Varicose Veins Treatment in Pune: Veins, Leg Ulcers and Compression

What are varicose veins?

Veins in the legs carry blood back up to the heart, helped by one-way valves. When these valves weaken, blood flows backwards and pools, and the veins stretch, twist and bulge under the skin. These are varicose veins. They are common, run in families, and are more likely with age, pregnancy, standing jobs and excess weight.

Symptoms include:

• visible, bulging, twisted veins, usually on the calves and inner thighs;
• aching, heaviness or throbbing legs, worse at the end of the day;
• swollen ankles;
• itching or burning over the veins;
• night cramps.

Over time, some people develop chronic venous insufficiency: brown staining of the skin around the ankle, eczema, hardening of the skin and, eventually, a venous leg ulcer, an open wound that is slow to heal.

Who may benefit, and how is it assessed?

Treatment is worth considering for veins that cause symptoms, skin changes, bleeding, inflamed clots or ulcers.

Assessment includes:

1. Examination of both legs, the skin and any ulcer.
2. Duplex ultrasound scan, which shows which valves leak and maps the veins for treatment.
3. Checking the arteries, usually by comparing blood pressure at the ankle and arm, because compression is unsafe if the arterial supply is poor.
4. Questions about clots, pregnancy and medicines.

What are the treatment options?

Option	How it works	Points to consider
Lifestyle advice	Walking, weight control, raising the legs	Eases symptoms; does not remove veins
Compression stockings	Squeeze the leg to support the veins	Relieve symptoms; used when procedures are unsuitable, and after treatment
Endothermal ablation (laser or radiofrequency)	Heats and seals the faulty vein from inside through a needle	Recommended first choice for suitable veins; local anaesthetic; walk the same day
Foam sclerotherapy	Foam injected under ultrasound closes the vein	When ablation is unsuitable; may need repeat sessions
Surgery (ligation and stripping, phlebectomy)	Removes or ties off the veins	When the above are unsuitable; longer recovery
Compression bandaging for ulcers	Layered bandages applied by trained staff	Main treatment for venous ulcers; needs good arterial supply
Skin grafting	Covers large, clean ulcers	Used with compression and vein treatment

Large ulcers that will not close may be covered with a skin graft. Other slow-healing wounds are covered under chronic wound treatment.

How is treatment performed?

Endothermal ablation

1. Under ultrasound, a thin catheter is passed into the faulty vein through a needle.
2. Local anaesthetic fluid is injected around the vein.
3. The vein is sealed with heat as the catheter is withdrawn.
4. Bulging side branches may be removed through tiny cuts or treated with foam.
5. A stocking or bandage is applied, and you walk out.

Compression dressing for a venous ulcer

1. The ulcer is cleaned, and dead tissue is removed.
2. A suitable dressing is applied.
3. Layers of padding and compression bandage are applied from the toes to below the knee, firmer at the ankle.
4. Bandages are changed regularly, often once to three times a week, as the ulcer heals.

How should you prepare, and what should you ask?

• Bring any previous scans or treatment records.
• Tell the doctor about past clots, pregnancy plans and blood thinners.
• Wear loose trousers on the day of a procedure.

Questions to ask:

• Which veins are leaking, and which treatment suits them?
• Is my arterial circulation good enough for compression?
• How long should I wear stockings afterwards?
• How can I stop an ulcer coming back?

What is recovery like?

Time	What to expect for most patients
Same day	Walk straight away; stocking or bandage on
Days 1-7	Tightness and bruising along the treated vein; walk daily; many return to work within a few days
Weeks 1-2	Stockings as advised; avoid long flights and heavy exercise
Weeks to months	Veins fade; ulcers heal gradually with compression

What are the risks?

• Bruising, tenderness and tightness along the treated vein.
• Inflamed surface vein (phlebitis), usually settling with painkillers.
• Skin staining after foam.
• Numbness from irritation of a skin nerve, usually temporary.
• Deep vein thrombosis, uncommon.
• New varicose veins developing over time.
• Skin damage from compression if bandages are too tight or the arteries are narrowed.

Remove compression and seek advice if your toes become numb, pale, blue or very painful.

What results can you expect?

Most people have less aching and swelling and a smoother look to the leg after treatment. Venous ulcers usually heal with sustained compression, and treating the faulty veins and wearing stockings afterwards lowers the chance of them returning.

What affects the cost of varicose veins treatment in Pune?

• Number and size of veins, and one or both legs.
• Treatment method: ablation, foam, surgery or compression only.
• Duplex scans before and after treatment.
• Dressings and bandage changes for ulcers, and stockings.

Treatment for symptomatic varicose veins and ulcers may be covered by health insurance; purely cosmetic thread veins usually are not.