The treatment of varicose veins is becoming more complicated. New methods of treatment have become available. For many patients operation may be the best option for a good long term result. However as there are alternatives and because we have to explain all these to you in detail there is a great deal of information that you have to absorb. This is why I make use of this written information so that you can take it away and consider at leisure.
In the old days we told you what we thought was best for you, usually operation, and it was easy. Now we have to tell you about all the alternatives, with their good and bad points, the possible benefits and all the risks.
- Endovenous laser ablation available privately
- Radiofrequency ablation available privately
- Cyanoacrylate adhesive available privately
- Conventional open surgery Local or general anaesthetic, might need overnight stay
- Foam sclerotherapy increasingly popular, not for very large veins
From 1 May 2007 the NHS has imposed very severe restrictions on varicose vein treatments of any sort which makes it more unlikely that these options will be available under the NHS. Nevertheless new ways of doing these ‘Endovenous’ treatments under local anesthesia have been developed, and the results have been shown to be as good as conventional surgery after 10 years.
These are out-patient procedures performed under local anaesthetic. The procedure takes less than an hour to be performed.
Colour duplex ultrasound imaging is used to confirm the diagnosis and assess the suitability of the abnormal vein.
A small cannula is inserted into the vein allowing a laser fibre or a radiofrequency catheter or a cyanoacrylate infusion system to be passed to near the top of the vein. Local anaesthetic is injected along the length of the vein and this can be a bit uncomfortable (no local anesthetic with the Cyanoacrilate procedure). Thermal energy is fed into the fibre to heat the vein wall to seal it shout. No thermal energy when Cyanoacrilate is used.
A support stocking or tights must be worn day and night for 5 to 7 days afterwards then just during the day for another week or so. You can return to normal activity as soon as you like but it might be a good idea to give the gym a miss for a few days.
These systems are intended to stop the progression of venous insufficiency that is the root cause of your varicose, reticular and thread veins. It is essential to perform this first, before any other treatments, as it well enhance the effectiveness of all subsequent treatments that will address the damage that has already occurred.
Larger bulging varicose veins can be treated at the same time or at a later visit if they have not resolved on their own. The options are removal through a tiny incision under local anaesthetic (ambulatory micro-phlebectomy) or by foam sclerotherapy.
Either way you can go home straight away although driving should be avoided for a few days until you can do an emergency brake without pain.
Is it safe?
Yes. Tens of thousands of procedures have been done world-wide. The risks of general anaesthetic, though small, are avoided.
Are there any complications?
All procedures carry a risk of complications, but with Endovenous Ultrasound-guided techniques they are minor.
Bruising is common and may cause some discomfort which responds to simple pain killers such as paracetamol.
There may be some discoloration of the skin overlying the vein. This almost always resolves in up to 6-9 months.
There can be a transient feeling of tightness where the vein was. This occurs as the damaged vein is replaced by scar tissue which contracts and it confirms that the treatment has worked.
If there has been bruising some thread veins may develop, especially if you are prone to them. These are simple to treat later with sclerotherapy.
On the whole, Endovenous ultrasound-guided procedures are very effective, but like all procedures there is a failure rate – in this case about 5%, mainly for very large veins. The treatment can be repeated if necessary, or an alternative technique can be chosen.
Other complications such as deep vein thrombosis or sensory nerve damage are very rare.
You will be asked to return to the clinic for review after 4 weeks. This is to make sure the outcome is satisfactory and to see if there are any remaining veins that you would like treated.
In making up your mind about treatment of varicose veins there are many things that you will need to consider. Many studies have shown that quality of life is improved by having varicose veins treated. We generally warn patients who are having operations that about a fifth of them (20%) will have further varicose veins. This seldom deters them and the fact that so many patients do come back for further treatment, sometimes after a period of 5-20 years, suggests that they have derived considerable benefit. Otherwise they would not have asked to have it done again.
Book a Consultation with Mr. Giuseppe Serpieri, Consultant Vascular Surgeon, UK GMC num. 7418507
Phone: +39 3356791027
Luxury Cosmetic & Vein Care Centre is based in the North West of Italy:
14 Corso Galileo Ferraris, 10121, TORINO
Enjoy your walk-in, walk-out, office-based varicose veins removal.