Secondary varicose veins
What are secondary varicose veins?
Secondary varicose veins are superficial venous dilatations in the lower limbs (especially the internal saphenous vein and the veins that serve the calf muscles) that usually occur after an episode of deep vein thrombosis. In some cases, they may resolve after the obstruction is removed, but there is a possibility of a chronic course of varicose veins with long-term complications (stasis venous ulcer).
Why secondary varicose veins appear
Deep venous obstruction affects the vascular valvular system followed by an increase in venous pressure that is transmitted to the surface (to the superficial, subtegumentary veins) through the communicating veins. The superficial veins dilate, become visible, sinuous, thickened and painful, the unfavourable evolution of varicose veins being influenced by several risk factors:
- Sedentary lifestyle;
- Obesity;
- Exposure to high temperatures;
- Smoking.
What are the specific symptoms of the disease
Varicose veins are frequently manifested by the presence of:
- Feeling of heavy legs;
- Edema of the lower limbs, especially towards the end of daily activities, in the evening;
- Affected limb pain;
- The sensation of tingling or stinging of the skin;
- Itching.
How we treat varicose veins
External compression with the help of elastic stockings (with maximum gradual compression at the level of the ankles with a gradual decrease towards the knees) to be worn before starting the daily activities (before getting out of bed). It is recommended to avoid: tight clothing (pants, belts, tight elastic stockings), warm baths, sauna, prolonged exposure to the sun, prolonged orthostatism with uneven bodyweight distribution and foot-to-foot position, heels larger than 3 cm or uncomfortable shoes with tight straps.
It is preferable to have a support point during the night that allows us to raise our legs above the level of the pelvis to help the venous return and change the lifestyle that includes weight loss. Reducing salt intake (which promotes fluid retention and promotes stasis edema) and quitting smoking are other helpful measures in ameliorating the clinical manifestations of the disease.
It is important to follow the rules of general hygiene and to be careful of any lesions that may occur at the level of varicose veins to prevent the occurrence of infections at this level.
Pharmacological treatment includes ointments with heparin, phlebotropics (food supplements to support venous function) and oral painkillers.
The minimally invasive techniques used to treat secondary varicose veins are sclerotherapy (venous injection of a sclerosing substance that closes the vein), cryotherapy, laser photocoagulation and radiofrequency venous sealing.
Surgical treatment is performed by venous stripping (the affected vein is removed), thrombectomy (removal of venous thrombi) or with the help of minimally invasive endoscopy through which the venous dilatations are ligated.
In case of complications such as varicose ulcers, it may be necessary to administer systemic or local antibiotics (in case of infections) but also the surgical treatment of debridement and dressing of persistent lesions.