Best varicose veins treatment

Nobody wants bulging, purple varicose veins on their legs or ankles. However, about half of adults have them, and they become more prevalent with age.

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What causes varicose veins and what can you do about them? Many people think they know, but vascular surgeon Kathleen Boyle, DO, sets the record straight. How many of these seven myths have you believed?

Myth 1: Crossing your legs causes varicose veins.

“No,” says Dr. Boyle. “Crossing legs does not cause varicose veins. Neither does wearing tight shoes or tight pants — although these things can exacerbate varicose veins if you already have them.”

While increased pressure can cause blood to pool inside a vein and make the vein bulge, it’s not external pressure that does it. (Besides that, tight clothing and leg crossing produce only minimal pressure.) It’s more likely due to defective valves in your veins or weakened vein walls.

Myth 2: Pregnancy causes varicose veins.

“Pregnancy can exacerbate varicose veins, but it doesn’t cause them,” says Dr. Boyle. According to the National Heart, Lung, and Blood Institute, varicose veins that become noticeable during pregnancy usually fade after delivery.

Myth 3: If your family members have varicose veins, you will too.

Just because your parents or grandparents had varicose veins doesn’t mean you will. Varicose veins run in the family for only half of all people who have them.

Myth 4: Massage can cure varicose veins.

“Massage may help reduce swelling or discomfort, but will not make varicose veins go away,” says Dr. Boyle. However, there are proven ways to treat them, especially when they’re causing symptoms, such as:

  • Swollen legs, ankles and feet.
  • Muscle cramps, throbbing, soreness, or aching in the legs.
  • Legs that feel “heavy.”

Treatment options include sclerotherapy (injections) and laser therapy, both which can make veins disappear.

Myth 5: If you pursue advanced treatment for varicose veins, you won’t need to wear compression stockings.

“That’s false,” says Dr. Boyle. “Insurance companies require that you try compression stockings first, before having other treatments. Also, some patients who have treatment need to wear stockings during recovery, for up to six weeks.”

Myth 6: Women should wait to treat varicose veins until they’re done having children.

“Actually, it isn’t necessary to wait,” says Dr. Boyle. “Women may benefit from having early treatment, even before becoming pregnant.”

Myth 7: Tattoos are bad for varicose veins.

According to Dr. Boyle, there’s no relationship between the two.

Can you avoid getting varicose veins altogether?

The truth is, you may not be able to avoid varicose veins. But you can delay their onset or make them less pronounced. Dr. Boyle shares two important tips:

  1. Maintain a healthy weight. “Being overweight definitely does increase pressure in your veins and can increase your risk of getting varicose veins or worsen their appearance,” she says.
  2. Wear compression stockings if you stand for long periods of time. Otherwise, take frequent breaks to sit down, elevating your legs when possible. If you sit for long periods, move your legs or stand up every now and then. Regular exercise can help improve circulation and vein health.

Varicose Veins

Deep vein thrombosis (DVT) is a serious condition with blood clots in the deep veins. This condition does not usually happen with varicose veins. That is because varicose veins affect the veins close to the surface of the skin. However, with severe varicose veins, there is a small chance of developing blood clots in the deep veins. Blood clots need medical care right away. Symptoms of blood clots include pain, swelling, and redness of the leg. Blood clots may also happen in the arms or other parts of the body. If you have symptoms that may mean a blood clot, call your healthcare provider.

A piece of a blood clot may break off and travel to the lungs (pulmonary embolism). A blood clot in the lungs is very serious and may cause death. Symptoms include chest pain, trouble breathing, coughing (may cough up blood), a fast heartbeat, sweating, and fainting. If you have symptoms that may mean a blood clot in the lungs, call 911 or get emergency help.

What are the symptoms of varicose veins?

The following are the most common symptoms of varicose veins. However, each individual may experience symptoms differently. Symptoms may include:

  • Color changes in the skin

  • Sores on the legs

  • Rash

  • Sensations in the legs, such as a heavy feeling, burning, and/or aching

Severe varicose veins may eventually produce long-term mild swelling that can result in more serious skin and tissue problems. These include ulcers and nonhealing sores.

