What are varicose veins?
Varicose veins are swollen, twisted and unsightly veins (usually on the legs) that look lumpy and bluish through the skin. They happen when the valves in the veins become weak or break, allowing blood to collect in the veins just under the skin instead of being carried up to the heart. If left untreated, the poor circulation associated with varicose veins can lead to skin problems, such as eczema and ulcers, and they may bleed heavily if a prominent vein is injured.
Varicose veins do not tend to get better without treatment, and usually get worse with time. There are a number of options for treating varicose veins – some of them are described below.
Surgical removal
The most effective treatment for many varicose veins is to have them surgically removed. Varicose veins are usually removed under general anaesthesia, which means you will be asleep during the procedure.
Varicose vein surgery is routinely done as a day-case. However, you may need to stay in hospital overnight, particularly if you are having varicose vein surgery on both legs.
The exact method used to remove varicose veins can vary. A commonly performed technique, called ligation and stripping, involves tying off and removing the main vein affected in your leg.
Two small cuts (about 5cm long) are made, one in the groin at the top of the main vein affected and one near your knee or lower down near your ankle. The top end of the vein near your groin is tied to stop blood flowing through it. Then a flexible wire attached to a special tool at one end is passed through the vein. The wire, along with the vein, is carefully pulled out of the leg through the lower cut. Sometimes the vein is tied off but not removed. Your surgeon will usually also make several tiny cuts (about 5mm long) on your leg to remove smaller veins.
The cut in the groin is usually closed with stitches, and any small cuts on your leg are sealed with fabric strips. Your legs will then be tightly bandaged. After surgery, blood can still flow up your legs because the deeper network of veins is left untouched.
The procedure usually takes one to two hours, depending on the exact type of operation you are having and whether one or both legs are being treated.
After surgery, your legs will be sore and bruised and the wounds may bleed a little. These side-effects should settle within a week or two. Scarring will usually fade with time, but won’t disappear completely.
Ultrasound guided foam sclerotherapy
Ultrasound guided foam sclerotherapy is a new non-surgical option for treating varicose veins. The procedure involves injecting foam into the affected veins. The aim is to inject and destroy the main surface vein which is feeding the varicose vein. This is usually either the long saphenous vein on the inside of your thigh or the short saphenous vein on the back of your calf.
Usually only one leg is treated per appointment and you may require more than one treatment. Foam sclerotherapy is performed as an out-patient procedure under a local anaesthetic.
While you are standing up, your consultant will mark the varicose veins with a pen. The main veins to be injected will be then mapped using an ultrasound machine. You will then lie down on a couch and your consultant will inject a small amount of local anaesthetic to the treatment area.
Once the anaesthetic has taken affect, your consultant will insert one or more fine plastic tubes into the affected veins. The number of tubes and where they are placed will depend on your individual pattern of varicose veins.
The leg being treated is then raised to empty all the surface veins. The foam is prepared and injected through the fine tubes into the veins. This should not be painful as the area will be numb after the local anaesthetic.
Your consultant will use ultrasound imaging to check that all the veins have been filled with foam. After the treatment, your leg will be bandaged and fitted into an elasticated compression stocking.
EVLT™
Endovenous Laser Treatment (EVLT™) is another non-surgical option for treating varicose veins. It involves passing a probe into a vein to heat it up and seal it from within.
It can usually be performed under local anaesthetic and takes between 30-45 minutes per leg. It is performed as an out-patient or day-case procedure, with no overnight stay in hospital. 60 to 70 percent of patients who have not had previous varicose vein surgery are suitable for EVLT™. After a previous varicose vein operation, EVLT™ is possible in 20 to 30 percent of cases.
Your consultant will use an ultrasound machine to mark the end of the vein in the groin and the best place to insert the probe at the knee (or below). A small incision (cut) is made and a fine tube placed inside the vein. A laser probe is passed up the tube within the vein, and following an injection of local anaesthetic, is then slowly withdrawn while energy is applied in short bursts. These short bursts of energy act to seal the vein.
Once the probe and tube have been removed, the incision will be closed by stitches and your leg will be bandaged and fitted into an elisticated compression stocking.
After both foam sclerotherapy and EVLT you should continue with your usual activities and stay active – your consultant will provide you with further advice.
Your consultant will discuss with you the benefits of having your varicose veins treated, which procedure is most suitable for you and also explain any alternatives to the procedures included in this leaflet.
Varicose vein treatment is commonly performed and generally safe. However, all surgical and medical procedures carry risks as well as benefits. You should ask your consultant how any risks to apply to you.
To find out more about having varicose vein treatment in a Spire Healthcare hospital, please call our treatment enquiry team on 0800 434 6600.
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