Varicose Veins - Treatment

Treatment of varicose veins

Severe thread veins and varicose veins affecting the skin of the ankle
 

The treatment of varicose veins and "hidden varicose veins" is clearly split into two sections:
  1. Treatment of the underlying venous incompetence to stop the venous reflux
  2. Treatment of the surface varicose veins or thread veins
To treat the underlying venous incompetence, a duplex ultrasound scan is performed to see which veins have lost their valves and are allowing the blood flowing the wrong way (venous reflux). Once these veins have been identified, they need to be blocked off to prevent the blood falling the wrong way down them.
 
Many patients ask why the valves are not repaired. In the world of phlebology, we would love to be able to repair these valves. However as we cannot repair the valves, we have to block off the vein to stop the venous reflux. By doing this, we force the blood to flow the right way back to the heart, stopping the damage of the venous reflux.
 
There are many different techniques available to treat venous incompetence and these are described elsewhere on The College of Phlebology's website. The treatment chosen by an expert will depend on which vein is incompetent and needing treatment and the size and shape of that individual vein.
 
Treatment options in summary are:
  • Stripping veins - performed under general anaesthetic, the old technique of tying and stripping veins should now never be performed. It is associated with unnecessary risks, pain and a very high chance of all the veins growing back again
  • CHIVA - an old technique that is still popular in some areas of the world which attempts to redirect refluxing blood but destroying fewer veins than other techniques. However the recurrence rates are poor and this has been largely superseded by the following techniques
  • Endovenous laser ablation (EVLA) - performed under local anaesthetic this is highly effective to treat large straight veins such as the Great Saphenous Vein, Small Saphenous Vein and the Anterior Accessory Saphenous Vein.
  • Radiofrequency ablation (RFA) - performed under local anaesthetic this is highly effective to treat large straight veins provided the walls of the veins are smooth and have good contact with the device during treatment
  • Ultrasound guided foam sclerotherapy (UGFS) - performed under local anaesthetic with utilinsing ultrasound for guiding the insertion of the needles, ultrasound guided foam sclerotherapy is very effective for small veins. However research has shown that in large veins it does not close permanently and can cause phlebitis. As such it is rarely a treatment by itself for varicose veins or hidden varicose veins unless the veins are very small
  • Coil embolisation of pelvic veins - this is only required when it is the pelvic veins (ovarian veins or internal iliac veins) that need treatment
  • Trans-luminal occlusion of perforating veins (TRLOP) - performed under local anaesthetic this is only performed in very short veins perforating from deep to superficial
 
And there are some new options currently being evaluated:
 
  • Non thermal ablation - including devices that mechanically damage the inside of the vein whilst injecting sclerotherapy into it at the same time
  • Steam vein sclerosis (SVS) - a technique where steam is injected into veins, the heat closing the veins away permanently
  • Glue sclerotherapy - a technique using a derivative of "superglue" to stick the veins together permanently 
 
Once the incompetent veins have been treated successfully and there is no more venous reflux, the veins visible on the surface can then be removed:
 
Leg thread veins should not usually be treated with laser, IPL or other electrolysis type treatments unless microsclerotherapy has failed or cannot be performed. Although there are some enthusiasts for other techniques, most experience practices find microsclerotherapy the the optimal treatment for leg thread veins in the majority of patients.
 
What to do if you have varicose veins or "hidden varicose veins":
If you have any of the signs and symptoms of varicose veins or hidden varicose veins, you need to have a duplex ultrasound scan in a specialist vein unit followed by a consultation with a venous expert who can decide which of the treatments you require to get the optimal result.
 
In many cases, you will need to go through your family doctor first. Unfortunately, many family doctors still do not regard varicose veins as important as there is still a "perceived wisdom" that varicose veins are "only cosmetic". This is completely untrue as they are associated with venous incompetence and therefore can coexist with all of the problems above including clots in the veins, bleeding, skin damage and eventually leg ulcers
 
No doctor or nurse can exclude venous incompetence and venous reflux without a duplex ultrasound scan. Although any good professional can see when varicose veins are visible on the surface, absolutely no one can see "hidden varicose veins" when the venous problem is hidden deep to the skin. Only a venous duplex ultrasound scan can accurately diagnose varicose veins and "hidden varicose veins". Without this test, no one should accept reassurance that they do not have varicose veins or "hidden varicose veins".  
 
This website was last updated on 11/10/16.

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