Varicose Vein Treatments


Since the majority of varicose veins are caused by valve failure in either the long or short saphenous veins, treatment should be directed towards either removal or occlusion of the relevant vein, together with removal or shrinking (sclerosing) the bulging visible veins. These two aspects of treatment may be considered as the first treating the cause of the problem and the second treating the symptom. Obviously removing the bulging varicose veins (the symptom) is very rarely good enough on its own, without treating the source of the problem.

Treatment of varicose veins is undergoing major changes in the 21st century. During the 20th century varicose veins were treated by either conventional surgery or sclerotherapy. The type of surgery, by tying the top of the long or short saphenous veins, with or without stripping and phlebectomies, has changed little for the best part of 100 years. Sclerotherapy (injecting varicose veins) was introduced about 50 years ago and although there was some early enthusiasm, it was found to be associated with a high recurrence rate because it only treated varicosities and not the source of the problem in it’s conventional form.

Recently though the increased use of duplex ultrasound to thoroughly assess both deep and superficial veins has provided a more focused approach to treatment as well as the possibility of less traumatic and less invasive ways of treating varicose veins.

The main disadvantages of conventional surgery have been the need for hospital admission, general anaesthesia and the extent of bruising and discomfort requiring time off work as well as restricted activities. Although considerable efforts have been made to refine surgical as well as anaesthetic techniques to increase the proportion of patients treated as day cases, nevertheless most surgeons still recommend 1-2 weeks off work depending on the type of work.

A number of new techniques have been developed to treat long or short saphenous veins where valves have failed, without the need for an incision at the groin or behind the knee and also minimising the pain and bruising previously associated with saphenous vein stripping.

These new techniques fall broadly into two categories. The first uses a laser fibre (EVLT), fed up the main saphenous trunk to destroy the inner lining of the vein and hence obliterate it. An alternative using radiofrequency energy achieves a similar objective although it appears to offer no real advantage over laser and until recently was more time consuming. The second is rather different and involves a development of conventional injection treatment. Ultrasound guided foam sclerotherapy (USFS) can similarly obliterate the main vein trunks as well as varicosities on an outpatient, local anaesthetic basis.


Which treatment is best for me?

Before a choice can be made as to the best treatment for your varicose veins, you need to see a vascular specialist who can carefully assess the source of the problem using either Doppler or duplex scanning. Advice can then be given on which techniques may be most appropriate in your case, as well as relative advantages and disadvantages. Not all cases are suitable for each method. For example patients with recurrent varicose veins after previous surgical treatment are usually not amenable to laser treatment but foam sclerotherapy can be highly successful.

Therefore a careful discussion of your needs and preferences is sensible after assessment of your veins before deciding upon a treatment plan. All medical and surgical treatments carry slight risks and these will also be discussed before embarking on any therapy.

 

  For Against
EVLT
  • New minimally invasive technology
  • Less pain than surgery
  • Short hospital stay
  • LA often possible
  • Shorter time off work
  • No long term follow up
  • Residual varicose veins may need additionl treatment
  • Some risk of recurrence
USFS
  • Outpatient treatment
  • Local anaesthetic
  • Minimal pain and discomfort
  • No scars
  • Minimal time off work
  • Often very effective in recurrent veins
  • No long term follow up
  • Larger veins take longer to settle
  • May produce skin discolouration
  • Some risk of recurrence
Conventional Surgery
  • Reliable
  • Tried and tested
  • Extensive long term follow up
  • General anaesthetic
  • Time off work
  • Pain and discomfort
  • Scarring
  • Some risk of recurrence