Is early treatment of varicose veins the best idea? Or should you wait until they are causing a lot of problems? Or until you have finished having children?
There are many opinions out there about the best timing for varicose veins treatment.
Some are based on old advice when surgery was the only option. Others arise from requirements certain health insurance companies impose for the sorts of problems they will cover.
Then there are opinions of health care providers that were established when they did their training.
Thinking and available treatments have changed a lot in recent years.
Waiting Until Family Completed
Why did surgeons use to recommend waiting until you had finished having your family before you had your veins stripped? Obviously this recommendation applied to women only.
Each pregnancy results in a large number of body changes that can bring out varicose veins. There is the increased blood volume. The increased heat as the mother gets rid of the excess heat generated by the baby, giving her that healthy pregnancy glow. Hormone levels are changing rapidly with effects on human tissue responses. The pressure of the baby in the pelvis on the major veins returning from the legs through the pelvis imparts increased back pressure on the veins of the leg.
Therefore each pregnancy has the chance of causing new varicose veins in women with a tendency to developing them. Waiting until all pregnancies have occurred enables all problems caused by the pregnancies to be addressed.
Two factors are important to realise in this thinking.
One is that a surgical approach creates surgical scars. Redoing a similar area for further veins means there is old scar tissue to operate through. Technically and from a healing point of view this is not ideal.
Secondly leaving established veins in place will actually tend to cascade or exacerbate the development of new veins. Damaged veins tend to produce similar nearby effects a bit like leaving a rotten apple amongst a collection of good ones. The rottenness is communicated!
This really is the thrust behind considering whether early treatment of varicose veins is best.
In the early surgical days of vein treatments, the understanding was that vein problems began at the junctions with the deep veins, near the top of the leg or in the crease of the knee. Surgical treatments were aimed at treating veins with this understanding.
Now, with ultrasound imaging of veins being available, without any significant risks to human tissue (whereas the previously available x-ray imaging did) following veins serially over months or years is now possible. This has demonstrated that varicose vein problems develop from a localised problem usually at the surface, just under the skin, and then spread to the connected veins. Eventually this will communicate with the junctions to the deeper veins.
There are very rare instances of people born lacking vein valves. But in most people the tendency to develop varicose veins develops the problem over time.
What this reveals then is that if we took out the rotten apple, or really the damaged section of vein, the problem would not be communicated to nearby ones.
Therefore early treatment of varicose veins is really ideal. It prevents an increased cascading problem occurring. The treatment required is much less invasive.
It does not mean that you will never get another varicose vein unfortunately. That tendency is still there. It is just that you are minimising the chances, pressures and effects to develop more of them.
Choices For Treatment About Pregnancy
But what does that mean for pregnancy? Surely further pregnancies will result in more veins. Which means more treatments.
With the newer treatment options and the fact these are now considered the best option for treatment previous sessions will not interfere with subsequent ones.
If we leave varicose veins present for subsequent pregnancies we multiply the new veins that will occur with the next pregnancy. People who have had treatment between pregnancies do get different outcomes. Some do not develop new varicose veins. Others do. But they are never as bad as they are when left untreated. For many the symptoms arising from varicose veins in pregnancy can be quite debilitating.
We would always recommend people who have had varicose veins in the past the wear proper supportive stockings for the duration of the pregnancy, at least while you are on your feet. These can prevent new occurrences.
How will this idea of early vein treatment affect insurance cover?
Obviously this is an important consideration. As I have covered about insurance companies the various policies vary between companies and also between policies within each company.
As an example, Southern Cross requires there to be an incompetence, or vein failure, between the surface and deep veins as well as certain associated problems to be present. They also offer cover for two treatment sequences per leg per patient lifetime. To benefit best from this therefore does require some careful consideration.
This still does not change our understanding now though that early treatment of varicose veins is your best option. There are some long term changes from varicose veins that will not disappear when they have been fixed. Scars from ulcers and most lipodermatosclerosis changes will not disappear. The latter may improve somewhat. But usually it remains visible for the rest of your life.
Your choice becomes a balancing act of cover as opposed to an ideal early treatment.