Varicose Veins Treatment

Management options for varicose veins in the last few years have changed drastically. In particular we have seen a proliferation in minimally invasive treatment options that allow patients to return to work and normal activities faster than ever before.

What happens on the first visit?

During the initial consultation a thorough ultrasound examination is performed by an experiences sonographer to assess the venous system of the lower limb. After this assessment, the vascular surgeon will explain these findings and advise a treatment plan (if required) that sometimes includes operative or non operative treatment. We are able to tailer solutions to each patient that may involve open surgery or minimally invasive surgery.

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Treatment Options

There are several treatment options for varicose veins, and importantly not one single treatment options is suitable for every single patient. There are several well established practices in place that consistently produce good results for patients and are well supported by the current medical literature.

Patients may be recommended one of the following options:

Radiofrequency ablation.
Endovenous laser ablation (EVLA)
Ultrasound guided sclerotherapy
Venaseal
Traditional open surgery (often called high ligation and stripping)

A current Cochrane Review Cochrane Review (Whing 2021) compares the various surgical treatment options available and compares their relative efficacy. The findings can be summarised as follows.

Laser versus radiofrequency ablation: comparable results at 5 years
Radiofrequency ablation versus surgery: similar early results, with a potential for better long term benefits.
Surgery versus sclerotherapy only: surgery generally produces mroe succesful results.

Treatment Selection

The primary goal in treating superficial venous insufficiency is closure of refluxing superficial veins, which alleviates symptoms and prevents complications.
The most proximal point of reflux should be treated first. An additional goal of the treatment of telangiectasias and reticular veins is the attainment of satisfactory cosmetic results.
Patients with saphenous reflux may also exhibit varicosities, enlarged reticular veins, or telangiectasias. Quite often treatment is undertaken to treat these veins also.
The Society for Vascular Surgery (SVS) and the American Venous Forum (AVF) have compiled evidence-based recommendations for the care of patients with chronic venous disease. Both radio frequency ablation and laser therapy are considered safe and efficacious and are recommended equally for the treatment of saphenous reflux.
Both are recommended in preference to open surgery because of reduced convalescence time and a decreased incidence of post procedural pain and morbidity.
Liquid or foam sclerotherapy is recommended for the treatment of telangiectasias, reticular veins, and varicose veins.

Radiofrequency Ablation (RFA)

RFA is a modern, minimally invasive treatment option for varicose veins. It involves passing a long catheter into the main refluxing vein, and applying controlled heat along its length to allow it to collapse. The catheter and system is named “ClosureFAST”.

Generally, the results of RFA are excellent and almost comparable to open surgery. Most people can generally undergo RFA under local anaesthesia only, and this is often performed in the rooms.

Venaseal

Venaseal is another excellent treatment option for varicose veins. Like radio frequency ablation, it is another minimally invasive treatment option. However unlike radiofrequency ablation or endovenous laser ablation it does not use heat. Rather, a glue is injected in the vein to prevent further blood flow within it.

Therefore one of its key advantages is to not require cooling fluid to be injected around the vein prior to being heated. Also, compression stockings are generally not required.

The main disadvantage of venaseal is permanent implantation of cyanoacrylate glue. Although only very small volumes are used (generally less than 1 or 2mL) some patients would prefer to not have anything permanently implanted into the body if it can be avoided.

Sclerotherapy

Sclerotherapy is a non surgical treatment for varicose veins. Sclerotherapy is used to injure the veins and cause them to become irritated and stick together. This leads to damage of the veins, but in doing so causes them to scar and shrink. The veins eventually disappear altogether.

What do you use for sclerotherapy, and how does it work?

There are different chemicals and substances used for sclerotherapy. Generally these are various substances that are injected directly into the vein under ultrasound guidance as a foam solution.