Phlebology: Varied Choice for Varicose Veins

Vaired Choice for Varicose Veins

Diagnosing a case of varicose veins is easy enough: the swollen and tortuous blood vessels stand out in bold relief on the victim's legs. Deciding on treatment is something else, and the choice is most likely to depend on the doctor's nationality. In U.S. hospitals, the preferred approach is to "extinguish" the offending veins by stripping them out in tedious operations that take up to twelve hours and leave the footsore surgeon himself a candidate for varicose veins. In Europe, doctors reach for hypodermics, hoping to harden the veins and cure the trouble quickly with simple injections.

While the international argument continues, the biggest excitement in phlebology (the study of veins) is now being generated in England and Ireland, where inventive surgeons are perfecting their injection treatments. Ironically enough, they are improving on techniques developed by Americans.

Purple Ropes. Behind the widely varied treatment for varicosity lies the basic fact that no one knows what causes the trouble in the first place. Doctors agree only that the condition tends to run in families, to strike people who spend most of their time sitting or standing, and to appear often during pregnancy. About 10% of the U.S. population are affected—men and women almost equally.

It is also certain that man's upright posture puts an unnatural burden on the veins of the feet, legs and thighs, which have to work against gravity when blood is returning toward the heart. Normally, most of the blood travels through deep, internal veins, which are tightly enclosed in muscle and other tissues. The rest of the blood goes through thin-walled surface veins. Connecting the internal and external veins, like the rungs of a ladder, are horizontal communicating veins. All these veins are fitted by nature with internal cuplike valves, which open rhythmically to let a certain amount of blood flow up, then close to make sure that none flows back.

When these valves fail, usually for unknown reasons, blood pools in the legs, especially in the fragile, surface veins, distending them until they look like ugly purplish ropes, all knotted and snarled. As bad as the appearance are the possible complications: the veins often develop inflammation (phlebitis) and sometimes become infected; they may also become ulcerated, or break at a touch and bleed copiously.

These risks are virtually abolished if the surface veins are extinguished, leaving all the blood to return through the deep internal veins, which can easily carry the added load in most cases. The same result, say European phlebologists, can be attained for most patients by injections that sclerose (harden) the veins, and close them.