The symptoms of varicose veins may resemble other medical conditions or problems. Always talk with your healthcare provider for a diagnosis.

How are varicose veins diagnosed?

In addition to a complete medical history and physical exam, diagnostic procedures for varicose veins may include:

  • Duplex ultrasound. A type of vascular ultrasound done to check blood flow and the structure of the leg veins. Duplex means two types of ultrasound are used.

What is the treatment for varicose veins?

Specific treatment for varicose veins will be determined by your healthcare provider based on:

  • Your age, overall health, and medical history

  • Extent of the condition

  • Your signs and symptoms

  • Your tolerance of specific medicines, procedures, or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

Medical treatment may not be necessary if there are no symptoms. However, varicose veins may sometimes worsen without treatment.

Medical treatment may include:

  • Elevation of the legs. You may be instructed to elevate your feet above the level of your heart 3 or 4 times a day for about 15 minutes at a time. If you need to sit or stand for a long period of time, flexing (bending) your legs occasionally can help keep blood circulating. If you have mild to moderate varicose veins, elevating your legs can help reduce leg swelling and relieve other symptoms.

  • Compression stockings. These elastic stockings squeeze the veins and prevent blood from pooling. Compression stockings can be effective if they are worn every day.

  • Sclerotherapy. Sclerotherapy is the most common treatment for both spider and varicose veins. A salt (saline) or chemical solution is injected into the varicose veins. They no longer carry blood. And, other veins take over.

  • Thermal ablation. Lasers or radiofrequency energy may be used to treat varicose veins. A tiny fiber is inserted into a varicose vein through a catheter. The laser or radiofrequency energy is used to deliver heat that destroys the wall of the varicose vein.

  • Vein stripping. This is surgery to remove varicose veins.

  • Microphlebectomy. Special tools inserted through small cuts (incisions) are used to remove varicose veins. It may be done alone or with vein stripping.

What are the complications of varicose veins?

Varicose veins are usually not serious. But, complications may happen. They include:

  • Inflammation or swelling of veins (phlebitis)

  • Blood clots

Can varicose veins be prevented?

Steps to prevent varicose veins include:

  • Keeping a healthy weight

  • Exercising regularly

  • Putting your feet up while sitting

  • Not crossing your legs while sitting

  • Not wearing tight clothing

The Best Ways to Treat Varicose Veins

Swollen, twisted, and enlarged veins seen under the skin, known as varicose veins, can cause achiness as well as embarrassment. “Varicose veins develop due to a weakening of vein valves and vein walls,” explains Luis Navarro, MD, director of the Vein Treatment Center in New York City. “The weakening of the valves causes the blood to pool, stretching the vein and causing it to protrude through the skin.”

Varicose veins usually start as a cosmetic issue, “but they may cause health complications over time, including bleeding, ulcers, phlebitis, and poor circulation,” Dr. Navarro says.

Luckily, there are remedies. “Varicose vein treatment depends on the severity of the problem and whether the issue originates in the saphenous vein or the veins that branch off of that trunk,” says Antonios Gasparis, MD, a vascular surgeon and director of the Stony Brook Vein Center at Stony Brook Medicine on Long Island, New York. “When people are at the point where they have heaviness and discomfort in their legs, it’s usually due to an abnormality in both the branches and the trunk.”

Treating Varicose Veins

You can find out how severe your varicose veins are by discussing results of an ultrasound with your physician. Together, you’ll find the best treatment options for your individual case. These may include:

Sclerotherapy: This is a painless saline injection treatment that collapses the vein so that it can then be reabsorbed back into the bloodstream. Navarro says he generally recommends sclerotherapy for small to medium varicose veins. Types of sclerotherapy for varicose vein treatment include:

  • laser-assisted — the least invasive and most advanced
  • foam sclerotherapy — for larger, more difficult-to-treat veins
  • and ultrasound-guided sclerotherapy — for large, deep veins that once required surgical treatment

The advantage of sclerotherapy is that it can eliminate varicose veins with no pain or downtime, Navarro says. The disadvantage is that the technique may not work for larger, more extensive varicose veins. You may also have to go back for follow-up treatments in order for your veins to completely disappear.

