London: Varicose veins affect one in three people at some stage of their lives. They occur as a result of blood not flowing properly through the legs.
Normally, valves in the vein keep blood moving toward the heart. With varicose veins, the valves do not function properly, allowing blood to remain in the vein. Blood starts to pool, causing the vein to enlarge.
Varicose veins can form with age, though being pregnant or overweight are risk factors, as these place increased pressure on the veins. Some people will live with them if the pain isn’t bad, but the condition can cause complications including eczema, thrombophlebitis — inflammation in the veins — and ulcers (when fluid leaks out of the varicose vein into the surrounding tissue).
One thing is clear, though: this is a condition which will not heal itself. There are several different treatments, but experts agree it’s important to find the right method for you because there are different types of varicose vein.
“There are lots of ways for sorting out problem veins — each has its pros and cons,” says Eddie Chaloner, vascular surgeon at Lewisham Hospital in South-East London.
“The best surgeons are the ones who can do several or all of the operations rather than just pushing one technique over the others — I think it is similar to having a full golf bag of clubs and being able to select the correct club for the correct shot.
“Different types of varicose veins respond better to different treatment. There’s no one-size-fits-all solution.”
So, what are the options for tackling varicose veins?
Leg lasers
Sometimes called the Star Wars technique, local anaesthetic is injected along the length of the offending vein and a very thin catheter is inserted into it, through which laser energy is sent.
The technique, called endovenous laser ablation, uses heat to blast the vein wall, destroying it. The vein then disintegrates over the next six months, though this won’t initially be visible to the patient. The body can survive without this vein: blood is simply rerouted through other veins.
As with all treatments, patients are advised to wear compression stockings for at least a couple of weeks, as these can help the blood in your veins to flow up towards your heart. The stockings may also relieve swelling and aching in your legs.
Advantages: Good for straight, small veins, as they make it easy for the laser to pass through. Takes less than one hour, and varicose veins recur in less than five per cent of cases.
Disadvantages: Not suitable for big twisted veins, as it’s harder for the laser to pass through, says vascular surgeon John Scurr, of Lister Hospital. It also requires around ten quite painful injections of anaesthetic into the leg and there can be several days of discomfort after surgery.
There is also the chance of the laser burning little holes in the veins, which can cause bleeding and pain, adds Matthew Waltham, a vascular surgeon at Guy’s and St Thomas’ Hospital in London.
Foam fillers
Here, a needle is placed in the vein, which is then filled up with a foamy detergent that acts like a chemical burn, dissolving the vein lining.
The procedure, called foam sclerotherapy, takes around 30 minutes per treatment — several sessions may be needed depending on the number of veins being treated.
Recovery time is a few days, and stockings need to be worn for at least two weeks to press the sides of the burnt vein together to make sure it remains blocked.
Advantages: Very good for small varicose veins — on larger ones it can cause phlebitis (inflammation around the vein) and discomfort. No pain relief is needed during the procedure.
Disadvantages: Relatively high recurrence rate compared to laser or radiofrequency, says Chaloner, but it is easy to repeat. Patients can often get brown marks along the track of the vein caused by blood leaking — these remain for a few months.
“There have been some reported cases of transient mini-strokes after treatment,” says Chaloner. “One theory is these may be triggered by bubbles from the foam travelling up to the brain. The bubbles come from the air in the foaming detergent and these can get injected into the vein.
“Specialists are arguing the issue. Some say because mini-strokes are rare and only last a few moments, there’s no significance or risk.’
Blast with electricity
This method uses heat from a radiofrequency electric current to destroy the veins. With local anaesthetic, a thin catheter is inserted into the vein, then radiofrequency current is used to collapse the vein walls. The technique, called radio-frequency ablation, is very similar to laser in terms of application, though not as successful. Stockings usually need to be worn for ten to 14 days, as these hold the vein area in place, making it more comfortable for the patient.
Advantages: This targets the vein more accurately than laser treatment, says Scurr. This means less chance of burning the tissues around the vein and so less risk of scarring and nerve damage, and slightly less pain. It’s good for early varicose veins rather than bulging ones on the lower part of the leg.
Disadvantages: Slightly higher failure rate than endovenous laser ablation but still more than 90 per cent successful, according to Chaloner.
Vein stripping
This is performed under a general anaesthetic. A four to six centimetre incision is made along the skin crease of the groin to expose the vein. The vein is then tied to seal off the blood and a hook-like instrument is used to remove the vein in sections through a small cut just below the knee. The wounds are then closed with dissolvable stitches or plasters and the leg bandaged. Surgery takes about an hour for each leg.
Advantages: Most effective way to treat large, lumpy veins because the surface area is too large for the thin light of a laser to tackle all parts of the vein. Also good for patients with needle phobia.
Disadvantages: There is nearly always bruising, which can be lumpy, painful and can last up to six weeks. There is also the risks associated with general anaesthetic, such as breathing problems, and an infection in an open wound.
Small nerves that lie next to the varicose veins can be injured during the surgery, causing numbness in the leg after the surgery in about one in five patients, although this often fades in time.
The groin cut itself can lead to recurrence because this promotes the growth of new blood vessels, which then connect to new veins. After ten years, about one in three patients in the UK report their varicose veins to be as bad as before their original operation. Recovery from a general anaesthetic operation can take a couple of days.
Painless removal
This relatively new procedure, called Clarivein, doesn’t require injections (other than the initial prick when the catheter is inserted) and is completely painless — so no need for pain relief. A rotating catheter is inserted into the vein, together with a drug called STD or Fibro-Vein, which causes the vein to collapse. The rotating motion helps spread the drug throughout the vein.
Advantages: The big advantage is there is no injection into the thigh and it is painless to perform, explains Chaloner. Results after a year are slightly inferior to lasering, he adds. Takes a maximum of 20 minutes.
Disadvantages: Not suitable for large veins or large legs, as the tip of the instrument is around 8mm. So with veins larger than this diameter it can be difficult to get the catheter to reach all of the inside of the vein.
Vein glue
Consultants are looking for better ways to stitch veins together and this technique, called the Sapheon system, is a potential step forward, says Scurr. In a trial at Charing Cross Hospital, in London, a medical ‘superglue’ is injected into the vein — this seals the inner walls of the vein shut and the blood is then rerouted through healthier veins.
Advantages: Can be done in as little as 20 minutes. But the main breakthrough is patients don’t have to wear compression stockings afterwards. Some people find these inconvenient in terms of appearance; they can cause dry or itchy skin, and discomfort if the weather is warm.
“There is also no need for the large doses of local anaesthesia that other procedures require, and we think there is less post-operative pain and discomfort — if any,” says Chaloner.
Disadvantages: The treatment is at a very early stage of assessment, so we don’t know how effective it will be, says Scurr.
