VARICOSE VEINS - modern non-surgical treatments
Abstract
Overview
Varicose veins affect about 40% of the population at some time.
Varicose veins can cause a range of possible symptoms or may be of cosmetic concern only.
Modern non surgical treatments are largely replacing the need for surgery.
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Varicose veins affect around 40% of the population at some point in their lives. The average age of presentation for treatment is 55 but varicose veins can present as early as puberty. Women tend to be over represented and this is because of hormonal differences and often because of the effects of pregnancy.
Most people presenting for treatment have a combination of concerns. For many, symptoms predominate, whilst for others it is the cosmetic appearance of the veins that bothers them.
Common symptoms with varicose veins are:
Aching, tired or heavy legs – particularly with prolonged sitting or standing. These symptoms tend to be worse at the end of the day and are often relieved by elevating the legs.
Swelling around the ankles.
Itchy skin which can lead to varicose eczema.
Restless legs and/or cramp.
Skin changes including a darkening of the skin, hard woody changes in the skin and varicose ulcers.
In the past surgery was the only viable option for managing varicose veins but because the operation is generally an unpleasant one to recover from, with a number of potential side effects, many people chose to put up with their varicose veins.
More recently however non-surgical options have made treatments relatively easy to cope with, do not involve general anaesthetic and have much lower side effects.
In the 90’s the technique of ultrasound guided sclerotherapy (UGS) was developed. This combined an injection technique called “sclerotherapy” with modern ultrasound technology to greatly enhance results. Prior to ultrasound only the visible parts of the varicose veins could be treated but this left the most important parts of the abnormal veins untreated. Ultrasound enabled a clear diagnosis of all the affected parts of the abnormal varicose veins to be seen, and also allowed controlled injections into the entire abnormal section of the veins in a very targeted manner. This greatly improved the success rate.
In 2001 a new technique called endovenous laser ablation (EVLA) was devised which allowed a special laser fibre to be inserted into the varicose vein under ultrasound control. The vein is surrounded with local anaesthetic to completely numb the treated area thus avoiding the need for general anaesthesia. The laser fibre is then turned on and slowly withdrawn from the vein while the laser fires. This causes instant cauterisation and closure of the varicose vein. This sophisticated but simple technique has revolutionised the treatment of varicose veins and has already proven to be the most effective way of treating varicose veins.
Frequently Asked Questions
Will the closure of the varicose veins put additional pressure on other veins?
In a normal leg without varicose veins there are two vein systems – the deep veins which are right inside the muscles of the leg and superficial veins which run just under the skin. The deep veins carry most of the blood out of the legs and are necessary for good venous circulation. The superficial veins only carry a small amount of blood out of the legs and we can easily do without them. When superficial veins become varicose veins it is because they have started to stretch because of a weakness in the vein wall. The dilated vein prevents the normal one way valves in the vein from working so that blood falls down the varicose vein instead of going up the leg. So even before treatment the varicose veins are causing blood to be redirected up the normal deep veins. By closing these varicose veins it prevents the blood falling down the abnormal veins and this restores a more normal venous circulation.
What is the procedure for a typical treatment for varicose veins?
Firstly you will complete an initial consultation to assess the condition of your veins, and to talk about the treatment options.
The next step is a diagnostic screening test known as Ultrasound Mapping. This gives a ‘road map’ of your veins, which is used in your treatment plan.
You then complete your individualised treatment plan (either EVLA or UGS or a combination of both), usually over a number of sessions.
Following your treatment, you will follow some simple guidelines for post operative care.
Will these treatments hurt?
UGS (injections) and EVLA (laser) are virtually painless procedures. The needle used for the injections is extremely fine making the injections much less painful than a blood test. The laser technique is completely without pain. In the recovery period the vein can become inflamed and this may cause some discomfort which typically settles with anti-inflammatories.
What do I need to do after treatment?
There are a number of post procedure requirements which apply to both UGS and EVLA. You will need to wear compression hosiery (surgical stocking) for three weeks. For one month you will need to walk for one hour a day, avoid straining or strenuous activities like the gym, and avoid international flights of greater than 4 hours. Apart from these restrictions you are free to lead a normal life and you will not need time off work apart from the time of the treatment itself.
What could go wrong?
Like all medical procedures there are possible side effects. The main one is DVT (deep vein thrombosis) but fortunately the incidence is less than 1% - that’s because you are not under a general anaesthetic for treatment and you are immediately able to walk because there is usually no pain post operatively.
Some blood gets trapped inside the treated vein and can take the body 3-4 months to reabsorb the blood. In the meantime it can feel a little hard and lumpy in the bigger parts of the varicose vein.
What is the cosmetic outcome?
By the end of a few months there should be no visible sign of the varicose vein. Occasionally there is some brown staining over the varicose vein caused by a pigment called haemosiderin released from the trapped blood. This is usually cleared by the body in 6-12 months. This problem affects around 15% of treated veins.
Why do varicose veins get worse during pregnancy?
There are a number of reasons. The hormonal changes during pregnancy can weaken the vein wall. There is a significant increase in blood volume during pregnancy which can stretch the veins. The weight of the womb can compress the main vein returning blood from the legs (inferior vena cava) and this puts pressure on the non return valves in the veins.
Is it necessary to treat varicose veins?
For most people it is not a medical necessity to treat the veins but because the modern techniques are so simple to perform with a very good safety record most people feel it is OK to treat varicose veins even if it is only for cosmetic reasons. If you have symptoms from your varicose veins then it makes sense to treat the cause of the symptoms as the natural progression of varicose veins is for them to deteriorate over time.
Are there other options for managing varicose veins?
Symptoms can be relieved by wearing below knee compression hosiery (Class 2). These work by providing graduated compression with the greatest compression at the ankle and the least compression toward the knee. This encourages venous flow out of the legs which in turn relieves the symptoms caused by congestion of blood.
There are no good studies to show that herbal remedies improve varicose veins and this is understandable as the problem is really a mechanical failure of non return valves caused by stretching of the veins. Instead of blood travelling up the normal veins they fall down the abnormal varicose veins through the faulty valves.
Is treatment covered by medical insurance?
Most medical insurers cover the treatment of symptomatic varicose veins when performed by qualified phlebologists (vein doctors). It is best to approach your medical insurer for prior approval.
For further information you can visit:
Non surgical treatment for varicose veins are generally performed by “phlebologists” who are doctors that specialise in vein treatments. To find a phlebologist near you visit www.phlebology.com.au.