.
      • "Flare" (or blush) of very small vessels around the point of injection.
      • Sore lumps can develop near the vein in spite of compression.
      • They usually deal within weeks.
      • Allergic reactions are rare.
      • At the site of the injection, a small skin ulcer may occur even with the best of care. Healing almost always occur.
  5. Surgical Treatment

    6. Surgery may be needed for some people. Usually the results of surgery are more attractive than the appearance of larger varicose veins.
    1. Technique

      2. The patient is usually admitted to hospital on the evening before or on the day of operation. Shaving of the leg will be done in the ward. The veins are marked by a __________before surgery. The surgeon may make a small cut high in the groin (for the long suphenous vein) or at the back of the knee (for the short saphenous vein). Stripping of the vein in the thigh is performed subsequently after more small incisions are needed for other surface varicose veins which must be removed.

    2. Care for surgery

      3. After surgery, the legs are usually bandaged to reduce bruising. This feels tight at first but is tolerable. Walking reduces the discomfort. Analgesics such as paracetomol is needed. The patient may leave hospital on the same day as the operation or within a day or two. Walking for at least half an hour every day is encouraged (not counting walking around the house). Bandages are left alone for a few days and are then taken off in the clinic. A compression stocking may be needed for a few more days. The surgeon may need to inject any remaining vein during the first visit or a few weeks later when bruising has settled down. Most patients need to take on one to two weeks off work and other heavy activities.

    3. Other effects of surgery

      4. While surgery on varicose veins is considered to be safe and effective, there are a few side effects:

      • Scars
      • Discolouration
      • Soreness
      • Numbness
      • Nerve damage
      • Swelling
      Swelling of the ankles or feet is common and may last for a few weeks. Swelling is due to the operation and not to a blockage of blood flow. This is reduced by wearing support stockings through the day.

    4. Side effects of anaesthesia

      5. Modern anaesthesia is safe with few risks.

    5. Complication after surgery

      6. Infections may occur in wounds, especially in patients who have ulcers. Blood clots can occur in the deep veins. Notify your doctor as soon as possible of any above side-effects.