Varicose Veins and Varicose Veins Treatments
Varicose veins affect about one in three adults – both women and men – especially with increasing age. They can cause troublesome symptoms - heaviness, aching and itching. In some people they can lead to skin damage and ulcers. Phlebitis is another risk of varicose veins, and occasionally bleeding can occur.
When varicose veins develop, the veins become widened and tortuous, so that their valves (which should allow blood to flow only upwards) stop working: blood can then flow the wrong way, creating a head of pressure in the veins, which can lead to symptoms and skin damage.
Do I need varicose vein treatment?
Varicose veins cause many people concern because of their appearance. People are also concerned about what problems their veins may cause them in the future. Really good advice is important – about these issues and about the pros and cons of treatment.
Varicose veins form in superficial veins and are not in veins which are normally important for the flow of blood up the leg. Most of the blood flow is up the main deep veins. That is why varicose veins can be treated without impairing the blood flow.
Treatments for varicose veins
Treatment for varicose veins has changed a lot in recent years and there is now range of effective treatments. Individual choice of treatment will be influenced by what your veins are like and by your own preferences. Ultrasound examination and duplex ultrasound scanning are used to guide the choice and planning of treatment. Scanning is also used during most types of modern varicose vein treatments.
The main principle of any treatment is first to seal off or to remove the veins which are putting a head of pressure on the varicose veins that you can see. If this is not done thoroughly then varicose veins are likely to reappear. Once the main “feeding” vein/s (most often the long /great saphenous vein) has been dealt with, the obvious varicose veins can be removed or injected – usually all at one procedure.
Traditional treatment was by surgery - removing (“stripping”) the main troublesome vein and then removing the obvious varicose veins through tiny incisions (phlebectomies). That works well, but it means a general anaesthetic, an incision in the area of the groin, and sometimes significant bruising from the “stripping”. Nowadays, other methods are used, under local anaesthetic, instead of removing the vein surgically.
There are a number of methods used to seal off the main problem veins, including techniques which use heat energy (endothermal) – laser (EVLA) and radiofrequency; and more recently cyanoacrylate glue. These have all been shown to work well. They usually need to be accompanied by surgical phlebectomies (or injections) to get rid of the obvious varicose veins, but that is normally all possible under a local anaesthetic. You are able to walk about immediately and frequent walking is a good idea.
Another kind of treatment is foam sclerotherapy, which means infection of a foam into the veins (usually under duplex ultrasound guidance). The foam is injected into all the troublesome veins and it causes them to seal off. Foam is more appropriate for some kinds of varicose veins than others. Discussion about its advantages and disadvantages, compared with the other treatments, is important for each individual.
Small varicose veins of limited extent can be treated by simple sclerotherapy (“injection treatment”) with an infection of a liquid sclerosant (chemical which causes the veins to seal off).
Whichever kind of treatment you would like to consider for your varicose veins, we will talk about the pros and cons; exactly what is involved in the various procedures; and the recovery after them. All the treatments are on a “walk in – walk out” basis and you should be able to return to normal activity very quickly. Some tenderness and lumpiness are common after both surgical treatments and foam sclerotherapy; and after surgical phlebectomies it is recommended to keep the wounds and adhesive dressings dry for a few days.
How long do treatments last?
Some people develop new varicose veins over the years after any of the varicose vein treatments, but thorough treatment minimises the risk. Varicose veins may simply re-grow in the areas which have been dealt with, or they may develop in a different system of veins which was normal at the time of treatment. If veins develop again they can be treated.
Varicose vein treatment cost
This varies depending on the kind of treatment. For example, simple sclerotherapy for small varicose veins costs about £300; foam sclerotherapy £850 (for one leg); and cyanoacrylate glue or laser £2,500-3,000 for one leg and around £4,000 (including surgical phlebectomies) for both legs.
Thread Veins (spider veins, telangiectases) are often present, alongside varicose veins. These can be successfully treated by microsclerotherapy (injections using tiny needles). That is normally done on a separate occasion to varicose vein treatment. If both are to be treated, then it is usually best to treat the varicose veins first.
Professor Bruce Campbell is one of the UK’s best known vein experts. He specialises in microsclerotherapy treatment for thread veins as well as varicose vein treatments. He has been a leader of major research studies on varicose vein treatments and how patients benefit from them. He is particularly recognised for giving people good information and informed choice. He has been a vascular consultant at the Royal Devon and Exeter Hospital since 1986.