Most of us have knowledge or experience about varicose veins on the leg. Sometimes we hear the words “hidden heir”, which is not visible on the surface but is said to be inside. Saying that the definitions of ‘hidden varicose’ / ‘internal varicose’, which are also used by some physicians, may actually mislead the patient, Cardiovascular Surgery Specialist Prof. Dr. Semih Barlas explained the details about the subject.
VEINS ON THE LEGS ARE LIKE A FLAT LADDER
Before moving on to the details about hidden varicose veins, let’s briefly summarize how the blood circulation in the legs occurs. Clean blood, pumped by the heart and containing the oxygen necessary for our tissues, is carried to every part of our body by veins called ‘arteries’. The veins that carry the dirty blood left behind after oxygen delivery to the lungs for cleaning are called ‘veins’ (veins). We can say that the placement of the veins in our legs resembles a straight staircase. ‘Deep Veins’, which form one of the steep legs of the ladder, watch in the furthest-deep layer from the skin surface and embedded in the muscles, invisible to the eye, where all the dirty blood is collected and carried; The ‘Superficial/Truncal veins’ (‘Saphene and Connecting veins’) forming the second leg of the ladder, outside the muscles, close to the surface, advancing in its own sheath, invisible like deep veins, and navigating just under the skin, visible if enlarged and enlarged. There are ‘subcutaneous veins’.
DISORDERING THE VALVES OF THE LEG VEINS CAUSES VARIOUS
Disruption of the valves in the leg veins is the most common cause of varicose veins. When the patient stands up, the valves that allow the blood to go one way from the bottom up leak back. This blood flow in the wrong direction is called ‘venous reflux/insufficiency/leakage’. In the reflux of the superficial veins, the blood begins to flow towards the subcutaneous veins. This gives rise to veins of different colors and diameters on the skin, namely varicose veins.
Varicose veins visible to the naked eye
Varicose veins that we see with the naked eye on the skin of the legs are the tip of the iceberg. The main problem is due to valve insufficiency in veins that we cannot see with the naked eye. Some call it ‘Hidden varicose’ or ‘Internal Varicose’ when there is a problem with the deep veins inside the muscles that function like a main highway, or when there is a problem with the invisible veins although they are called ‘superficial’. In fact, varicose veins are mostly caused by the veins inside. Therefore, it is not a correct approach to separate the heirs as ‘internal/hidden’ and ‘external’. Approximately 50% of the cases with valve leakage in their superficial veins do not develop a leak into the subcutaneous veins. Although the patient may have burning or discomfort on the soles, swelling (edema) in the ankles, night cramps, redness or wound opening, there may be no prominent veins in the legs. With proper definition, valve leakage in superficial veins is called ‘Superficial Venous Reflux (SVR)’, ‘Superficial Venous Insufficiency (SVI)’, ‘Chronic Venous Insufficiency (CVI)’. In this process, if visible varicose veins have not developed yet, there are physicians who use the definition of ‘Hidden Varicose’ (Dr. Mark Whiteley). As a result, ‘superficial incompetence’ on the one hand and describing it as ‘hidden or internal heir’ on the other hand can make the problem confusing.
SYMPTOMS OF HIDDEN HERCESIS LEG FAILURE, PAIN AND Tenderness
Even if you do not have ‘spaghetti pasta’-looking thick varicose veins on your legs, leg pain when standing, fatigue, feeling of heaviness and tenderness in the legs when standing again, thin capillaries becoming prominent, swelling in the ankles or leaving a sock rubber scar, red dot-like spots on the ankles (‘venous veins’) You should definitely go to a cardiovascular surgeon if you notice ‘eczema’), brown dots on the ankles (‘hemosiderin’ accumulation), sores on the ankles (‘venous ulcer’) and superficial, painful, hard areas on the legs (‘thrombophlebitis’). You should have a venous Doppler ultrasound done on your legs and look for hidden varicose veins.
WHO HAS THE RISK OF ARRIVALS?
If you are over the age of 40, if you are taking birth control pills or other hormone-containing medication, if you have a hormonal disorder such as thyroid disease, if you are overweight or obese, if you have had a clot in your veins, if you have a job that requires prolonged sitting, if you stand for long hours, or if you are pregnant You run the risk of varicose veins.
AGE, HERITAGE, PREGNANCY AND LIFESTYLE EFFECTIVE ON VARICES
If we look at the numbers, the incidence of varicose veins is as follows;
- 22% for those under the age of 40,
- 35% at age 50
- 60 years old 41%
- Frequency independent of age and gender 20-60%
- 20% at any age when the mother or father does not have varicose veins
- If one of the parents has it, 25% if the child is a boy, 60% if it is a girl
- If the mother and father have it, 90% in the child
- 32% if never conceived
- 38% after a single pregnancy
- 43% after two pregnancies
- 48% after three pregnancies
- 59% after four or more pregnancies
- 36% of those who work by standing constantly
- Varicose veins are seen at a rate of 27% in those who work by sitting constantly.
UNTREATED VARICES CAN CAUSE FATAL PAINTING
Varicose veins, which are often thought of as a ‘cosmetic’ problem, are ignored by people who are not experts for the same reason, but are planned to be treated only in terms of aesthetics, in fact, it is a vascular disease. If left untreated, they can lead to painful wounds that do not go away for months, clot formations in the veins or fatal pictures called ‘pulmonary embolism’.
TREATMENT OF VARICOSE IS MUCH EASIER THAN THE OLD
Classical varicose surgeries used in the past have been largely abandoned. Similarly, instead of almost ‘blind’ diagnoses and treatments, detection and treatment of sick vessels and valves with 100% accuracy can now be done under Doppler ultrasound imaging. Today, in the treatment of varicose veins, ‘superficial foam sclerotherapy’, ‘superficial laser’; ‘endovenous truncal ablation-EVTA’, ‘chemical ablation under Doppler-DGS’ and ‘ambulatory phlebectomy’ are used.