Phlebectomy: Also called vein “stripping,” this is a surgical procedure during which the surgeon makes small cuts near the damaged vein and removes the entire vein. Doctors sometimes do phlebectomy together with other procedures, such as ablation (see below).

RELATED: Long Flight? Bed Rest? Easy Exercises to Prevent Blood Clots

The main advantage of phlebectomy is that it’s a permanent treatment because the affected vein is totally removed, Dr. Gasparis says. But like any surgical procedure, it comes with some risks and requires more recovery time than less invasive methods of varicose vein treatment.

Thermal ablation (also called radiofrequency ablation): “Thermal ablation, which has been around for about a decade, involves using laser or radio frequency energy to heat the inside of the vein,” Gasparis explains. “This destroys the vein wall, the vein shrinks, and the body absorbs it over time.” Thermal ablation tends to work well as a varicose vein treatment, he says, but it can cause a little bruising and discomfort for the first week or so — “and because we heat the vein to 200 degrees to destroy it, we need to numb the area around it with an anesthetic, which can cause some discomfort as well.”

Veins usually become less visible within one to two weeks. The procedure requires some local anesthesia, but most people have little pain after the procedure and can return to their normal activities the next day.

Non-thermal ablation: Two similar non-thermal techniques were recently approved by the Food and Drug Administration (FDA), Gasparis notes. The first, Varithna, which the FDA approved in November 2013, uses a medicated foam. “It’s basically the same as thermal ablation, but instead of heat, we use a potent drug that destroys the vein more permanently,” Gasparis says. The second non-thermal ablation treatment for varicose veins, called the VenaSeal system, which received FDA approval in February 2015, uses a glue to shut off the vein, Gasparis says.

So far, these procedures seem to work well for varicose vein treatment, he says. But because they are so new, they aren’t time-tested to see if they keep varicose veins under control long term.

The Bottom Line

If you’re considering varicose vein treatment, make sure you go to someone who has experience doing the procedure you choose. Gasparis says that doctors of all types, including primary care physicians, cardiologists, and OB/GYNs, are doing varicose vein treatment these days. He advises you to look online for a physician or facility accredited by the Intersocietal Accreditation Commission.

What treatments are effective for varicose veins?

EVIDENCE-BASED ANSWER

For larger trunk varicose veins, as in the saphenous vein, therapeutic options include conservative measures (such as leg elevation and compression stockings), injection sclerotherapy, and surgical vein ligation, with or without stripping.Long-term outcomes appear superior with surgical treatment.

For mid-sized reticular veins and spider telangiectasias, several options are available, including sclerotherapy, laser ablation, and thermal ablation. However, no randomized trials have compared the relative effectiveness of these treatments.

Venotonic medications (primarily plantderived and synthetic flavonoids, such as horse chestnut seed extract, that improve venous tone) provide symptom relief. Head-to-head comparisons are needed to identify the most efficacious therapies (strength of recommendation: C, based on case series and extrapolations from small trials.)

Evidence summary

Graduated elastic compression stockings improve lower-extremity hemodynamics (including reflux and residual volume measured by color flow duplex scanning) in patients with varicosities, and can improve symptoms such as swelling, discomfort, and leg tightness.1,2

A Cochrane review concluded that existing evidence supports the use of sclerotherapy for recurrent varicose veins after surgery and for relatively minor “thread” veins.3 Data did not show that any particular type of sclerosant or pressure dressing or duration of post-treatment compression have significant effect on outcomes, such as disappearance of varicosities and cosmetic improvement.3

A Cochrane protocol is in progress regarding comparison of the outcomes of surgery and sclerotherapy.4 Few randomized trials have compared surgery and sclerotherapy.

Belcaro reported results of a 10-year randomized trial including 121 subjects, 96 of whom completed the study.5 Surgery consisted of ligation of the saphenopopliteal junction without stripping. At 10 years, 16.1% of patients receiving surgery plus sclerotherapy had distal venous incompetence (assessed with color duplex scanning and ambulatory venous pressure measurement), compared with 36.4% of those who underwent surgery alone and 43.8% of those who received sclerotherapy alone. The authors concluded that long-term outcomes (defined as saphenofemoral junction competence) are superior with strategies that included surgery, but at greater cost.

