Varicose Veins Treatments
Varicose veins can be treated at any stage and at any age, provided the appropriate assessments have been performed beforehand.
Consultation and clinical examination is therefore usually followed by Ultrasound Duplex Colour Scanning of the veins. This painless procedure objectively assesses the circulation in the legs and will pinpoint damaged or leaky valves, any blockages or sites of thrombosis.
Treatment can then be targeted to restore the state of the legs to normal, using the most appropriate techniques.
The 3 main aims when treating varicose veins are:
- To treat the underlying cause - usually a leak from one or more valves, commonly in the groin or knee. These leaky valves often end up damaging and making redundant a superficial vein such as the internal or external saphenous vein. Treatment usually requires either keyhole endovenous therapy such as radio frequency (VNUS) or laser ablation. Rarely open surgery may be required in complex cases.
- To remove those lumpy or bulgy varicose veins which have been stretched and elongated. This often requires micro surgery, but in certain conditions may now be treated with Foam Sclerotherapy.
- To obliterate any associated thread or spider veins. These never require surgery, and are frequently treated by micro-injection sclerotherapy (microsclerotherapy) although other techniques, such as laser therapy may also be useful.
Leaky valves usually lead to damage in their associated vein, usually the internal or external saphenous vein, which then requires treatment. This treatment is usually performed using endovenous keyhole techniques, either radio frequency or laser ablation. The damaged vein responsible for the development of superficial varicose veins will have been identified by a Colour Duplex scan and your venous surgeon will advise you on whether they will require endovenous treatment. Endovenous therapy involves sealing off the responsible vein and its leaky valves from within the vein under ultrasound control. There are no incisions or sutures, and treatment is usually performed as a day case. Rarely open surgery may be required in complex situations. Your venous surgeon should be able to advise you on the treatment best suited to you and to your veins.
The main aim of management is to remove these unsightly veins and restore the leg to its normal appearance. In minor cases, this may be a primarily cosmetic procedure, but varicose veins can eventually lead to local damage from pressure or stasis, and in extreme cases to phlebitis (clotting in the varicose vein, associated with a painful, reddened area of surrounding skin). Consequently, most surgeons recommend removal of any varicose veins at the same time as treating the underlying cause. Treatment takes place in one sitting and does not require multiple attendances.
A safe, tested cosmetic procedure for the removal of superficial varicose veins is by Multiple Cosmetic Phlebectomies. This procedure removes the vein via tiny punctures in the skin placed over the vein, which is then removed using a keyhole technique. It requires no suturing, and may be performed under local anaesthetic (if a few veins are present) or sedation (if many veins require removal).
Previously, attempts at sclerotherapy of varicose veins were hampered by a failure to eradicate the veins, the development of staining which could last for years, or in severe cases the development of an ulcer in the skin.
The advent of Foam Sclerotherapy has reduced these problems, and offers an attractive alternative to surgery in some cases. The technique allows greater volumes of chemical to be used without increasing the overall dosage. It is particularly useful in congenital venous conditions, but should not be confused with microsclerotherapy.