Varicose Veins

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“Varicose veins are when veins become abnormally tortuous and dilated. This is often associated with failure of the valves within the veins to direct blood back towards the heart. “

Based on their size, we classify veins into one of the following categories

Telangectasia/spider vein: <1mm
Reticular viens: 1-3mm
Varicose veins: >3mm

Management options for varicose veins in the last few years have changed drastically. In particular we have seen the explosion in endovenous options that permit patients to pursue more minimally invasive options than ever before. Despite this, there is still a role for open surgery in some patients.

Varicose Vein Treatment

There are several treatment options for varicose veins, and importantly not one single treatment options is suitable for every single patient. Further, the landscape for the treatment of varicose veins is rapidly evolving with newer techniques being developed with equally rapid pace. Despite this, 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 encounter one of several options

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

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 more successful results.

Radiofrequency Ablation (RFA)

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

Generally, the results of RFA are excellent and are comparable to open surgery. Most people can generally undergo RFA under local anaesthetic, and this can be performed in the rooms.

Sclerotherapy

Sclerotherapy is a non surgical treatment for varicose veins. Sclerotherapy is used to injury 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. We generally use an agent that acts like a detergent. It is injected directly into the vein under ultrasound guidance as a foam solution.

What are the risks?

Ulceration and skin damage
Hyperpigmentation – this is where areas of the skin appear brown and discoloured. One in three people will experience this and it will eventually disappear in most people. In a very small group of people these will persist.
Nerve injury – extremely uncommon. This in– volves nerves being damaged by the injections. Sometimes people experience chronic pain or burning.
Deep vein thrombosis (DVT) or blood clots.
Extremely rare complications such as stroke have been reported to happen with large doses of sclerotherapy. We typically use safe doses only to minimise major complications.