Non-surgical

Very basic advice should be given to everyone with venous disease prior to contemplating surgical treatment. This includes:

Exercise
Elevation of legs when resting
Loss of weight
Support stocking – these are readily available either on prescription or over the counter. Many chemists will measure your leg for you to ensure proper fitting. The stocking provides a gradient of pressure from ankle to knee (or higher) which facilitates the muscle pump and flow of blood up the leg. They may reduce the symptoms suffered, they may prevent further progression of venous disease and can occasionally improve the appearance of the ankle in more advanced cases.
 

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Surgical

Treatment of abnormal veins is dictated by their size and also the results of the duplex scan. Smaller dermal thread veins or those small varicose veins without a specific feeding vessel may be treated with injection sclerotherapy or laser. Newer techniques are currently under evaluation (foam injections).

More severe varicose veins often require surgery. The basic principle of surgery is to correct the major reflux within the superficial veins and then to remove the varicose veins. Conventional and more innovative techniques now exist to correct the underlying reflux but the visible varicose veins are removed through a series of small cuts (phlebectomies) within the leg. Reflux within the perforating veins can be corrected using telescopic surgery beneath the main fascia. New techniques for varicose vein surgery are now available and include radiofrequency ablation (VNUS) which appears to shorten the recovery time, reduce postoperative pain and reduce the incidence of wound infection.


Injection sclerotherapy

Smaller varicose veins can be treated effectively by injection treatment providing the reflux within the larger veins is not present or has been previously treated. Many patients undergoing superficial vein surgery may notice an improvement in their thread veins but this cannot be guaranteed and they may occasionally become worse. More commonly this technique is now used for cosmetic thread veins.

A sclerosant (chemical) is injected into the veins with very fine needles. The sclerosant irritates the lining of the wall causing it to become inflamed. The walls stick together and the vein is prevented from reopening.

The effects of treatment are not immediate. The inflammation can affect the immediate adjacent tissues leading to brown staining of the skin or ulceration. Allergies to the sclerosant are very rare but may limit the number of treatments that can be offered to a patient. The small veins can thrombose and this may rarely involve the larger veins. Generally speaking the veins are more prominent and inflamed for the first month after injection. The appearance then subsides over the course of the following 2-3 months but improvement can still be observed in some patients for up to 1 year after treatment.

Treatments last approximately 30 minutes with you lying on a couch. Most people tolerate the procedure with little discomfort. A stocking or support bandage is provided for the first 48 hours after treatment.

Other techniques are being used for the treatment of thread veins including laser and Veinwave. Evidence is still accumulating as to their overall efficacy and safety with injection therapy remaining the current gold standard.
 

Surgery

Conventional surgery has changed significantly over the last decade due to the specialisation of vascular surgeons and the increasing availability of the duplex scanner. Techniques have become more refined and this has improved early recovery and the long term risk of recurrence of the varicose veins.

Surgery will be guided by the duplex scan and may involve an operation in the groin with stripping of the long saphenous vein or an incision behind the knee and partial stripping of the short saphenous vein. Subfascial endoscopic perforator surgery (SEPS) may also be offered to correct abnormalities identified within the perforating veins.



Surgery may be performed as a day case or inpatient depending upon the severity of the venous disease and proposed length of surgery. A general anaesthetic is commonly used supplemented by local anaesthetic to make the wounds numb immediately after surgery. Your legs are wrapped in support stockings to help reduce postoperative swelling, bruising and thrombosis. A gentle return to normal activities is sensible over a 1 –2 week period. Complications are rare but include bruising, bleeding, infection, sensory loss/numbness of the skin and recurrence of the varicose veins. Recurrence can be reduced significantly by good surgical technique.
 

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