The goal of the treatment varies according to the type of the varicose veins
WHAT ARE THE TYPES OF VARICOSE VEINS
Varicose veins are classically divided into three groups according to their diameter: large varices, medium varices and capillary varices:
Large varices (varicose veins)
When standing, these varices are seen to protrude from the skin. In such varices, there is almost always an underlying venous insufficiency (valve failure). In fact, venous insufficiency starts first and varices begin to appear several years later. The diameter of the varices is a good indicator for the severity and duration of venous insufficiency. In other words, the larger the incompetent vein and varicose veins, the longer the venous insufficiency is present. Since venous insufficiency and varicose veins are progressive, they increase in number and diameter each year.
In patients with venous insufficiency, blood flow in the incompetent veins and varicose veins is much slower than normal, so clots can easily occur. The resulting clot may make the endovenous treatment difficult, if not impossible, and may occasionally go into the lung (pulmonary embolism), creating a life-threatening risk. In these varicose veins, problems such as bleeding, wound formation and deterioration of healthy vessels may also occur over time. For these reasons, we recommend that patients with large protruding varices with incompetent veins always be treated even if they do not have any symptoms.
Medium-sized varices (reticular veins)
These are blue-greenish varices with an average diameter of 3-4 mm which protrude slightly from the skin. Typically, they are behind the knee and on the outer side of the leg. Generally, there are accompanied by capillary varices (spider veins) with different size. In fact, medium and capillary varices are visible parts of a single vascular network in many patients. This vascular network, whose medical name is Lateral Subdermic Venous Plexus (LSVP), is thought to be the remnant of the normal veins we use before the birth. This venous network is disabled at birth because our circulatory system is completely changed and we start to use new veins. In fact, this vascular network, which is present as a residue in every human being, can be reactivated in some people, especially in women, and forms such ugly-looking network of varices. In such patients, Doppler ultrasound does not usually show insufficiency of the main vessels and there are no symptoms. The main complaint in these patients is cosmetic impairment and treatment should be done to improve this.
Small varices (spider veins)
Capillary varices are usually associated with medium (reticular) varices and need to be treated with them, the ideal treatment being a "well done" sclerotherapy. In some cases, capillary varices are isolated, without medium-sized varices. If such capillary varices are too thin, they should be treated with transdermal laser applied from the skin, and with sclerotherapy if they are a little larger. In general, in capillary varices, insufficiency of the main vessels on Doppler ultrasound is rare and health problems do not occur. The main complaint in these patients is visual impairment and treatment should be done accordingly.
A special type of spider veins is "Corona Phlebectica". These veins are mostly seen on the ankle and feet, consist of pink purple small blisters and their appearance is extremely uncomfortable for patients. Corona Phlebectica, unlike other spider veins, is often associated with venous incompetence and larger varicose veins. In the treatment, leakage vessels should be detected by color Doppler ultrasound and should be closed with laser, then large varices should be treated and then corona phlebectica with very fine needles should be eliminated with a "good and careful" sclerotherapy.. Ideally performed, sclerotherapy is extremely successful in treating corona phlebectica.