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Treatments for varicose veins

Treatment of varicose veins is not always necessary, particularly if they are not causing you any discomfort. If that is the case, there are lots of things you can do to help yourself, or your doctor may recommend the use of compression stockings (your blood circulation will be checked first to see if these are suitable for you). However, you may decide to seek treatment for cosmetic reasons or to treat discomfort or complications.

Surgery for varicose veins has changed completely in the last 10 years. The old surgical operation of ‘ligation and stripping’ has been replaced by minimally invasive procedures, in which the damaged vein inside the leg is sealed using heat or chemical energy.

The new minimally invasive techniques are almost always performed under local anaesthetic (like going to the dentist) and do not need a stay in hospital. A vascular specialist (a doctor who specializes in veins) will be able to recommend the best treatment option for you, depending on your general health, and the severity and location of the varicose veins.

Endovenous laser treatment

Endovenous Laser treatment is the minimally invasive option with the most data and widest uptake globally. It is usually called EVLT or EVLA. A tiny laser fibre is inserted into the vein. This generates heat, which damages the vein and makes it close up completely. Afterwards, the treated vein(s) may be somewhat thickened with a sensation of tightness in the thigh, but this resolves within 10 days. 

EVLT has been shown to have a technical success rate greater than 90–95% with a low recurrence rate of approximately 5% at 5 years after treatment.

EVLT requires a number of injections of anaesthetic to be administered into the leg. These can be painful for some patients, so a sedative is occasionally used for nervous patients. The procedure takes about 30 minutes. The skin surface veins on the calf can be removed at the same time as EVLT, or can be left alone and treated later with injection techniques to improve the cosmetic appearance.

Foam sclerotherapy

Foam sclerotherapy is an injection treatment in which a foam preparation of a chemical called a sclerosant is injected into the faulty vein. The most common chemical used in the UK for this purpose is called Fibrovein (chemical name sodium tetradecyl). It is made into a foam by mixing it with air or carbon dioxide.
 
The foam spreads rapidly along the vein after it is injected, and also fills the smaller veins next to it. The injection is guided by an ultrasound scanner. The chemical causes irritation, inflammation and eventually scarring, which permanently blocks the vein. The body absorbs the accumulated blood from the varicose vein and the lumps flatten out over time.
 
Initial success rates with foam sclerotherapy are high but there is also a high recurrence rate of about 30% within 2 years of treatment, requiring repeat procedures. Foam often produces prolonged skin staining and lumpiness, which can take 6– to 8 weeks to resolve after treatment. Foam sclerotherapy can be used after EVLT to treat smaller veins remaining after laser treatment.

Radiofrequency ablation

Radiofrequency ablation (sometimes called VNUS after the US company that developed the technique, or the closure procedure) is a keyhole treatment, very similar to EVLT. It involves inserting a narrow tube up through the length of the vein from a tiny cut around the knee, guided by an ultrasound scanner. Heat is generated in the device which then seals the vein in a similar fashion to EVLT.
 
The temperatures created by the device are usually lower than with a laser and there is slightly less pain and bruising seen after the operation. However, the recurrence rate is a little higher than after EVLT.

Liquid sclerotherapy

Liquid sclerotherapy is another injection technique using Fibrovein, but in liquid form rather than a foam. A lower concentration of the chemical is used to inject tiny thread veins (or spider veins) which remain after vein surgery, to improve the cosmetic appearance of the leg.

Mechano-chemical endovenous ablation

Mechano-chemical endovenous ablationalso known as MOCA and often referred to by the proprietary name of ClariVein, is a combination of a mechanical device and a chemical infusion of a sclerosant drug to seal the vein in the leg in the same way as lasering, but with fewer injections into the leg. It has the advantage of being less painful than laser treatment initially, but has a higher recurrence rate for large veins and can create some skin staining afterwards. Long-term follow-up is still required with this technique and there are no long-term reports of its effectiveness yet.

Written by: Eddie Chaloner
Edited by: embarrassingproblems.com
Last updated: Thursday, April 19th 2018

 


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Comments on this article

Posted by Optional on 13/07/2012 at 09:52

I have developed many major spider veins over both my legs within last few years.I am horrified at the sight of my legs. I have recentltly spent at least £700 at a beautician with the vein goth system and the veins only appear much worse to me following treatment.In future before I pay so much money I shall reguest a picture before and after picture.

Posted by Optional on 22/07/2011 at 06:46

I have found that after wearing compression stockings for 2 to 3 hours I develope red blotches on my legs has anyone else had this problem

Posted by Optional on 10/05/2011 at 06:05

i had problem in my left leg as there is swelling a lot.and the blood circulation is not frequent there.im ex drug user and i used a injection for 4years. so what i can do. im frustrate wid my life. plz help me.

Posted by Gill Line on 24/05/2010 at 10:45

I would like to find a consultant in Larnaca that could advise on treatment for varicose veins I have been told mine are not suitable for laser treatment and need injections

Posted by boitumelo on 07/04/2010 at 06:39

ive developed blot clots on my left leg,advised to buy elastic stocking,cant find them anywhere inSouth Africa

Posted by Anonymous on 02/01/2009 at 07:11

How do I treat an itchy ankle caused by varicose veins. The skin is not scaly or broken.

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Fascinating facts

Varicose simply means swollen

Varicose veins are the price we pay for our upright posture; if we still walked on all fours, we probably wouldn't have them

One person in five has varicose veins or is likely to get them

Varicose veins usually develop slowly over 10-20 years

Recent research has found that varicose veins are more common in men than in women

60 000 people in England have hospital treatment for varicose veins every year

Varicose veins are more common in Wales than anywhere else in the world

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