Treatment of varicose veins

Sometimes varicose veins do not cause any symptoms and may not need treatment.

Reasons for treating them include:

• Symptoms e.g. acheing, pain, swelling
  
• Cosmesis: unsightliness
  
• Complications: bleeding, skin eczema, thrombophlebitis, skin pigmentation and ulceration

Veins may be treated conservatively using compression stockings. These can be either knee length or thigh length depending on the distribution of the veins. There are different types of compression stocking depending on the degree of compression required. These range from class I (lightest compression) to class III (strongest compression). For varicose veins class II compression is usually recommended. These stockings apply graduated compression i.e. the degree of compression is greatest at the ankle and least at the top.

Although compression stockings may improve symptoms from varicose veins, they do not treat the underlying cause or stop them from getting worse. Before using stockings the arterial circulation to the leg must be checked so it is best to consult your GP before using them.

This involves injecting a substance into the vein to damage the lining   causing them to block off. Liquid sclerotherapy is only effective for smaller veins and thread veins. For larger varicose veins the sclerotherapy agent is mixed with air and injected under ultrasound guidance into the affected veins (foam sclerotherapy). This technique can be performed under local anaesthetic as an outpatient. More...

This involves passing a fine laser fibre into the defective superficial vein trunk leading to the varicose veins. The laser heats up the vein wall causing it to block off. This can be done under local anaesthetic as a day case. More...

Radiofrequency Ablation

This involves using high frequency electrical current to damage the lining of the vein wall causing it to block off in a similar way to laser treatment. More...

This is the traditional way of treating varicose veins and with the longest follow up. The treatment usually involves tying off the leaky junction between the superficial and deep veins and stripping the main leaky superficial vein. Small incisions are made over the lumpy veins (varicosities) and vein hooks are used to remove them (phlebectomies). Surgery is usually done as a day case under general anaesthetic. More...

Whatever method is used to treat varicose veins recurrence is relatively common over a period of time. For surgery, which has the longest follow, up about 3 in 10 patients treated will have recurrence of their varicose veins in 10 years. Although newer treatments (foam sclerotherapy, laser and radiofrequency ablation) have promising short and medium term results, long term results are unknown since these treatments have not been around long enough.

A number of factors need to be taken into consideration before deciding which method to use to treat your varicose veins these include:

• Whether you have had operations of your varicose veins before
• Whether you have suffered phlebitis of your main vein trunks
• Fitness for surgery
• Anatomy of the veins (on ultrasound colour duplex)
• Patient choice. Newer treatments mean that there is much more choice of treatments available