Large varices must be treated even if they don't cause any symptoms
WHY ARE VARICOSE VEINS IMPORTANT?
Varicose veins are one of the commonest health problems in the community. Although it varies from country to country, it is estimated that 10-40% of the adult population has varicose veins. The frequency of varicose veins is 2-3 times higher in women than in men. However, males apply to the doctor much later because they care less about the appearance and the leg hairs cover the varicose veins decreasing their visibility. Therefore, varices in men are usually much more advanced when they come to the doctor.
Varicose veins in the leg are classified in three types: capillary, medium size and large varices. Most of the medium-sized (reticular veins) and capillary varices (spider veins) are mainly cosmetic problems. In such varices, if Doppler ultrasound does not show any venous incompetence, this means that there is no health problem, and such varices should be treated only if the patient is not happy with the cosmesis. Most of these patients can be easily treated with microsclerotherapy in several sessions.
In the case of large varices (varicose veins) that protrude from the skin, there is almost always an underlying venous circulation problem. This problem is mostly incompetence of the valves in the superficial veins, and rarely deep venous incompetence or thrombosis. In such varices, first the underlying problem should be identified and then treated with varices. People with large varicose veins may sometimes have complaints such as pain, swelling, itching and muscle cramps although in some patients there may be no complaints. However, it is well-known that even in such patients, there is a risk of clot formation, bleeding, wound (venous ulcer) formation and deterioration of deep healthy veins over time. Such asymptomatic patients are usually prescribed compression stockings and some medications, and adviced to undergo operation only if they have severe complaints or complications. This approach could be justified in the past because color Doppler was not widely used for diagnosis and the only treatment option was surgery. As a result, the treatment results were suboptimal with high rates of failure, recurrence and adverse effects. But today, with the systematic utilization of color Doppler ultrasound for diagnosis&treatment and use of minimally invasive therapies such as endovenous laser, RF and foam sclerotherapy, varicose vein treatment has become extremely safe and effective in experienced centers. Therefore, we recommend that all patients with large varicose veins who have leakage (reflux) on color Doppler ultrasound be treated even if they don't have any symptoms.