FAQ's - Best Vascular Surgeons in Delhi, Endovascular Surgery in Delhi, Professor Dr. Digvijay Sharma

1. What are varicose veins?
  Varicose veins are abnormally longer, visible, tortuous and dilated veins. Unlike arteries the veins have very thin walls (they easily expand if pressure inside increases) and they flow towards the heart. So for varicose veins the venous pressure inside must be higher. This leads to the term CHRONIC VENOUS INSUFFICIENCY (CVI). Varicose veins is a part of CVI.

What causes varicose veins?
As said earlier the pressure inside the venous system is raised. This can happen because there is
1. obstruction to flow,.
2. reflux (downwards flow away from the heart) This is mainly because the one way valves that ensure blood flows only upwards as we are standing become incompetent.
3. Increased flow - this will only happen when the artery and veins get connected.
The most common cause seen is reflux. The most reason is familial and very rarely as a delayed complication of recanalizing of the veins after they were filled with clot (venous thrombosis)

How common is this condition?
In the general population it's 25% of the population of which most commonly seen are spider veins / dermal flares. These are spider leg looking very superficial veins. They donot usually involve the defined and named veins of the body. They are just under the skin.

Overall CVI is a big disease burden to the health care system. In USA alone more that USD 3 billion needs to be spent per year on varicose vein management alone.

1. Do stockings work in varicose veins?
  Yes they do. The vein walls are thin and can be squeezed closed. Once you close the vein there will be no reflux. Only when using stockings we are modifying the lifestyle of the patient to control the issues of CVI. WE ARE NOT REVERSING THE CAUSE. If you stop using stockings or they get lose then disease recurs. I advise this only for patients with poor life expectancy and extensive co morbid or bedridden state of the patient. But yes most of the skin changes due to complications of varicose veins can be controlled by stockings or upscaling to proper 4 layer bandages.

1. Besides looking ugly do varicose veins cause any other issues?
  Yes they do. Ugly looking varicose veins are graded 2/6 after this skin changes ranging from discolouration itching and ulcers do happen. That is why they drain about 3 billion USD worth of health care each year in USA alone. Here I will stress that once you form ulcers then treatment duration can range up to one year for complete ulcer healing.

When should varicose veins be treated?
Treatment should be early though I stress that all treatments will not be procedure. They range from stockings, skin care and procedures.Once the diagnosis of varicose veins is made a complete search has to be made to find the cause of the same . Only after the cause is determined then only can treatment be planned. The range of treatment ranges from Compression Stockings Chemical Ablation Endovascular Ablation (RFA/Laser) to formal surgery. Veins are broadly classified as Superficial Deep and Perforating (they connect superficial and deep veins). Location of the problem and quantifying of the problem finally will lead you to proper management that should be individualised to the patient.

What is laser or RFA treatment method and When should we go for laser or RFA (Radiofrequency ablation)?
These are Endovascular meaning from inside the veins procedures. We pass a catheter of Laser or Radiofrequency inside the vein and basically burn the veins close from inside. Both methods use heat to destroy the veins. They are used to close the veins so that they a no longer pipes but scarred thin rope like tissues. As compared to open surgery where we tie the top end of the veins and remove the lower part from the leg here the veins are destroyed but remain inside.SURPISINGLY REMOVAL OF THE REFLUXING VEIN SEGMENT DONE PREVIOUSLY BY US LEAD TO A RECURRENCE OF 10% IN 5 YEARS AFTER THE PROCEDURE. The theory being surgery became a stimulus for regeneration of the vein.
How are Endovascular procedures better to surgery?
They are done as day case procedure and generally need only local Anesthesia.They leave only puncture scars that usually are not seen.They have a much low recurrence rate of 10% at 10 years.Post surgery quality of life is much superior.They are considered gold standard of refluxing issues for any CVI condition.We are able to close the incompetent perforators also at the same sitting with Endovascular methods.

FAQ’s