Treatment of varicose veins without surgery

RF ablation uses a wire passed along the vein from the knee or calf towards the groin to treat large varicose veins in the thigh. The progress of the wire is monitored using ultrasound imaging. When the wire is in position the end of the catheter is heated electrically and the vein is destroyed. Gradually the wire is removed from the leg until all of the diseased veins are destroyed.

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  Advantages

  • Stripping of the vein is avoided and there is less discomfort and bruising after the operation
  • This treatment is usually done with local anaesthetic, so general anaesthesia is avoided

  Disadvantages

  • This technique involves heating the vein, which is painful, unless local anaesthetic is injected around the vein or the treatment is done under general anaesthetic
  • This method can only be used to treat the major superficial veins. Prominent varicose veins either need surgical treatment or can be managed by foam sclerotherapy
  • RF ablation is generally unsuitable for the treatment of recurrent varicose veins, following previous surgery
  • Due to the heating effects of the treatment, thermal damage to nerves in the skin may occur

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This method is similar to the RF ablation technique, but this time a laser fibre is passed along the vein from the knee or calf towards the groin to treat large varicose veins in the thigh. The progress of the wire is monitored using ultrasound imaging. When the laser fibre is in position the laser is fired to heat the vein. The vein near the end of the laser fibre is destroyed. Gradually the wire is removed from the leg until all of the diseased veins are destroyed.

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  Advantages

  • Stripping of the vein is avoided and there is much less discomfort after the operation. With modern laser systems, the results are similar to the RF ablation method
  • This treatment is usually done with local anaesthetic, so general anaesthesia is avoided

  Disadvantages

  • This technique involves heating the vein, which is painful unless local anaesthetic is injected around the vein or the treatment is done under general anaesthetic
  • The cost is greater than for foam sclerotherapy due to the extra expense of the equipment and fibre
  • This method can only be used to treat the major superficial veins. Prominent varicose veins either need surgical treatment or can be managed by foam sclerotherapy EVLA
  • EVLA is generally unsuitable for the treatment of recurrent varicose veins, following previous surgery
  • Thermal damage to nerves in the skin may occur due to the heating effects of the treatment

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This method is used as an alternative to surgery for large varicose veins. The main surface vein is injected with a special foam under ultrasound guidance. The foam destroys the lining of the vein and a firm bandage is applied to the leg. This type of injection is suitable for treating the main surface veins, as well as varicose veins. The procedure does not require an operating theatre and is usually carried out in a consultation or treatment room. The injection causes only trivial discomfort.

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  Advantages

  • Stripping of the vein is avoided and there is only minor discomfort and bruising after the treatment
  • There is less bruising than following surgery
  • There is no need for general anaesthetic, incisions in the leg or an operating theatre
  • Re-treatment for further varices is simple
  • The cost of treatment is much less than for surgical treatment or for either VNUS Closure or Laser treatment
  • A walk-in walk-out procedure that can be performed in a simple clinic room and only a very small amount of local anaesthetic is required
  • The outcome of this treatment in clinical trials is the same as for surgery, RF ablation and EVLA

  Disadvantages

  • A final treatment after six months may be necessary to complete the treatment.
  • Long-term results in very large veins are a little worse than the endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) when performed properly
   
  • A higher recanalisation rate is seen in veins that are larger than about 7 mmm in diameter
  • There is a risk of phlebitis (painful lumps in the legs in the healing period) and temporary brown bruising of the skin

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Patients are justifiably confused about what treatments really work for varicose veins, given the amount of information on the Internet about home treatments. Creams, gels. and even tablets are touted as the "easy" remedy for the aching, heaviness, and throbbing caused by varicose veins. Although they may help to reduce aching and the heaviness you can feel with venous reflux, once the one-way valves in the veins are damaged, no cream or pill can make them return to normal.

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  Medi compression stockings, leg elevation, and the elimination of the sources of back-flow that are causing the symptoms should be considered.

  Advantages

  • Some of the pills may help reduce the aching caused by varicose veins and the heaviness you can feel with venous reflux

  Disadvantages

  • No medication of any type removes varicose veins – whatever the suppliers may say!

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