treatment for veins

How are varicose veins treated?

There are now many treatments for varicose veins. We will examine the pros and cons of each below. No one treatment is right for everyone. The procedure or combination of procedures recommended by your specialist will be based upon the extent of your specific condition and your overall health and age. The specialist will usually recommend an ultrasound examination to assess the severity and extent of your vein disease, many of which may not be visible on the surface of the leg. Without an accurate ultrasound picture of your veins we cannot determine the source of the problem or treat it very effectively.

Is it OK to remove the veins?

Many people ask whether it is alright to remove the veins because they worry how it may affect their circulation. In fact removing the leaking veins often makes the circulation more efficient. There are 2 sets of veins in the legs, the superficial ones (dark blue) that become varicose veins and the much larger deep veins (light blue) that run near the bones in the leg.

These deep veins carry the majority of blood out of the leg. In patients with varicose veins the blood goes up the deep veins as normal but then leaks backwards down the superficial veins – this is obviously not very efficient.

These varicose veins are therefore contributing nothing to the normal circulation, in fact they’re making it worse, and so it is safe to remove them.

What are the options for treating varicose veins?

Conservative treatment
Injection therapy
Conventional surgery
New vein occlusion techniques (Laser or VNUS®)

Conservative treatment:

The most non-invasive way to manage varicose vein disease is wearing prescription-strength compression stockings (usually knee length, but sometimes thigh length). Compression stockings help alleviate the swelling and pain caused by varicose veins by squashing the leaking veins shut but not actually getting rid of them. These stockings may also help heal any skin inflammation or ulcerations which have developed. However, there has never been any evidence to show that compression stockings prevent the formation of varicose veins. Since the diseased veins that are causing the symptoms are not being eliminated, the compression stockings have to be worn indefinitely. Some patients tolerate the stockings well during the winter months but find the stockings intolerable in the warmer weather.

All operations and interventions carry some risks and one of the advantages of the stockings is that they carry the least risk for the treatment of your veins. Sometimes wearing stockings for a short period can be helpful – if your symptoms improve to some extent then it’s likely that more permanent treatment will be beneficial for you. Some patients get no benefit from stockings though. In the past the appearance of the stockings has understandably put some people off using them. The heavy brown stockings of the past now have a number of more cosmetically appealing options available.

If you wish to see these newer products please try the following links:

Credenhill or Activa

Injection of varicose veins

Some varicose veins can be injected with a liquid to cause them to block up and so stop leaking. This is called sclerotherapy. It is used for treating small to medium size varicose veins. It involves the injection of a solution into diseased veins with the intent to create scar tissue inside the vein that will seal it closed. The veins then shrink and gradually disappear. The solution used is extremely safe and relatively painless. No anaesthetic or sedation is required as the needle that is used is smaller than those used for taking blood. For larger or deeper varicosities ultrasound is often used to "guide" the injections into the underlying diseased veins below the surface of the skin. This allows the medication to be administered to precise locations safely and accurately.

Here we can see the needle being guided into the vein using an ultrasound device.

The image is magnified and the needle appears much bigger than it really is!

In this setting the liquid used is actually turned in to foam. This is made by mixing gas bubbles with the liquid, giving a consistency like shaving cream or mousse. One part of liquid solution will make 3-5 parts of “bubbly” foam. When injected inside a vein, the micro foam displaces the blood (rather than mixing with it) creating better contact with the vein wall. Improved contact between the medication and vein wall gives better and faster results. The expanded volume of the mixture also allows for less medication to be used at a weaker strength.

Here the liquid is being turned into a foam by passing it repeatly between 2 syringes prior to using it to treat the veins.

Sclerotherapy (vein injections) may be used alone as a treatment or it may be done during post operative visits to eliminate any diseased veins that were too small to remove during your operation. Thus, surgery and sclerotherapy are often complementary, enabling the specialist to treat as many of your veins as possible.

The Pros and Cons of Sclerotherapy

Pros: One of the main advantages this technique has is that it requires no anaesthetic and can therefore be useful in older patients. It can be undertaken as an out-patient and patients walk out of hospital 10-15 minutes after the procedure is completed. The procedure causes minimal discomfort whilst it is undertaken and is well tolerated afterwards. These benefits mean that people can return to work or their normal activities within a day or two.