Beresford and colleagues also concluded that surgery lessened the likelihood of additional treatment.6 Another randomized trial showed that saphenous vein stripping reduced by two thirds the need for reoperation due to recurrent saphenofemoral incompetence, compared with saphenofemoral junction ligation alone.7

A meta-analysis studied the effectiveness of venotonic medications (such as rutoside, flunarizine, and dihydroergotamine) in chronic venous insufficiency.8 These agents significantly reduced pain, leg heaviness, cramps, and paresthesias. However, a Cochrane Collaboration reviewer questioned the validity of pooling results from this heterogeneous group of studies into a single meta-analysis.9

A Cochrane Review did find that horse chestnut seed extract significantly improves leg pain, edema, pruritus, and lower leg volume and circumference, but suggests that larger randomized trials are needed to establish conclusively this agent’s efficacy.10

Recommendations from others

A recent clinical review indicated that patients whose main symptoms are swelling or aching can be treated with compression stockings alone; trunk varicosities should be treated with saphenofemoral or saphenopopliteal ligation, plus stripping of the long saphenous vein for long saphenous varicosities.11 They suggest that sclerotherapy should be reserved for varicosities that persist after surgery.

The Venous Insufficiency Epidemiologic and Economic Studies (VEINES) program recommends sclerotherapy for telangiectasias and reticular veins, and surgery for saphenous varicosities.12 However, they noted the need for randomized trials to compare therapies.

CLINICAL COMMENTARY

Alan Adelman, MD, MS
Penn State University, State College, Pa

Choosing the best treatment for varicose veins can be complicated. Symptoms and the type of varicose veins (truncal varices, reticular varices, or telangiectasia) can guide the clinician in selecting therapy. Asymptomatic varicosities can usually be observed without treatment. Patients with symptomatic varicosities may be treated conservatively before referring for invasive treatment.

Surgery is probably the best treatment for truncal varices, whereas sclerotherapy is better for reticular veins or telangiectasia. The long-term risks and benefits of newer modalities such as laser and thermal ablation need further evaluation. Regardless of the treatment chosen, patients with varicose veins should first undergo a thorough investigation.

What works best against varicose veins?

More than 40 million Americans suffer from varicose veins, which can be both unsightly and painful, but the best way to get rid of them hasn’t been clear.

Now, British researchers report that laser ablation and surgery appear to be better options than ultrasound-guided foam sclerotherapy. All three treatments essentially close off the swollen, twisted vein.

“Minimally invasive treatment for varicose veins which destroy the vein by heat using a laser is the most effective treatment,” said lead researcher Dr. Julie Brittenden, a professor of vascular surgery at the University of Glasgow.

When Brittenden speaks of the best treatment, she’s referring to patient satisfaction five years after the procedure.

The problem with getting rid of varicose veins is that even when one vein is destroyed, other varicose veins can appear over time.

“Varicose vein is a chronic condition and new veins often occur after treatment,” Brittenden said.

The treatments for varicose veins shunt blood from the affected veins to others. When this happens, the veins fade away.

In laser ablation, the doctor uses a laser’s heat to close off the affected vein. This procedure involves a small cut in the skin and compression of the leg after the procedure.

Surgery involves inserting a tube into the vein, which closes the vein. Recovery usually takes a couple of weeks.

In foam sclerotherapy, the surgeon injects a solution into the vein, which scars it, forcing the blood to find an alternate route. This procedure usually takes several sessions and can be done in a doctor’s office.

The differences in quality of life seen in the study are likely related to fewer patients experiencing new varicose veins with laser treatment and surgery than with foam, Brittenden said.

“Laser ablation was comparable to surgery concerning the quality of life, and had the highest chance of being cost-effective of the three treatments,” she said.

For the study, Brittenden and her colleagues randomly assigned nearly 800 parents to laser ablation, foam sclerotherapy or surgery.

Of the nearly 600 patients who completed a quality-of-life questionnaire five years after their procedure, laser ablation and surgery were preferred over foam sclerotherapy.

“For patients who have varicose veins, heat ablation is the preferred treatment options in terms of both quality of life and cost-effectiveness, and patients should be offered this as first-line treatment,” Brittenden said.

