Hi XXXXXXX,
Thanks for writing in.
I read your mail with diligence and in following paragraphs describe the treatment options available to you. You may have further question please write, I will be happy to answer. Let us review precipitating factors at least one is present in you.

1.With overweight alone, in some persons varicose veins develop and these cause really "bad" swelling usually on both sides but occasionally on one side, as in your case on one side also. Apart from distended belly major causes of varicose vein you ought to look for are:
2. Straining: Chronic constipation, urinary retention from any cause, chronic cough, or any other conditions that cause a person to strain for prolonged periods of time causes an increase in the forces transmitted to the leg veins and may result in varicose veins. These mechanisms also contribute to the formation of hemorrhoids, which are varicosities located in the rectal and anal area.
3.Prior surgery or trauma to the leg: These conditions interrupt the normal blood flow channels. I do not think you have undergone surgery to be the cause.
4.Age: Generally, most elderly individuals show some degree of varicose vein occurrence. That of course is not in your case.

Symptoms: As you are well aware of: these may bulge from under the skin and feel "ropey" the leg affected by varicose veings often ache and feel heavy and itchy
Symptoms can intensify after a long day of standing the feet. These may cause severe pain upon standing or even have cramps in the legs at night. Pigmentation is a known complication of varicose veins and one of the cosmetic reason for going in for treatment.

If a person has varicose veins, any of the following warrant a visit to a health care professional:
1. Inflammation, discoloration, or ulceration of the skin or swelling of the calf or leg is more typical of problems related to the deeper veins, especially a blood clot.
2.Unexplained pain or swelling in a leg particularly suggests a blood clot. Varicose veins by themselves do not usually cause a leg to swell.
Varicose veins alone are relatively harmless, but every now and then they can cause minor problems.
3.If the skin overlying the vein is thin or irritated, minor trauma from a bump can tear the vein and cause bleeding. In this case, elevating the leg and applying pressure for several minutes should be enough to stop the bleeding. If it does not, the patient may need to visit a hospital emergency department.
4.If, at any time, the patient feels chest pain or have trouble breathing, this may indicate the presence of a blood clot in the blood vessels of the heart or lungs. The patient should go to a hospital emergency department immediately
Medical Treatment
A. Sclerotherapy :involves injecting a chemical inside the vein that obliterates it and causes it to scar. Sclerotherapy is not completely successful in aleviating symptoms, and preventing formation of more varicose veins.Complications associated with sclerotherapy include allergic reactions to the chemical used, stinging or burning at the various injection sites, inflammation, skin ulcerations, and permanent discoloration of the skin. Bandages often remain in place for as long as three weeks.
B. Wearing compression stockings is usually recommended after sclerotherapy.
Doctors who perform this procedure must have specialized training and experience in order to avoid complications. Bandages can give temporary relief in absence of going in for sclerotherapy
C:Lasers: Lasers are also used as a treatment for varicose veins, but are frequently used in the treatment of smaller veins, medically referred to as telangiectasias. The technique is less helpful in the treatment of larger varicosities.
D: If a person have superficial thrombophlebitis, a health care professional will usually recommend warm compresses and pain medication. Additional treatment depends on whether the physician thinks the patient may have an infection.
Varicose Veins Surgery:
Several surgical procedures are available to relieve varicose veins, but not everyone with varicose veins is a candidate for surgery.
     If the patient is pregnant or recently pregnant, it is advisable to wait at least 6 weeks after delivery before considering this option, because many of the varicose veins that occured during pregnancy will fade.
A: If the veins bother the pateint for cosmetic reasons only, and the patient is not bothered by pain or inflammation, then surgery may not be the best option.Surgery is usually reserved for people who either do not get relief from the home care techniques or lifestyle changes, or who for cosmetic reasons want to try methods other than sclerotherapy or laser treatment to make the veins less prominent.
Most of the surgical procedures are performed on an outpatient basis.
     The surgery involves either vein ligation (tying) or stripping or avulsion
1. Avulsion
Avulsion requires many tiny incisions and removal of the varicose veins that have been outlined on the skin.
2. Stripping
This involves at least two incisions, one at the groin and one at the knee.
A tunneling device is placed under the skin between the two points, and the saphenous vein is dragged or pulled out of the tunnel.This technique will leave not only scars from the incisions, but also a significant amount of bruising and possibly bleeding. The bleeding is easily controlled by pressure dressings and stops immediately. The bruising is usually noticeable for a few weeks. For vein stripping, a recovery period of 5-10 days is needed before returning to a regular routine. For just vein ligation, a few days off is more than adequate.
     
3. Endovascular laser therapy
     Endovenous laser therapy is a technique that uses a laser to destroy the vein. The procedure is usually performed in a doctor's office and takes about 30-45 minutes. The small laser is passed into the vein with guidance from the ultrasound machine. The laser is then fired up and the entire vein is fibrosed. The laser is fired at multiple locations and the entire procedure is performed with some local anesthesia.     Recovery is rapid and involves minimal pain. The procedure is relatively new and except for some mild bruising and a numbing sensation, no other effects have been seen in the short term.
4. Radiofrequency ablation
Radiofrequency ablation is a similar technique to endovascular laser, but it uses heat to destroy the vein. The probe is placed in the vein under ultrasound and once in position, the vein is heated along the entire length. The procedure is performed under local anesthesia and takes about 30 minutes. Short-term results are excellent using radiofrequency ablation.
5.Ligation
     This was formerly the surgical treatment for varicose veins before the newer treatment modalities described above became available. It usually involved an incision at the groin and tying off of the saphenous vein where it enters the femoral vein. It is tied just at the entrance. The procedure can be performed under local anesthesia

Prognosis is usually excellent with surgical procedures and recurrence rare.

With Best Wishes.


Dr Anil Grover
MBBS, MD (Internal Medicine) DM (Cardiology)

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Hello,
Thanks for writing back.
It is believed that the venous system of a person (who eventually develops varicosity) has inherent tendency to become varicose. Yes, both knee replacement can be precipitating cause(by all cutting and suturing) but then varicosity would be confined to lower legs. As I gather from your original question you have problem above the knee also.
Moreover, treatment options (conservative: Do not stand for long, keep legs elevated, use of Crape Bandage), medical treatment or surgical treatment are individualised after discussion between the patient and doctor. These do not change whatever the immediate precipitating cause might have been.



If you have further query, I will be happy to answer.

Good Luck.

Dr Anil Grover

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