Without treatment, varicose veins will steadily get worse over time. Choice of treatment will vary between patients and depend on the severity of their varicose veins as well as their overall health and age. Some treatment options include sclerotherapy, endovenous laser, surgery and venous embolisation.
Sclerotherapy is a widely used procedure for superficial varicose veins. Small and medium sized veins can be injected with a solution that makes the vein collapse. As a result, the treated vein can no longer carry blood and in a few weeks the varicose veins should fade. After injection, compression is applied to the area. An advantage of sclerotherapy is that is does not require anaesthesia and can be performed in Dr Shakibaie’s office.
There is the possibility for complications with sclerotherapy injections. Skin discolouration (such as red patches) may occur after injections and there may be bruising or swelling which tends to subside over a few weeks. If you have any concerns, discuss these with your doctor.
Endovenous laser therapy (EVLT)
Being minimally invasive, this is the preferred treatment for treating the underlying vein that is causing the varicose veins. Using ultrasound guidance, a thin tube (catheter) is inserted into the varicose vein. When in place, the tip of the tube is heated using laser energy and the tube is then removed. This causes the vein to collapse and thus no longer allow the blood to flow back towards the feet. This procedure can be performed under local anaesthetic and is usually performed in Dr Shakibaie’s office.
It is a safe and effective treatment of varicose veins and patients can usually return to normal activities, including work, within 24-72 hours. Pain and bruising are the most commonly reported side effects. Nerve injury, skin burns and deep vein thrombosis are very rare. EVLT is considered a safe treatment for varicose veins in the legs.
Radiofrequency ablation works in a very similar way to endovenous laser therapy. A tube is guided into the vein using ultrasound. A device, which gives off radiofrequency energy, is put through the tube. This heats up the vein and causes it to close. Side effects can occur but are uncommon and include inflammation and abnormal sensation in the area.
Surgery can improve the cosmetic appearance of your legs and improve symptoms you may be experiencing such as aching. Surgery is performed in a hospital and involves making an incision in the groin and another incision at the knee. The vein usually tied near the incision at the groin and then stripped (removed) through the incision at the knee. Importantly, removing the vein will not affect circulation in your leg due to the fact that the deeper veins are responsible for draining larger volumes of blood.
Surgery usually requires a general anaesthetic, and although very effective, it may involve a longer recovery and more discomfort post-procedure than some of the other treatment options. You may feel sore and experience discomfort for several weeks after surgery. There are also more risks associated with surgery than the other treatment options. For example, there is the possibility of being allergic to the anaesthetic, bruising, having numb patches on your legs or bleeding during or after surgery.
This procedure is reserved for when the source of the leg varicose veins originates from the veins higher up in the pelvis and abdomen. A small catheter is placed inside the vein at the groin and guided under X-ray’s to the pelvis to the source of the varicose veins (usually the ovarian vein in women and testicular vein in men). Once there, a small device (coil) is deployed which will then stop flow in that particular vein and hence remove the pressure being transmitted to the leg varicose veins.
Although it is minimally invasive and done under a local anaesthetic, it requires sophisticated X-ray equipment and is done as a day case in a hospital. Recovery takes only a few hours.