Varicose Veins

The choice of treatments available to patients with varicose veins is varied and can sometimes be bewildering.

Our aim is to successfully treat your varicose veins using the most effective modern techniques, with the minimum of discomfort and the best cosmetic result.

The treatment recommended is based on your symptoms, the severity of the varicosities, the presence of skin changes and the location of the leaking valves. A further consideration is the need for local anaesthetic (or the desire to avoid a General Anaesthetic!)

Options include:

• Do nothing. Occasionally the most sensible option for minor asymptomatic varicosities.
• Injection of a sclerosant solution e.g. FOAM into the veins, which collapses the veins causing them to disappear.
• Endoluminal Treatments e.g. laser or radio-frequency ablation These are commonly referred to as 'laser' treatments. Incisionless, under Local Anaesthetic, early mobility and 'painless' are the main advantages.
• Surgery involves an incision in the groin or the back of the knee and stripping of the veins. The smaller veins are removed by tiny incisions. Surgery is normally under general anaesthetic.

Varicose Veins - Endo-luminal Treatments

The main aim of these techniques is to decrease the discomfort, time off work and scarring associated with traditional surgical methods Some of the newer treatments can be carried out as out-patient procedures and do not require the use of a general anaesthetic i.e. can be done under local anaesthetic. The current gold standards are:

• Radio-frequency ablation (VNUS):

  A catheter is passed along the vein from the calf towards the groin. The tip of the wire is heated electrically and the vein is gradually destroyed as the catheter is withdrawn. The progress of the tip is monitored using ultrasound imaging. There is a small risk of damage to the main vein (femoral) of the leg and there are concerns that the procedure may not completely disconnect the varicose veins from the deep veins. However, the up side is that there is no need for a groin incision and the amount of discomfort and bruising in the thigh is minimal.
  Find out more

• Endoluminal Venous Laser Ablation (EVLA):

  Similar to the radio frequency ablation technique, here a laser fibre is threaded up the main vein feeding the varicosities under ultrasound guidance. Activation of the laser heats up the vein, gradually destroying it as the fibre is withdrawn. There still are a number of minor incisions along the varicosities where multiple phlebectomies are undertaken. The entire procedure can be undertaken with local anaesthetic.
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Varicose Veins - Surgical Treatment

Surgery for varicose veins still has a place in the treatment of varicose veins. However, the indications are few and far between. The main one being recurrence at the groin or popliteal fossa..

The procedure is performed under General Anaesthetic (i.e. you are asleep). It usually involves an 3 cm incision either in the groin or behind the knee. It also commonly involes a technique known as 'stripping' of the long saphenous vein. The procedure has been around for over one hundred years but has become increasingly refined.

It is undertaken as a Day Case procedure (i.e. out of hospital the same day), recovery is quick and post-operative mobility is good.

Although surgical treatment is a safe and effective treatment for large varicose veins, modern endoluminal techniques have made it virtually redundant.

Varicose Veins - Βeta Testing

New techniques have recently been reported in some newspapers and magazines and are being vigorously being promoted. All claim a quicker return to normal activity but in the author's opinion are relatively unproven. They involve the injection of significant amounts of air, sclerosant and even 'super-glue' into the venous circulation. At present we are adopting a wait and see approach as the author is old enough to have seen many techniques arrive in a blaze of publicity and then disappear just as quickly.

• Foam Sclerotherapy:

  Injection of foam (a mixture of air and a sclerosant), usually under ultrasound into the offfending vein.
  

• Clarivein ®:

  Another endoluminal technique using a combination of sclerosant and mechanical disruption
  Find out more

• Venaseal ®:

  Injection of a cyano acrylate glue into the vein with a view to ablation
  Find out more

Varicose Veins - Other Information

You may find the following of interest and can be printed at your convenience.

Watch BBC News segment on modern treatment of varicose veins

Peri-operative Information Sheet (pdf)

Giving Consent to an Operation (pdf)

Medline® - more about veins.