Varicose vein : Doctors interventions

 In fact when I see people with thread veins, one of the important things is that you check very carefully for underlying reflux so that the problem is treated correctly. Are they simply cosmetic?

Well, a question I get asked a lot is "I've been to my doctor with my veins and he tells me that treatment is not available on the NHS" and often that person is told that they're simply cosmetic.  Well, they're not simply cosmetic as you can see from this slide, a healthy vein is nice and straight and it's got strong folds,strong valves in the lining that meet properly, keeping blood directed upwards from the leg back to the heart. 

On the right we have a varicose vein, it's wider than it should be,it's tortuous, it's wiggly and the valves, these little folds, are weak and floppy and they're allowing blood down in the wrong direction, so varicose veins are unhealthy veins with faulty valves and this condition called reflux.  So it's not simply a cosmetic issue. As you can see in this slide, we've got a leg where we've got a superficial vein, that's a vein underneath the skin that is refluxing and faulty, and the blood is coming down in the wrong direction from the top of the thigh down into these lumpy varicose veins and further down into these little spidery veins.  So the underlying problem is reflux, it's not simply a cosmetic issue, it's a shorthand way of saying the majority of people don't get major problems but to dismiss them as simply being cosmetic is not correct. This is a lady I saw a few years ago and she too was denied NHS treatment initially. 

She had quite bad reflux in the veins in her thigh, feeding into varicose veins in her calf, which were causing quite a lot of swelling of her leg, and they were causing quite a lot of thread veins and spidery veins around the ankle, and also after a little while were causing a condition called varicose eczema, which I'll come on to in a moment.  In her case they weren't simply cosmetic, she actually had to argue her case quite strongly and at that time had to appeal to the Primary Care Trust, the PCT.  Eventually she was granted NHS treatment but her operation was cancelled three times, twice on the day of her operation she'd been all prepared and got ready and in frustration she decided that she would have her veins treated privately and she was concerned, quite rightly, about the possibility of ulcers.

So what problems can arise? 

One of the questions I get asked again quite a lot is "I've got bad varicose veins, will I get a leg ulcer, I'm worried about leg ulcers".  Well in fact the majority of people with even quite severe varicose veins do not come to any harm and i think this is the main reason why the NHS doesn't treat veins.  They do, however, cause a lot of ache, a lot of itch, swelling, these symptoms do tend to be worse in hot weather.

They tend to be worse at the end of the day and they are also very unsightly. I think it's sometimes difficult for us men to understand how much distress they cause to women particularly, and increasingly men.  It interferes with what you can wear, what sort of holidays you can take, what sort of social activities you might be involved in.