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This article discusses the treatment of uncomplicated varicose veins. The treatment of complications such as phlebitis, haemorrhage and ulceration is not included. Varicose veins may require treatment for symptoms or for cosmetic reasons. Many patients have had their lives made a misery from the appearance of their veins.

Injection Sclerotherapy
Superficial varices below the knee, which are not associated with long or short saphenous vein reflux, may be injected. This can be done with STD or Sclerovein in a strength of 1% or less. The longterm results can be disappointing. Extravasation of sclerosant can cause pain or even ulceration. Staining of the skin over the injected vein can occur.

Surgical Treatment
Most symptomatic veins will require surgery for effective treatment. The connections between the superficial varicose veins and the deep veins must be tied off. This connection is usually the saphenofemoral junction, sometimes the saphenopopliteal junction and occasionally a perforating vein. The recurrence rate from varicose vein surgery is reduced if the long saphenous vein is stripped. People harbour memories of their mothers in pain and nursing large scars following this procedure. Nowadays varicose tributaries are teased out with small hooks through tiny stab incisions. The scars are much smaller. Patients require a bandage for a day and a stocking for a week. Patients can resume driving when they can safely perform an emergency stop, usually about one week. The amount of time taken off work depends on age, fitness and occupation, normally two weeks is sufficient.

New Techniques
There are a number of interesting new techniques for the treatment of varicose veins. Unfortunately none are as yet available on the NHS but our patients will still ask us about them.
 

Endovenous Laser Ablation

This technique has recently become available in the UK. The principle is similar to VNUS ablation. A laser catheter is passed up the long saphenous vein (LSV) under ultrasound guidance to the sapheno femoral junction. The laser is activated and withdrawn down the LSV obliterating it by thermal ablation. The procedure takes about 45 minutes. It can be done as an office procedure under local anaesthetic, leaves minimal bruising and requires no groin incision. Because very little heat is transmitted outside the vein it has the potential to treat short saphenous vein (SSV) incompetence. This eliminates the need for an incision in the popliteal fossa and reduces the risk of common peroneal nerve injury and foot drop. Like VNUS, this is not available on the NHS.

The potential advantages of the technique are:

+ No groin incision
+ Faster recovery - back at work 24hrs
+ No bruising
+ No requirement for stockings
 

See our pages on EVLTŪ for more information

TriVex Technique

At operation once the long saphenous vein has been dealt with, either by conventional stripping or by the laser method, some patients still have moderate or even huge varicose veins. These varicose tributaries cannot easily be removed by small stab incisions. It is sometimes necessary in these cases to make numerous larger incisions. For these patients veins can be removed using a new method called transilluminated powered phlebectomy with an instrument called the TRIVEX. This entails endoscopic resection and ablation of the superficial veins using a powered vein resector and an illuminator. In this technique a bright light is introduced into the leg under the skin so that the veins can be easily visualised. A second instrument is then introduced for removing the veins. It has a powered oscillating end which dislodges the veins and cuts them. The pieces of vein are then gently retrieved by suction down a tube. The advantage of this procedure is that large areas of the leg can be treated and all the veins removed through only two small incisions. The illumination allows precise removal of the veins under direct vision. For moderate or large veins this is a useful method.

SEPS (Subfacial Endoscopic Perforator Surgery.)

This procedure has replaced older operations where a long incision was made down the back of the calf to tie off incompetent perforator veins. With SEPS, a 2cm incision is made on the medial side of the calf. The fascia covering the muscle is opened and a scope passed into the subfascial space. The perforator veins can be seen traversing this space from the muscle to the superficial veins. They are ligated with clips.

Dermal Thread Veins

Patients find the leashes of dermal thread veins very unsightly and distressing. The treatment can be disappointing. They can be treated by microsclerotherapy in which sclerosant is injected through tiny needles. The main complications are skin staining and ulceration. It is best avoided on the face. This is still the treatment of choice in most cases. Laser treatment offers similar results but is more time consuming, more uncomfortable, more expensive and can cause abnormal pigmentation of the skin. It is useful for smaller areas of residual veins. A new procedure is Vein Wave. Here, a tiny needle is placed over the thread vein. A microcurrent is discharged through the needle, obliterating the thread vein. The advantages of Vein Wave is that it requires no anesthetic, causes no ulceration or abnormal pigmentation, needs no bandaging and can be used on skin anywhere on the body, including the face.

More information on Varicose Veins Symptoms and Diagnosis.

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