Varicose veins, which are manifested by a permanent dilation of blood vessels, evolve over time and benefit from being treated as soon as they appear. How to know if we are at risk, how to treat them, how to prevent them? Dr. Dominic St-Amour, specialist in phlebology and medical director of the Medicart Montreal clinic, answers our questions.
1- Why do some people have varicose veins and others don’t?
The most determining factor is heredity. In women as in men, the risk is more than 50% if one of the parents has a severe form of the disease, and it exceeds 80% if both have it. Age is also involved, but mainly because the disease is progressive. We can start to have varicose veins at 20 years old, but, since venous deterioration increases slowly over the years, it is only around forty that many people consult us. Another aggravating factor: pregnancy, due to the combination of weight gain, hormonal changes and, from a more mechanical point of view, a possible decrease in venous return. That said, the incidence of varicose veins in women who have not had a pregnancy is the same as in men.
2 – How do varicose veins appear?
To illustrate, our blood circulation system is similar to a water ecosystem. If a stream is blocked for one reason or another, the water will overflow elsewhere. It’s a good thing in itself, but it can lead to sequelae. The veins are considered varicose when they are dilated and the blood circulates less well in them. The spectrum of the disease, very broad, ranges from telangiectasias, or small veins distributed in cobwebs, to the apparent “cords” formed by the saphenous veins, larger vessels on the surface of the skin. Although small varicosities are generally more harmless, it is however important to emphasize that there is no perfectly linear correlation between the size of the varices and the intensity of the symptoms. In other words, it is possible that very apparent varicose veins do not cause heaviness or pain, and that varicosities that may seem innocuous are linked to more serious problems.
3 – When should we consult?
As soon as vessels are apparent or symptoms such as heavy legs, cramps, edema and itching appear. Skin changes, such as dermatitis or even ulcers, are also signs to watch closely, as they can announce a serious problem. Thereafter, it is strongly recommended to do a regular follow-up from year to year, because even if we treat certain veins, other varicose veins are likely to appear, since it is a chronic disease.
4 – What treatments are offered?
Depending on their size, course and nature, varicose veins can be treated in three ways. The good news: 90% to 95% of cases that once required surgery can now be treated non-invasively.
Sclerotherapy Conventional is the most used approach, especially for varicosities. It involves injecting an irritating drug directly into the vein, which will cause an injury and ultimately a scar. Since the blood can no longer circulate there, the vein will disappear. The treatment is usually administered by a nurse, under the supervision of a doctor, and may require several sessions. Patients can return to their normal activities without delay.
Echo-sclerotherapy can replace surgery to treat the saphenous veins in some cases. The injections, which do not require anesthesia, are administered under ultrasound guidance by the doctor. In the majority of cases, this intervention, whose effectiveness reaches 95%, does not require convalescence.
Venefit endovenous radiofrequency treatment is reserved for more severe cases. Less invasive than surgery, it is done under local anesthesia. The intervention consists of inserting a catheter into the vein from the knee to the groin, then proceeding to its ablation by means of radiofrequencies. The duration of treatment is approximately one hour, and patients can quickly return to their normal activities. Clinical studies show that this treatment allows faster recovery and has fewer side effects – pain or bruising – than surgery. In addition, recurrences are less frequent, with a satisfaction rate of 93% after three years.
5 – How is patient care carried out in the clinic?
We first carry out an evaluation, with or without an ultrasound, before proposing a treatment plan. It is often possible to receive treatment from the first visit, especially if it is classic sclerotherapy.
6 – Are the treatments reimbursed by RAMQ or private insurance?
They are not covered by the RAMQ 1984, although people who need vascular surgery can undergo surgery in the hospital; that said, the wait can be long. As a general rule, private insurance, whose coverage may vary, reimburses a good part of the initial ultrasound and a small part of the medication used in injection. Compression stockings to be worn as a preventive measure, in particular during plane flights, are also likely to be reimbursed.
7- Finally, how to prevent the appearance of varicose veins?
Adopting healthy lifestyle habits, such as exercising and controlling weight, can play a positive role. Physical activity – but I’m not necessarily talking about rigorous training – in particular is very important. The fact that people moved less during the pandemic and spent whole days in front of their computers led to a lot of venous symptoms. Going for a coffee, taking the stairs in the subway, walking: these movements generate muscle contractions in the legs, which generate a pump effect to stimulate blood circulation.
Assignment : Medicart’s mission is to provide consumers with a full range of beauty and wellness treatments. These are provided in a safe and accessible manner by health professionals and experienced technicians under the same multidisciplinary banner in dermatology, phlebology and aesthetic medicine.
This content was produced by Le Devoir’s special publications team in collaboration with the advertiser. Le Devoir’s editorial team had no role in the production of this content.
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