Phlebitis (sometimes called thrombophlebitis) means inflammation of the veins, and is often accompanied by some thrombosis (clotting of blood) inside the affected veins, which become hard and tender. This is not the same as deep vein thrombosis (DVT) and is not usually dangerous. It does not mean that the varicose veins necessarily have to be treated.
Bleeding as a result of knocking varicose veins worries many people, but this is very rare. It will always stop with firm pressure and the veins can then be treated to remove the risk of further bleeding.
Deep vein thrombosis varicose veins are associated with DVT in some patients. It is not clear whether varicose veins themselves increase the risk of DVT, but certainly DVT leads to varicose veins and skin damage around the ankle. If you feel your varicose veins are presenting any of these symptoms, you should see your GP and ask for a referral to a vascular surgeon.
There are two tests to investigate varicose veins. As most varicose veins originate from leaking valves at groin level or behind the knee it is important to accurately locate the site of the valve leaks. At your outpatient appointment the doctor will use a small probe to assess your veins, This procedure is called continuous wave Doppler. The probe can detect the direction of blood flow which is audible, both in the skin veins and in the deep veins. It indicates where the veins have come from and helps in the planning of any operation that might be required.
The second test is an ultrasound scan (duplex) that may be performed instead. This will allow detailed examination of your deep veins particularly if there is a past history of deep vein thrombosis. Varicose veins behind the knee and recurrent varicose veins will also require duplex scanning.
Treatments available to treat phlebitis include an operation, endovenous laser therapy, foam sclerotherapy and radio frequency ablation.
All of the above will require duplex scanning as part of their selection process and the monitoring of the treatment itself. Very occasionally, if the scan is not clear, an X-ray of the veins, called a venogram, may be required.
This involves the injection of dye (contrast) into a vein in the foot. The contrast can be seen outlining the veins in the calf and thigh, and is the best way of detecting previous damage to the deep veins. Other scans which are sometimes used include MRI and CT.
Is treatment for this general condition successful? Stockings are effective in controlling symptoms and preventing skin complications.
They are only effective if worn regularly, but can reliably avoid the need for surgery in the majority of patients.
Injection of varicose veins can be successful, but the long-term outcome of the new treatment of foam sclerotherapy requires further evaluation.
Surgery is followed by a recurrence rate (varicose veins returning) of about 1 in 7 over a ten-year period. This recurrence may be due to poorly planned or performed surgery, new vein formation, or due to new valve leaks beginning elsewhere. There is a small risk of deep vein thrombosis (DVT) after surgery which can be reduced by wearing compression stockings and remaining mobile after the operation.
This discussion will continue next week.
Lizel Britz 072 243 7707.
