Varicose veins are often thought to be "only" a cosmetic problem. However research over the last decade or so has shown this to be wrong. Some 20% of patients with varicose veins will go on to get leg ulcers if left untreated. Others will get swollen ankles, skin damage, discomfort, phlebitis or rarely bleeding.
It is amazing how many people claim to have had "phlebitis". The term seems to be used by the general public and many doctors and nurses to mean any pain or inflammation in the lower legs. In fact, it is a term so commonly used that many people think they know what they mean by "phlebitis" when they clearly don't.
We have always been taught that varicose veins are caused by the valves in the veins failing, allowing blood to fall the one wrong way down the vein... causing varicose veins and worse. If the problem is not corrected, blood clots, ankle swelling, skin damage and even leg ulcers can ensue. So why do these valves fail? And why do some people suffer with the condition and not others?
As we all know, the medical world moves slowly, particularly when it comes to recommendations or guidelines. In many instances when drugs or malignant conditions are being assessed, there is a very good rationale for this slow change and there are many examples to support a thorough and well-reasoned (albeit slow) approach.
Over the last decade there has been a gradual shift away from traditional 'open' vein surgery (the so called 'tie and strip' operation) towards the newer operations that use lasers and other heat-based techniques. These are safer, less invasive, and quicker - patients can leave the hospital on the same day, an hour after the procedure.
Ever since the advent of treating veins with heat (a procedure called endovenous thermoablation) we have used ultrasound to check which veins need treatment in the first place, to guide the endovenous surgery and then to check the veins after the surgery to find out how successful the new techniques are.