Do I need treatment?
Treatment for varicose veins is seldom essential since serious complications rarely occur. The choice is yours and many patients have varicose veins for the whole of their adult life and never suffer any problems with them.
How can I help myself?
Avoid being overweight and wear support stockings if you have to stand up a lot of the time. Regular exercise such as walking also helps to pump the blood out of the leg. Dry itchy skin can often be helped by moisturising (emollient) creams or bath additives available at the chemist.
If I need treatment, what treatments are available?
These may be all that is required if aching and swelling are the main problems. Properly fitted UK Class II strength compression stockings above the knee usually work best but are inconvenient so below knee stockings are easier to wear on a day to day basis.
Ultrasound-guided Foam Sclerotherapy (Injections)
This is a new development of a long established treatment for varicose veins. A small amount of a special chemical (Sclerosant) is mixed with air to make a foam. Under ultrasound monitoring the foam is then injected into each vein and the leg is bandaged and placed in a full length stocking for a week. The foam causes inflammation in the vein (phlebitis) which then shrivels up and eventually becomes less visible. Sometimes the inflammation can be uncomfortable for a few weeks, and occasionally the skin can blister and become scarred. Sclerosant injections are not a “magic bullet” they cause some skin staining in more than a third of patients. This usually resolves within 12 months but can be permanent. Other complications which occur in about 5-10% of patients include allergic reactions, temporary visual disturbance, deep vein thrombosis (DVT), and headache. It is thought that recurrence rates are higher too when this is used for treating the main veins.
Microsclerotherapy (Injections) for Thread Veins
Sclerotherapy is a cosmetic medical procedure used to treat small varicose veins and spider veins. A tiny needle is used to inject a solution directly into the vein. The solution irritates the lining of the vessel, causing it to swell and stick together, and the blood to clot. Overtime, the body will absorb the treated vein. Mild discomfort may occur, and a cramping sensation may be felt for 1 to 2 minutes when larger veins are injected. The number of veins injected in one session is variable, depending on the size and location of the veins, and the patient’s overall medical condition. Anywhere from one to several sclerotherapy sessions may be needed for any vein region. Medically prescribed support hose and/or bandages may need to be worn for several days to several weeks to assist in resolution of the veins. In general, spider veins respond to treatment in 3 to 6 weeks, and larger veins respond in 3 to 4 months.
Traditional Operation (Vein Stripping)
The traditional treatment is ligation of the saphenofemoral juction, stripping of the long saphenous vein and multiple stab avulsions of the distal varicosities. There have been few improvements since it was first described by Trendelenberg in 1940. Now we only strip to the knee and so avoid saphenous neuritis, stripping is performed with a PIN stripper to decrease pain and bruising and compression stockings are now applied on the table rather than the next day to decrease post operative pain and swelling.
None of these improvements obviates the need for a GA or a groin incision and so the costs, complications and limitations of these remain. Patients have a 10% risk of groin wound infection, bruising and swelling remain a painful and ugly problem. The need, cost and inconvenience of admission remains- either as a day case for unilateral treatment or overnight for bilateral procedeures. Operation can still be used to treat most varicose veins and a few patients with varicose veins are still best treated by this type of surgery. Most patients are able to go home the same day after their operation, but you are not usually able to resume driving for 1 week, and it may take this long to resume your normal activities after surgery.
Complications of conventional surgery include occasional bleeding from the wounds, infection in the groin wound, deep vein thrombosis (DVT) and some numbness and/or pain in various places in the leg. These usually settle within a few months; rarely a small area of permanent numbness remains. Bruising, especially along the inner thigh is common in the first week or two after the operation and this can require painkillers until the inflammation eases. The scars on your legs will continue to fade for many months.
Venefit™ Therapy (Formally known as VNUS™ Closure)
Venefit™ Targeted Endovenous Therapy (Formally known as the VNUS Closure procedure), is an alternative treatment option to traditional vein stripping surgery, and brings state-of-the-art technology to an age-old disease.
The procedure is performed on an outpatient basis and only requires a simple local anaesthetic. Using ultrasound, your surgeon will position the Closure catheter into the diseased vein, through a small opening in the skin. The tiny catheter delivers radio-frequency (RF) energy to the vein wall. As the RF energy is delivered and the catheter is withdrawn, the vein wall is heated, causing the collagen in the wall to shrink and the vein to close. Once the diseased vein is closed, blood is re-routed to other healthy veins.
Following the procedure, a simple sticky plaster is placed over the insertion site, and additional compression may be provided to aid healing- usually a stocking supplied before you are admitted. Your doctor may encourage you to walk, and to refrain from extended standing and strenuous activities for a period of time.
More than 70% of varicose veins are suitable for day case treatment using the Closure procedure. There may be a few visible varicose veins left after treatment, but these do not cause symptoms and become less visible with time. As with any surgical procedure there is a small risk deep vein thrombosis (DVT).
We do not know how Venefit™ Targeted Endovenous Therapy compares with conventional treatment in the long term, although results over the last 5 years appear to be as good as or even better than surgery. Patients who undergo Venefit™ therapy typically resume normal activities within a day.