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Varicose Vein Surgery Fails One in Five Women


It's fair to say that there is somewhat of a baby boom sweeping across the celebrity world at the moment. For many of the leading ladies involved in this 'pregnancy epidemic' it is their first foray into motherhood, which undoubtedly will involve an array of physical and emotional experiences as they prepare to give birth.

One physical change that is important to highlight to these young expectant mothers that is not often discussed is the possible appearance of varicose veins of the vagina and vulva - a condition which is often experienced during pregnancy and one which can open the door to some more serious concerns if not treated correctly.

There was a time when it was thought that pregnancy caused varicose veins. It seemed obvious. Women who had no varicose veins visible on their legs suddenly got varicose veins during pregnancy. Surely there had to be a link?

Unfortunately it is this sort of observation that leads to "old wives tales" which gets perpetuated throughout society, until they become accepted as a truth.

In 1999, a research project showed that whilst varicose veins became worse during pregnancy, the pregnancy itself did not cause the varicose veins. It may be thought that the difference between "worsening" and "causing" varicose veins is only semantics. However, when we want to treat varicose veins with the smallest chance of them ever coming back again, the understanding of how varicose veins form and what causes them becomes essential.

From this research, it became clear that pregnancy merely made small varicose veins or hidden varicose veins bigger and therefore more visible. As such, this research suggested that previous pregnancy should have had little effect on how we treat varicose veins.

Further research in 2000 highlighted another link between pregnancy and varicose veins.

Whereas most vein clinics only check the legs of patients with varicose veins, at The Whiteley Clinic we perform a more detailed scan, tracing the source of every varicose vein in the leg. By doing this, we discovered that 20% of women with varicose veins - who had previously given birth - actually have varicose veins arising from the veins in their pelvis. In some cases this was the only cause of the varicose veins. In others, the varicose veins were coming both from the pelvis and the veins deep in the legs.

What was particularly surprising about this discovery was that in the majority of women, these veins are clearly visible on the surface. Women suffering from this problem have visible varicose veins on the inside of their thighs right at the very top of the legs. From here, these varicose veins either run down the inside of the thigh or run diagonally down the back of the thigh. Unfortunately, most doctors treating venous disease are not trained to identify these tell-tale signs and just treat the veins in the legs, leaving the pelvic source of the varicose veins completely untreated. Not surprisingly, it appears that this is a major cause of recurrent varicose veins.

Although we could see this ourselves, it is impossible to change a doctor's behaviour without research. With this in mind, we performed a study over the summer looking at patients who came to us with recurrent varicose veins, who had had treatment elsewhere but had not had their pelvic veins checked or treated. The results will be presented at the American Venous Forum in February, however as we suspected, the research showed that a much higher proportion of women with recurrent varicose veins had these arising from the diagnosed and untreated pelvic varicose veins. This suggests very strongly that the failure to diagnose and treat the pelvic veins in women who have had children results in a lack of adequate surgery to treat the condition. This causes a higher chance of recurrent varicose veins in women.

Medicine moves very slowly. Those that fund healthcare whether it is national governments or private medical insurance companies demand randomised controlled studies before they will accept anything new. Such studies take years to show an answer. In the meantime, the majority of doctors who treat varicose veins will continue to fail to treat the underlying cause and any arising from the pelvic veins, therefore allowing the number of patients with recurrent varicose veins to continue to increase.

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