How The Modern Surgeon Treats Varicose Veins
( Originally Published 1936 )
These enlarged and tortuous veins of the leg may be the cause of very considerable disability. And it is a pleasure to be able to announce that with modern treatment there is no necessity for the serious grades of disability which formerly inevitably occurred.
The nature of these varicosities is not as simple as it looks. The veins return blood to the heart and, therefore, have no force behind them to push the blood on as the arteries do. This means that in the veins of the leg a column of blood is constantly standing, which is pushed forward simply by the filling up of the veins behind. In order to overcome the mechanical difficulty which this situation imposes, nature has placed a, number of valves inside the veins, so that the vessel wall is compelled to stand the strain of only a short column of blood—that is, the column between the valves. Under certain circumstances these valves break down. Then the entire column of blood is supported in the vein, which becomes swollen and tortuous.
The causes of varicose veins are usually given as long continued standing on the feet imposed by certain occupations, and pressure from above in the abdomen. (Women who have given birth to several children frequently have varicose veins.) It is also probable that there is some inherent weakness in the vessel wall which causes the valves to break down.
The results of varicose veins are not entirely due to the condition of the veins themselves. If allowed to go on without treatment there is a bad circulatory condition in the limb which results in the formation of ulcers on the skin. Even if these do not form, the nutrition of the skin is poor, and the legs feel heavy and uncomfortable.
The treatment of these veins has always aimed at supporting or obliterating the diseased vessels. The support is usually made with an elastic bandage to the legs, but these makeshifts are troublesome and not always satisfactory. Surgical removal of the veins was difficult because the ramifications of the veins involved widespread cutting. In certain cases, however, it is the method of choice.
Within recent years a new method of treating these veins by injection of various solutions to obliterate them has proved very successful. A solution of chemical substances which irritate the inside of the vein is injected into it, and eventually the vein is entirely closed up. The treatment can usually be done in the doctor's office. It does not necessitate withdrawal from work or household duties. It may require several treatments before success is obtained. The results, however, are worth it, because nothing has proved as satisfactory in curing up the disagreeable and unhealthy ulcers on the skin as this method. Surgeons everywhere in the country have learned to do it, and the technique of the operation is well known.