On Thursday 21 July, the live Facebook stream was held with Marco Bianchi, scientific divulger of the Veronesi Foundation, and Dr. Elisa Casabianca, angiologist and vascular surgeon in Humanitas.

A great many questions came from the live users and not all of them could be answered. We will take back some of them in this article, thanks to the help of Dr. Casabianca.

I have been prescribed first class socks. I wanted to know if the leggings he was talking about are fine.

The elastocompression leggings can be an alternative when you just cannot tolerate the traditional elastic socks, as often happens during the summer. However, I recommend resuming wearing the elastocompressive socks as soon as possible, whose action is more complete and effective. In your case, given the fact that the prescription that has been made is a “therapeutic” sock, I deduce that you already have a diagnosis of varicose veins or venous insufficiency, so also in relation to the work done, I recommend wearing it continuously. An angiological examination, if not yet carried out, will allow you to know if in your case it is necessary to use surgical treatment and what techniques are most suitable for you.


What are the tips for flying long hours?

When facing a long journey, it is extremely common to find yourself with sore legs and swollen ankles. To avoid or limit these annoyances, it is advisable to reduce the immobility time as much as possible, trying – when possible – to take a few steps and often change the position. It is also useful to wear knee-highs or elastocompression tights, which will help to drain the stagnation of liquids in the leg, making it lighter. If you have varicose veins (but only on prescription), the risk of phlebitis may be lurking and can be prevented by a small subcutaneous injection of Heparin to be made shortly before departure.


What is the advice for sun exposure?

Contrary to what one might think, it is not sunlight that is harmful to our veins, but prolonged heat. Therefore, without renouncing to the use of creams with protective filter, which protect the skin from dermatitis and burns, it is also necessary to keep the legs fresh, wetting them frequently and taking advantage of the movement of seawater to drain the lymphatic circulation.


How can you intervene in case of evident capillaries?

What we commonly call capillaries are called, in medical terms, telangiectasies and are harmless dilations of small vessels visible under the epidermis. They may be the indicator of superficial venous insufficiency, as they may occur instead of the characteristics of the skin. Therefore, first of all, it is necessary to exclude the presence of a safenic reflux, which in the present case must be treated before acting on telangiectasies. Telangectasies are commonly treated by laser or sclerotherapy. After treatment, a local compression with sock or bandage is required for a few hours, sometimes creams are prescribed to be used before and after treatment. It is important to underline, however, that the treatment of capillaries only has an aesthetic value and does not have a functional impact on the superficial venous circulation of the limbs.


What to do in case of heavy legs and cramps?

Cramps are painful muscle contractures that can occur both at rest and during or after exercise, and can be caused by multiple factors, very often trivial such as minor food deficiencies, dehydration, medications. They may also be due to venous insufficiency, especially if nocturnal and accompanied by the presence of varicose veins in the legs. If they appear constantly on the way, especially after a number of steps, they may be an indicator of a problem with arterial occlusion. So a consultation with a specialist and possibly an ecocolordoppler are essential investigations to resolve the doubt and solve the problem.


Is laser surgery also indicated for very twisty varicose veins?

Endoscopic surgery of varicose veins (laser or radio frequency) can be applied in most cases. The presence of particularly tortuous superficial vessels can be a factor of added difficulty, especially when the veins in question are those that must be occluded and not collateral, removable with millimeter incisions. However, there are intraoperative precautions, such as the use of endovascular guides, which make it possible to remedy this anatomical feature and treat the patient in a minimally invasive manner.

However, in our team all the patients who are candidates for varicose veins surgery are studied with an ecocolordoppler in the pre-hospital phase, in order to agree with the patient upon the most suitable surgical option for his case, and an accurate preoperative ultrasound mapping in order to reduce the cases of difficulty due to unfavorable anatomical characteristics to a minimum.