Varicose Vein Treatment
As with most surgical conditions, treatments for varicose veins can broadly be divided into non-invasive (conservative), invasive (open surgery) or minimally invasive (endo-venous).
These are aimed at counteracting the venous congestion due to venous incompetence. Patients with varicose veins know themselves if they can sufficiently elevate their legs the varices are far less visible and symptoms of the aching etc are temporarily relieved. This is because gravity is now no longer causing increased congestion at the capillary bed and is why people with ankle oedema notice that first thing in the morning swelling is markedly reduced.
I often explain to patients that the muscles of the calf and foot are affectively the heart of the venous system. In the same way that maintaining a healthy heart to keep the arterial system functioning well it is imperative to develop a healthy heart for the venous system. Hence the importance of exercise to maintain muscle function in the legs and feet and to maintain mobility of the knee and ankle joints.
The effect of gravity can also be counteracted by the wearing of graduated compression stockings during the day. These are constructed in a way that the compression pressure is highest at the ankle and reduces further up the calf.
Emollients to keep the dry skin moisturised can also be a helpful measure.
Whilst conservative measures can alleviate the symptoms of varicose veins they do not treat the underlying cause and are therefore not curative.
Open surgery was a very effective treatment for primary i.e. first time treatment for varicose veins but did involve a general anaesthetic and recovery time away from normal activities and work.
Open surgery for recurrent varicose veins was technically much more challenging and carried not inconsiderable risk due to scarring around the major leg arteries and nerves.
Minimally invasive treatments:
Minimally-invasive techniques are now the mainstay of varicose vein treatments. They treat the veins from the inside (‘Endo-venous’) and seek to destroy the lining of the vein (the endothelium). Without the endothelium the vein can no longer function so it ceases to transmit blood and shrinks down to become a fibrous cord of scar tissue. Various techniques involve different modalities to achieve this endothelium destruction (known as ablation).
Endo-venous techniques can be broadly divided into catheter-based and non-catheter-based.
Catheter based techniques:
These achieve destruction of the endothelium by the use of an energy source delivered via a catheter (specialised tube) passed into the vein.
The energy can be thermal i.e. the use of heat energy to effectively cook the inside of the vein, laser energy, steam, or radio-frequency energy.
Non-Catheter based techniques:
These involve injection of a chemical irritant (‘sclerosant’) directly into the vein system being treated.
Sclerosants can be used in varying strengths employing varying sizes of needles depending on the diameter of the vessel to be treated. Weak sclerosant solutions (0.2% or 0.5%) are injected in liquid form have long been known to be effective in very small veins and thread or spider veins and is the technique I use for Microsclerotherapy.
A stronger solution (1% or 3%) of sclerosant is mixed under pressure, the Tessari technique, with air or carbon dioxide (CO2) to form foam. The foam displaces blood within the larger varicose veins allowing this to be an effective treatment for varicose veins. The foam is visible on ultrasound which ensures deployment of the foam into veins requiring treatment hence ultrasound guided foam sclerotherapy (or ‘USGFS’……..we are addicted to pseudonyms in the medical field!).
At Southwest Veins we offer the minimally invasive Foam Sclerotherapy treatment.
I am now booking FREE initial consultations via video which are proving highly effective. This enables us to meet, virtually, face to face and for me to diagnose your condition and answer any specific questions.