Varicose veins are extremely common, affecting one in every three Singapore residents. This chronic medical condition impacts quality of life by causing a wide range of symptoms such as heavy, aching legs, skin discoloration, or even leg ulcers. Although some people may be predisposed to developing varicose vein solely because of genetics, others may have made lifestyle choices that increase their risk of developing varicose veins. The good news, however, is that effective medical treatments are available for those who struggle with varicose veins. This serves as a guide for those considering treatment of varicose veins in Singapore.
It is a common misconception that varicose veins are purely a cosmetic issue; many people believe that varicose veins are nothing more than a cosmetic blemish or an inconvenient ‘sign of aging.’ Indeed, varicose vein is frequently dismissed as a mere ‘aesthetic concern.’ However, this is not true. Whether a person’s varicose veins are causing them severe physical symptoms or distressing them emotionally, the truth is that varicose veins should be taken seriously. It is essential that those who suspect they may have varicose veins, and those who have already been diagnosed with varicose veins, make an appointment with a vascular specialist for a proper assessment. As Singapore’s population continues to age, varicose veins will create increasing social and economic burdens. This is because there may be a growing number of people who experience varicose veins alone or alongside other chronic medical conditions. Like many other chronic diseases, varicose vein symptoms can be managed best with lifestyle changes and medical treatment. Minimally invasive treatments such as CLaCS Singapore and sclerotherapy are available for patients with varicose veins.
Understanding Varicose Veins
Varicose veins are superficial veins of the lower extremities that have become widened, bulging, engorged, and twisted. They are often associated with impairments of the venous circulation. Varicose veins are common among adults and tend to be more prevalent among females. They have the potential to result in considerable morbidity due to being unsightly as well as painful, particularly if superficial thrombophlebitis develops. Moreover, they can lead to leg ulceration. Varicose veins vary in size and to some extent location. Many of them are small, not visible on the clinical examination, and although the patient may be troubled because of these telangiectases, they really represent a benign side of venous disease.
The term varicose veins refers to a clinical presentation and not to a specific underlying arterial condition. Human veins return blood from the various organs to the heart. Their walls are thinner, they easily expand, and have valves, which prevent reflux of blood towards the extremities when the pressure in the abdomen and lower parts of the body exceeds a certain value corresponding to that in the veins. When valves become incompetent because of the obstruction and/or stretching of the veins, reflux of blood occurs, thus increasing the venous pressure. This causes stasis of the blood and consequently the manifestation of the abnormalities known as the clinical presentation of chronic venous disease, the common entity being varicosities or varicose veins. Blood stasis causes a reactive thrombosis in the veins that, if organized, leads to further complications known as chronic deep vein thrombosis with the associated possible sequel of developing a post-phlebitis syndrome.
Risk Factors
Aging and gender are significant non-modifiable risk factors: almost half of women and a quarter of men develop varicose veins as they age. Hormonal changes during pregnancy and menopause also increase the risk of developing varicose veins. Genetics could play a role in the risk of varicose veins. A study reported that genetic factors account for 73 percent of variations in the development of venous diseases.
A lifestyle-associated risk factor is obesity. Excessive body mass increases the risk of varicose veins by 2.5-fold. Obesity’s contribution to increased hydrostatic pressure on the venous valves increases the risk of saphenous vein reflux and hypertensive symptoms. The inherited susceptibility to obesity has not been ruled out. A study reported that genetics had a moderate effect on the prevalence of varicose veins. Prolonged standing or sitting in a stationary posture at work reportedly doubles the risk of varicose veins. It was surmised that sedentary behavior impairs leg muscle pump function, increasing reflux in veins. The study found that flight attendants had twice the risk of varicose veins compared to the general population.
Available Treatment Options
Aside from lifestyle modifications and leg elevation, there are many treatment options available for managing varicose veins. The choice of treatment will depend largely on the severity of the varicose veins, the presence of symptoms, and the patient’s preferences. It is important to undergo a comprehensive evaluation at a vein center to receive personalized care. Various therapeutic options are available to treat varicose veins. These options can vary from lifestyle interventions to potent oral medications, and range from minimally invasive surgery to very minimally invasive surgery. Factors that influence an individual’s choice of treatment will depend largely on the perceived efficacy, the nature of the disease, and the potential complications of the treatment.