But treatment options may vary by cost, according to one U.S. surgeon who was not involved with the study.

Regardless of which procedure you choose, your insurance may not cover it, said Dr. Peter Gloviczki, a retired professor of vascular surgery at the Mayo Clinic in Rochester, Minn.

That’s because many people with varicose veins have no symptoms, like pain or bulging ulcers on their legs. They simply find the veins unsightly and want to get rid of them.

If any of the procedures are done for cosmetic reasons alone, most insurance, including Medicare, won’t cover it.

Insurance usually covers these procedures when they are done to relieve symptoms. Some companies, however, may not cover the cost until other methods, such as compassion stockings and over-the-counter painkillers, have been tried, Gloviczki said.

You may not be covered if you don’t use an accredited vein clinic or vascular surgeon, he added.

“There is an increasing number of restrictions, which in a way you can understand,” Gloviczki said. “Because with 40 million Americans with varicose veins, that’s a high burden on the insurance companies.”

These restrictions are an attempt by health insurers to weed out those whose goal is cosmetic from those who are really suffering, Gloviczki said.

If you pay for the procedure yourself, you can expect to shell out between $1,500 and $3,000, according to Medicine Net.

The report was published Sept. 4 in the New England Journal of Medicine.

Explore further

Study highlights preferred treatment for varicose veins More information: For more on varicose veins, head to the U.S. National Heart, Lung, and Blood Institute. Journal information: New England Journal of Medicine

Copyright © 2019 HealthDay. All rights reserved.

Citation: What works best against varicose veins? (2019, September 5) retrieved 2 February 2020 from https://medicalxpress.com/news/2019-09-varicose-veins.html This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.

Vascular surgeons of Top Doctors UK

What conditions does a vascular surgeon treat?

Vascular surgeons will often see patients who do not yet require surgical intervention but require advice on how to reduce their future risk of stroke and heart disease. Hence, vascular surgeons will frequently give advice to patients about weight-loss and taking up regular exercise.

The main responsibilities of vascular surgeons include:

  • Promoting good cardiovascular health
  • Controlling vascular bleeding
  • Treating venous leg ulcers and varicose veins
  • Treating peripheral arterial disease
  • Avoiding limb amputation as a result of peripheral arterial disease
  • Treating aortic aneurysms by reducing or eliminating the risk of rupture
  • Providing symptom-relief and improving the quality of lives for patients with vascular disease

Other conditions treated by vascular surgeons are:

  • Stroke
  • Transient ischaemic attack (TIA or mini-stroke)
  • Carotid stenosis
  • Arterial ulcer
  • Hyperhidrosis
  • Deep vein thrombosis (DVT)
  • Venous insufficiency
  • Lymphoedema
  • Diabetic foot issues

Which subspecialties are included under vascular surgery?

Whilst vascular surgery has no specific subspecialties, some vascular surgeons will have areas of interest and expertise. Endovascular surgery, for example, uses minimally-invasive surgical approaches to treat vascular disease, and some vascular surgeons will use endovascular techniques. Other vascular surgeons may have a focus on aneurysms, stroke, arterial diseases of the leg, vascular diseases of the leg, or conditions such as lymphoedema.

When should you see a vascular surgeon?

You should see a vascular surgeon if you have been warned by other doctors of your vascular health (e.g. if you are overweight and a smoker). You may also see a vascular surgeon following a stroke, or if you have a leg wound near a vein that refuses to heal (i.e. leg ulcer). If you have varicose veins that are causing discomfort, you may also be referred to a vascular surgeon. Hence, if you see your GP, they may refer you to a vascular surgeon if they suspect any problems with your arterial, venous or lymphatic systems.

Varicose Vein Treatment Experts

Before a consultant can work with us, we have a unique recruitment and in-house training programme so that we, and you, have confidence that the doctor is a true expert (and friendly, kind and caring too).

Varicose Vein Treatment on the NHS vs Private

Over 30% of the population will suffer from varicose veins at some point in their life. They cause enormous physical and phycological distress to sufferers and yet the NHS have severely restricted funding for the painful condition. For the vast majority of our patients this is the first time they have sought private treatment. Our patient advisers are available to talk you through what you can expect from private care at Veincentre.