Cons: The main point to note about sclerotherapy is that it is not as durable as some other treatments. In the long term, over 10 years, the risks of the veins coming back are around 50%. This compares to a figure of around 10% with other treatments such as surgery. About 15% of patients treated with sclerotherapy require a second treatment to completely block the vein. Some people do not worry about having to have a further treatment at a later date as it is a fairly minor procedure.

If you are very concerned about the cosmetic outcome of your treatment please be aware that about 1 in 5 patients develop some brown skin marking along the line of the vein. With time this often fades but in some individuals it can be permanent.

Our full patient information can be found here if you want more information.

Conventional surgery

For many years surgery has been the mainstay of treatments for varicose veins but newer treatments are quite quickly replacing it. Surgery involves a cut, commonly in the groin but sometimes behind the knee. The leaking vein is then isolated and divided from the main deep vein. Following this a plastic wire is passed down the vein and the vein then tied onto one end of it. The end of the plastic wire is then brought out through the skin and the vein is pulled (stripped) out. This is followed by small cuts on the lower legs where the varicose vein bulges are and these veins pulled out piecemeal (avulsions). This technique is commonly referred to as a high tie and stipping.

Pros and Cons of Surgery

Pros: Surgery such as this has been performed for many years and therefore has a proven track record. Its long term results are good in the hands of specialists, with only around 10% of patients requiring further surgery even after 10 years. As the veins are physically removed, once the pain and bruising has settled, patients usually experience satisfactory relief of their symptoms.

Cons: This procedure is relatively uncomfortable and certainly requires a general anaesthetic. It is often performed as a daycase but some patients who are having more extensive surgery may require admission overnight. There can be quite extensive bruising which may takes some weeks to settle. Patients usually require 2 weeks off work to recover.

Our full patient information and consent form can be found here if you want more information.

Newer vein occlusion techniques

There are a number of different devices available for treating varicose veins without conventional surgery. These all work on similar principles but do have some subtle variations.

The basic technique involves the use of an ultrasound scan to identify the veins underlying the problem in the leg. The leaking vein often originates in the groin, although sometimes it is behind the knee and it usually runs down onto the calf to form the visible veins. Through a tiny incision (3-4mm long) a guidewire is passed into the vein and all the way up to its origin. The device for treating the vein is then guided into position using the wire and the ultrasound.

Fluid is then injected all around the vein which helps keep the vein wall in contact with the treatment device and also protects surrounding structures. The device is then “fired” and the energy it releases is transmitted into the wall of the vein, thus destroying the vein and preventing any further leakage through it. The device is then removed and any remaining veins are removed through tiny nicks in the skin. Bandages are worn for 5 days after the procedure, followed by a period in compression stockings.

The picture on the left shows the endovenous catheter being used to treat the main vein responsible for varicose veins - the long saphenous vein. The treatment is halfway through.

Above shows veins before and after treatment

The 2 main techniques in use in the UK are Endovenous Laser treatment and VNUS®. The first of these obviously uses laser energy to treat the vein, whilst the latter uses radio-frequency energy to achieve the same result. The differences between the outcomes for these 2 types of device are relatively small but the big difference is the improvement in patient outcomes relative to conventional surgery. Patient satisfaction is around 80% after conventional surgery but this rises to well over 90% with the improved endovascular techniques. Your specialist will discuss with you whether he feels that either the laser treatment or the VNUS® closure is better suited to you.

Pros and Cons of Vein Occlusion Techniques

Pros: The main advantages relate to the fact that these newer techniques cause less pain and bruising than conventional surgery. Patients require painkillers for a much shorter period of time following the newer treatments. The average number of days off work needed following ordinary surgery is around 2 weeks but after the new endovenous treatment this is reduced to around 4 days. Many patients can be treated under local anaesthetic but some patients with extensive veins may be advised to have a short general anaesthetic.

Cons: When this technology was first introduced some experts were concerned that in the years after treatment some of the veins would begin to open up again. As experience has grown with this treatment this doesn’t appear to be the case but it still doesn’t have the very long follow (10 years+) that some conventional surgery patients have had.

If you wish to know more then please click here to access our detailed patient information sheet.

If you wish to look at websites for the two different techniques please follow the links below, but bear in mind that these are commercial websites that understandably promote their products in as favourable light as possible:

VNUS® or Laser