Traditional Surgical Methods
Before the advent of newer treatments, ligation and stripping were the surgical techniques of choice for the treatment of varicose veins. Ligation of the saphenofemoral junction or other perforating veins was the traditional method to stop abnormal backward flow of venous blood. Once the higher pressure has been eliminated, the varicose veins tend to disappear. The more of the failing veins that could be tied off, the fewer vein segments there would be for the blood to accumulate in, and the fewer veins that would be dilated. Following the previous principle, the fewer veins that would end up with a large mass of stagnant blood surging into them.
Minimally Invasive Procedures
Treatment options have evolved from stripping to other minimally invasive techniques in recent years. Introduced almost two decades ago, endovenous laser therapy is now a treatment option. Through a small puncture made on the skin, a slim laser fiber is inserted into the affected vein and heat is applied to occlude and close the vein. As the procedure requires only a local anesthetic, patients are commonly treated within an outpatient setting. The same can be said for other types of similar treatments: radiofrequency ablation, cyanoacrylate closure, etc. Minimally invasive sclerotherapy is an alternative treatment for smaller and spider veins. Sclerotherapy solutions, irritant solutions that destroy or occlude the lining of the blood vessel, are injected into the vein via a very small needle. These treatments are well received by the public due to less discomfort, lower post-operative pain, and shorter recovery times when compared with traditional surgical treatments.
However, it should be noted that not all individuals are candidates for minimally invasive treatments. Patients with multiple medical conditions and chronic venous insufficiencies may have more suitable options. In addition, performing highlights careful evaluation and diagnosis of all types of varicose veins before treatment in order to identify suitable candidates and tailor a care plan for them. Although minimally invasive varicose vein treatments are now commonly practiced, they are often misunderstood as treatments for all varicose veins of all sizes, and therefore new challenges for physicians in this particular sector are to remove these misconceptions from society. Most varicose veins can be treated effectively without surgery. The success rate for endovenous laser therapy was almost 95% of treated veins, and two-thirds of patients experienced no recurrence at the two-year mark. The frequency of adverse events such as pigmentation and phlebitis after treatment, in particular, has been reported to be low. Efficacy rates and associated complications will vary according to the type of treatment and physician experience. Generally, as part of the practice of comprehensive vein care, very few individuals are better treated surgically. Treatment with laser therapy or sclerosing agents is more effective, safer, and much less invasive.
The Role of Vascular and Interventional Centre (CLACS Singapore)
Varicose veins are not just a cosmetic problem. Many patients with this condition may experience pain, swelling, itching, and discomfort. There are a number of centers dedicated to the treatment of vein problems in Singapore. Some background information about our facilities and our team of caregivers is now provided. Our center is one of the few private vascular surgical programs in Singapore. Our surgeons regularly perform minimally invasive varicose vein and vascular procedures.
Our center has access to the latest medical treatment for vascular diseases through an integrated approach with our regular clinics. We aim to provide compassionate and advanced vascular care through customized medical services, treating every patient as family. We strive to ensure every aspect of patient care is delivered to a high standard of excellence at an affordable price and will continue to be innovative in our service offerings. We take a pragmatic approach to the treatment of varicose veins. We utilize a ‘test of time’ approach, using a combination of affordable medication and non-invasive treatments, and only consider non-major surgeries when necessary. Our non-invasive treatments have a strong success rate and meet the needs of most patients. We believe that disseminating information is very important, and hence our approach will be to educate patients about their diseases and rehabilitation during the treatment phase. Our commitment to the quality of patient care makes our care program unique in Singapore. In addition, our affiliation means we can provide better support and vascular healthcare should our patients be diagnosed with or require treatment for other conditions.
Services Offered
At Vascular and Interventional Centre in Singapore, patients can benefit from a one-stop solution performed exclusively by our physicians and highly trained staff. We possess the state-of-the-art equipment required not only for a fast diagnosis but also to ensure that any necessary treatments are carried out comfortably, safely, and effectively. Our diagnostic services include comprehensive examinations, such as the performance of a detailed color duplex ultrasound scan, as well as a detailed consultation. Treatment options that are suitable and appropriate for you are then discussed with you. The advantages and disadvantages of each treatment will be highlighted. Should you require treatment, it will be performed either on the same day or scheduled at your earliest convenience. For those who have opted for surgery, you can be operated upon 1 to 3 days after your initial consultation.