Upfront, Fixed-Cost Prices

We want our prices to be as affordable as possible, especially as treatment is not available on the NHS. This does not mean that we compromise on quality! All our treatment prices are available on the Our Prices page and you can see what over 95% of patients are charged for treatment on the Pricing Examples page.

Will Medical Insurance fund Varicose Vein Treatment?

Veincentre is a centre of excellence for the treatment of all varicose veins and as such we are recognised by all the major health insurers.

Varicose veins are not just a cosmetic issue especially when they start causing symptoms such as aching, throbbing, ulcers etc. They are caused by underlying valve issues in your veins and the only way to investigate this is with a Colour Duplex Ultrasound Scan. If you have varicose veins causing you symptoms it is responsible to investigate the cause. We frequently treat patients who were initially denied authorisation.

Surgery is Not Needed

Many patients are fearful of seeking treatment for their veins as they assume that surgery (under general anaesthetic with weeks off work and high recurrence rates) is their only treatment option. This is not the case.

We have been treating varicose veins using minimally invasive techniques since 2003, years before the NICE Guidance was updated to state that:

  • All patients with Varicose Veins and Symptoms should be referred to a Vascular Service.
  • Assessment should include full Colour Duplex Ultrasound scanning
  • Treatment should be by Endovenous Thermal Ablation and if this not possible or required Foam Sclerotherapy. Surgery should only be undertaken if both these fail. (However, in expert experienced hands surgery is in fact never required)

Our treatments are NICE offer the following advantages over traditional surgery:

  1. No General Anaesthetic Needed
  2. No Need for Time Off Work
  3. No Scars
  4. Low Recurrence Rates

Our Experience

With any medical treatment, experience and focus are crucial to success.

Our extensive experience shows in recent audits of our results which demonstrate:

  1. That we can effectively treat over 99% of patients suffering from varicose veins without surgery
  2. Minimal serious complications. Our DVT rate for the last 5 years is 0.35/1000 patients
  3. Less than 1% recurrence over 5 years

So confident are we that we can manage your problem without surgery, we offer appointments for consultation and treatment at the same visit. Many patients travel long distances, have EVLA treatment to both legs and are back on the train home within two hours.

Our Regulator

Our service has been rigorously assessed by the Care Quality Commission (CQC) with whom all our clinics are registered. CQC Reg No: 1-136108318.

Veincentre’s Founders

Veincentre was set up by Dr David West, a Consultant Invervetional Radiologist, and his wife Deborah.

Impressed by what he learned on a training visit to the US back in 2003, Dr West wanted to radically improve not only the medical techniques themselves but also the culture and process of varicose vein treatment in the UK.

Countless patients across the country were referred to NHS outpatient clinics, examined by a junior doctor, given another appointment for a scan, and returned to outpatients to be told “Your veins are not bad enough we can’t treat you on the NHS”. What a waste of everyone’s time and resources!

In the private sector things were not much better with long winded assessment processes necessitating multiple visits before a treatment plan was agreed and costed. No choice of treatment was usually offered and unreasonable charges were (and often still are) levied for traditional operations which had changed little in decades. Scientific studies on patients’ satisfaction with management of their varicose veins showed poor results.

David was determined to change all that and provide a vein service that truly met the needs and expectations of patients in the internet age.

He set the following core values:

Honesty | Safety | Effectiveness | Efficiency | Respect | Value for Money

Effectiveness: To utilise the latest proven innovations and equipment to produce the best possible results. To carefully analyse each patient’s problem and provide the most effective bespoke treatment. To manage 99% of all patients without surgery.

Efficiency: To minimize the number of visits necessary, the time treatment takes and the time off work and hobbies. To respond to all queries and requests knowledgeably, quickly, directly and confidently. To do our very best to fit patients in at a time of their convenience and to have no significant waiting lists. To complete treatment as planned and never have to bring patients back for a repeat attempt.

Personal Service: To treat every patient with respect and listen to their needs and wishes. To be friendly, open and cheerful. To offer a wide choice of appointment times and convenient locations.

