About Varicose Veins 認識靜脈曲張
◼ 1.1 About varicose veins
Veins are part of the circulatory system responsible for returning blood to the heart. Within the veins, there are structures called venous valves, which act like gates to prevent blood from flowing back down to the feet due to gravitational forces when standing. If the venous valves within the veins fail to function properly, it can result in blood reflux, causing blood to accumulate in the superficial veins of the feet, leading to superficial vein dilation, which is known as varicose veins. Varicose veins can have different distribution patterns: Great Saphenous Vein (inner thigh and calf), Lesser Saphenous Vein (back of the calf), and perforator incompetence.
In most cases of varicose veins, the condition occurs due to blood reflux at the junction between the great saphenous vein (superficial vein) and the femoral vein (deep vein) located in the upper part of the thigh crease, causing blood to flow from the deep veins to the superficial veins and resulting in dilation of the superficial veins.
◼ 1.2 Problems of varicose veins
The most common symptom experienced by patients with varicose veins is the presence of bulging vessels in the thighs and calves (most commonly on the inner side of the thighs and calves, followed by the back of the calves). Patients may initially notice the appearance of tiny blood vessels on skin surface, known as spider veins. As the condition of blood reflux worsens, patients may observe protruding veins resembling small snakes or worms, affecting their appearance. In addition to this, patients may experience persistent mild pain or soreness, leg cramps, leg numbness, and other symptoms in the calves.
Severe varicose veins can cause skin changes in the calves. The refluxed blood can lead to pigment deposition, resulting in the skin of the calves becoming dark brown. It may even trigger an inflammatory response, causing the skin to become hardened and thickened, eventually leading to a condition called lipodermatosclerosis. In the most severe cases, venous ulcers can develop, which are non-healing wounds that appear on the feet.
◼ 1.3 Severity of varicose veins
Varicose veins can be classified into six stages based on the severity of symptoms:
Stage 1: Appearance of spider veins (telangiectasia).
Stage 2: Development of worm-like varicose veins.
Stage 3: Varicose veins accompanied by edema (swelling).
Stage 4: Skin changes, pigment deposition, and inflammatory hardening.
Stage 5: Skin changes and lipodermatosclerosis.
Stage 6: Skin changes, lipodermatosclerosis, and skin ulcers.
Doctors will choose appropriate treatment methods based on the severity of the patient’s varicose veins.
◼ 1.4 Conservative management and pressure stockings
Popular methods such as hot compresses or using medicated creams for leg massage provide temporary relief by stimulating the contraction of blood vessels, thereby temporarily alleviating the pain of varicose veins. However, these methods are not considered effective treatments for varicose veins and cannot truly cure the condition.
Compression stockings
Compression stockings are one of the methods used to prevent varicose veins and prevent the worsening of varicose vein symptoms, but they do not treat varicose veins.
The principle of compression stockings is to apply progressive pressure to the calves, aiding blood flow back to the body and reducing blood stasis in the legs. By reducing blood stasis, it can improve leg discomfort caused by blood reflux and prevent the worsening of varicose veins.
The difference between medical-grade compression stockings and those available in the general market lies in the design of progressive pressure. Medical-grade compression stockings are designed with the highest pressure at the ankle and gradually decrease the pressure upwards. This design helps facilitate blood return in the veins. On the other hand, general market compression stockings may not have a progressive pressure design. Inappropriate pressure can cause blood stasis in the lower limbs, leading to discomfort without improving varicose vein problems and increasing the burden on the body and heart.
Compression stockings come in different designs to cater to different patient needs and the severity of varicose veins. They can be in the form e.g. cover the thigh or below the calf, etc. Ready-made compression stockings available in the market are suitable for individuals with average body sizes. However, if patients are too overweight or too thin, or if they have more severe swelling in the legs, customized stockings may be necessary.
Compression stockings also come in different pressure levels, typically categorized as Class I to Class III, suitable for patients with varying degrees of severity. We recommend patients to follow their doctor’s instructions and purchase suitable compression stockings. Generally, compression stockings are durable and can be worn for over a year. Doctors usually recommend patients who have undergone varicose vein treatment to wear compression stockings for more than a year for protection.
However, doctors emphasize that conservative treatments such as compression stockings can only relieve the symptoms of varicose veins and cannot cure the underlying problem. If patients do not wear compression stockings, varicose vein symptoms may immediately recur. Moreover, due to the humid and hot weather in Hong Kong, many patients find it difficult to tolerate wearing compression stockings and choose to discontinue their use.