THE BLOG

Varicose Veins in Children

19/11/2013 13:55 GMT | Updated 23/01/2014 23:58 GMT

Many people seem to think that varicose veins affect older people or women after pregnancy. A large number of my younger patients, who are otherwise fit and well, often express great surprise that they have varicose veins, as if they are "too young" to get them. Even more interestingly, the majority of the celebrities that I treat readily tell me that they are more embarrassed about having varicose veins than they would be about having a great many other medical conditions and treatments. They frequently say that to own up to having had varicose vein treatment would make them feel as if their peers would be judging them adversely.

As such, it should not be much of a surprise to find that many parents completely miss quite significant varicose veins on their children's legs, assuming that the bulges that they can see could not possibly be varicose veins.

Fortunately, severe varicose veins needing treatment is not common in children. However, as with all medical conditions, if varicose veins are present and if they are starting to cause symptoms or tissue damage, they should be investigated fully by a duplex ultrasound scan regardless of the age of the patient. In addition, any treatment required should also be based upon the severity of the veins and the duplex ultrasound scan, not based on whether the patient is a child or an adult.

Last year a mother and father, both of whom I had treated for their severe varicose veins, brought their 12-year-old son for assessment. He had very large bulging varicose veins on both legs which, when he laid down and elevated his legs, disappeared. Duplex ultrasound scanning showed that he had lost the valves in all four of his major truncal veins which were all massively dilated. He was offered the new pinhole endovenous surgery that we have been promoting since 1999 and has now been approved by the National Institute for Health and Clinical Excellence (NICE).

Despite being only 12 years old, his veins responded exactly the same as any adults to treatment. The biggest difference came when I phoned up the day following surgery to check he was all right, to find he was already out playing football with his friends!

Over the last decade, we have treated numerous 15, 16 and 17-year-olds patients with severe varicose veins. Of course this is a very small proportion of the total number of patients we have treated but it does show that this condition can affect children and young adults. In the last year we have also had a 19-year-old young man who had a persistent ulcer on one of his ankles. His local doctors believed that he was too young to have an underlying vein problem and so kept ordering him to have dressings being certain that this would heal.

Eventually he came to our clinic and we found the underlying "hidden varicose veins" medically known as venous reflux or chronic venous incompetence. It was obvious he had been suffering with the condition for many years and the constant damage had slowly affected the skin causing a leg ulcer. This story is the same as the majority of venous leg ulcers, the only surprising thing being his age. Not surprisingly, with good duplex ultrasound scan and endovenous surgery under local anaesthetic, the veins were cured and the ulcer also went away without any dressings whatsoever.

Back in 1999 when I was a junior doctor, I ran a research study looking at how common varicose veins are in school children. Rather than just look at visible varicose veins on the surface, we used Doppler and another method called PPG (photophlethysmography) to see how many school children had already lost their valves - the so-called "hidden varicose veins", that can lead to either varicose veins or inflammation around the ankles such as swelling, skin discolouration or eczema. Rather shockingly, we found that 1 in 20 schoolgirls had already lost valves in their leg veins at age 9, and by age 18, 1 in 9 had "hidden varicose veins" or venous reflux.

So all in all what can be said about children and varicose veins?

Firstly, significant varicose veins in children are uncommon. The underlying cause, valves in the leg veins becoming incompetent, starts surprisingly young. This probably means that the progression from the valves giving way to having symptomatic varicose veins or other venous problems such as swollen ankles, discoloured skin, venous eczema or venous leg ulcers, is very slow in the majority of people. However in some children, varicose veins and venous damage seems to occur early. Fortunately with the correct duplex ultrasound examination and endovenous surgery, they seem to respond exactly as an adult would.

Therefore it is important to know that children can have varicose veins or the associated complications with "hidden varicose veins" and, if symptomatic varicose veins or other signs of venous disease do appear, it should be investigated fully and not ignored because the person is "just too young to have varicose veins".