Safety: To adopt rigorous risk management systems. To keep facilities scrupulously clean. To provide regular staff training and appraisal.

Comfort: To create modern environments of the highest quality. To utilise techniques which minimise pain.

Honesty: To be upfront about costs, likely outcomes, side effects etc. To encourage, regularly analyse, and act upon feedback about our service.

Value: To charge reasonable rates and have no hidden and unexpected charges. To provide low cost credit facilities for those who request them.

From our internal audits and feedback we have received over the last 15 years we feel confident that we are fulfilling these aims and are particularly pleased to note that we have achieved all this at a price is consistently found to be the lowest in the UK.

See Our Quality Measures.

  • Varicose Veins Introduction

Types ofvaricose vein procedures

Varicose vein procedures aren’t usually urgent, unless you have complications like blood clots or bleeding.

Some procedures can be done in your doctor’s rooms or a day clinic, using local anaesthetic and sedation. If you have high ligation and vein stripping you’ll need to go to hospital and have a general or regional anaesthetic.

All these procedures can cause painful swelling caused by superficial blood clots (thrombophlebitis, also known as venous thrombosis).

Minimally invasive procedures

These procedures work by sealing varicose veins off and diverting the blood to deeper veins. Once you’ve healed the vein becomes a cord of collagen which eventually softens and blends into the surrounding tissues.

Minimally invasive procedures are widely used because of the relatively poor results from standard varicose vein treatments.

Sclerotherapy

Your doctor injects a solution or foam into your varicose veins that causes scarring and makes them collapse. After the treatment, your leg will look worse for a while and then it should improve. You might need more than 1 session, but you can go back to work immediately after each one.

After sclerotherapy, you’ll probably have some itching, aching and discomfort in your treated leg. Going for a 5-minute walk to reduce pressure in your leg should help. You may need to wear compression stockings for a several days to weeks and this will improve the final result.

Possible adverse effects include an allergic reaction to the solution, staining or pigmentation along the line of the treated vein, small injection site ulcers, and rarely deep vein thrombosis.

Sclerotherapy can be used as the first-line of treatment for varicose veins, or after vein-stripping surgery.

Thermal ablation

Thermal ablation can be done in 2 ways: using laser or radiofrequency fibres. Your doctor makes a small cut in the skin to help them puncture the large leg vein with a needle. They then insert the fibre into the vein. The fibre is slowly withdrawn and as it goes it releases heat which destroys the whole length of the vein.

Afterwards, your doctor will fit you with compression stockings or bandages to maximise the effect of the procedure. You can return to work within 1 or 2 days.

Possible adverse effects include bruising, pain and, very rarely, skin burn. Additional treatments are often needed after thermal ablation.

Mechanical chemical ablation

In this procedure, called ClariVein®, your doctor uses an instrument that bruises the inside of the vein. The mechanical abrasion of the vein, together with a special fluid, collapses the vein wall. It’s done under a local anaesthetic, and you won’t have to take any time off work.

Possible adverse effects include itching, pain and skin discolouration over the treated vein.

Vein gluing

In this new technique, called VenaBlock®, glue is used to collapse and seal the vein. Your doctor first uses local anaesthetic at the puncture area, then inserts glue to seal the vein.

Possible adverse effects include skin discolouration and swelling.

Ambulatory phlebectomy

This is minor surgery in which your varicose veins are removed through small incisions, under a local anaesthetic. It can be done in a day clinic and you can go back to work the next day. You may need to wear compression stockings, depending on the extent of veins removed.

Possible adverse effects include infection, bleeding and scarring. Other complications are quite rare.

High ligation and vein stripping surgery

Your surgeon ties the varicose vein at the point where it meets the deep vein, then removes the whole superficial vein from your leg through two or more small incisions. Blood circulation to your leg isn’t affected, because the deep vein system remains intact.

This surgery is done under regional (the area is numb but you’re still conscious) or general anaesthesia. You’ll need to stay in hospital for a few hours afterwards, possibly up to 2 days, depending on the extent of your surgery.

This procedure carries all the usual risks of surgery. You’ll need a week off work and for the first 2 weeks you’ll need to wear a compression stocking. You can expect bruising afterwards, which improves within a month.

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