Just about everyone I know complains of aching legs after a long day standing up – nothing remarkable about that you might think – except that some people really do have cause to complain about aching heavy legs, because a third of the population have a problem with the way the valves work in their leg veins, even if they are not aware of it.
Veins are the vessels in the legs that return blood to the heart – as we stand up a lot of the time, this means the blood has to go uphill against gravity – it won’t do that on its own without being pushed. The pressure to push the blood up the leg is provided by the action of the muscles of the calves which squeeze the veins and push blood up the hill. However, when the muscles relax, the blood tends to drop back down again. In order to prevent the blood dropping down the pipe, all the veins have valves in them – a bit like locks in a canal – to make sure that the blood continues to flow up the leg in the correct direction.
If these valves don’t work properly, the blood tends to ‘pool’ in the leg veins, making them stretch and swell. Living structures don’t like being stretched – it’s very uncomfortable – just think of the discomfort from a full bladder without being able to pee and you will have some idea of what swollen varicose veins feel like.
Some people will be well aware of their varicose veins due to the bulging blue lumps on the legs visible when they stand up – on the other hand there are a substantial number of people who will have no external sign of vein trouble, but who suffer from excessively heavy and aching legs on standing due to vein leaks inside the leg. The commonest vein that leaks is called the long saphenous vein which runs down the inside of the thigh like a drainpipe from the groin to the ankle. We can detect the valve leakages in the vein by doing a non-invasive ultrasound scan on the leg – an ultrasound probe can pick up the tell-tale signs of distended veins and blood flow going the wrong way (down the vein, rather than up the leg). Doctors call this wrong way blood flow ‘venous reflux‘.
Once the valves in the veins are leaking, there is little that can be done to repair them. Surgery has so far not invented a technique to replace damaged vein valves – that’s not really surprising as the valves in a vein are not the same as a chunky metal or plastic valve in a car that can just be removed and swapped for a good one – in real life the vein valves are so delicate that they are translucent – in fact they are so flimsy it’s surprising that they work at all!
For leaking veins there are really only two options (other than putting up with them) – compression stockings or surgical treatment.
Compression stockings provide external compression to squeeze the veins from the outside and squash them flat- that prevents the blood going the wrong way down the pipe. The compression option is not attractive to most people as it requires the wearing of compression stockings on a daily basis. These are quite tight (that’s the whole point of them) and difficult to get on. They also don’t look especially flattering for ladies and, although some stocking companies have made great efforts to design compression wear that are indistinguishable from normal stylish stockings, some of the brands still look suitable for Norah Batty from Last of the Summer Wine. Even the best ones are not comfortable during hot weather.
The good news for sufferers of heavy legs is that surgical treatment has come a long way in the last 10 to 12 years.
Advances in technology mean there are now several options available for the treatment of varicose veins, and all of them are ‘minimally invasive’- that is, they are done under local anesthetic, similar to a trip to the dentist.
Endovenous Laser – EVLT- is when a thin laser fibre is passed up the main leaking vein in the leg, with laser energy closing the leaky vein by burning it. EVLT is executed with the patient fully awake, and though is not completely painless is markedly less uncomfortable than the old fashioned surgical procedures. Radiofrequency ablation is similar to EVLT, but uses electrical energy over laser energy to seal the leg vein.
With EVLT and radiofrequency recurrence rate is incredibly low, and up to 85% of vein patients are suitable. The National Institute for Clinical Excellence has recently assessed vein treatments and recommended that minimally invasive treatments are offered to all patients with vein reflux and that old style surgery should be the option of last resort if no other technique is suitable.