In most cases, varicose veins are a cosmetic issue that does not need treatment. However, if the veins affect the quality of your life by causing pain or any other form of discomfort, you may need treatment. Before the treatment, your physician may recommend specific self-care measures, including regular exercises and compression stockings, to determine if the condition can resolve independently.
There is no single varicose vein treatment that can be said to be the best. The ideal treatment for a particular case of varicose veins depends on various factors, including the severity of the condition and the vein from which the condition originates. For instance, while surgery may be the best option for large varicose veins, microsclerotherapy may be the ideal treatment for small varicose veins. The next section of this article explores various varicose vein treatment methods you can choose from depending on the factors above.
1. Endovenous Laser Ablation
In this treatment, your doctor uses a laser catheter to heat and destroy varicose veins under your skin. It is a minimally invasive treatment, and it usually takes place in an outpatient setting. Typically, this procedure is applied in treating large varicose veins in the legs. During this procedure, your doctor will do the following:
- Administer a local anaesthetic medication to numb your leg. You will not feel any pain during the treatment session.
- Make an incision into your skin near the knee.
- Insert a laser catheter into your body through the incision.
- Run the catheter to the varicose vein under ultrasound imaging guidance.
- Burn the varicose vein lining with laser heat. The heat will shrink and damage the vein.
- Pull the catheter from your body.
- Dress the wound to prevent infection and speed healing.
- It is a quick procedure that is usually completed within one hour.
- Since it is minimally invasive, there is not much pain after the procedure, and complications resulting from this procedure are rare.
- The chances of developing stasis ulcers after the procedure are minimal.
- The procedure is done under local anaesthesia, preventing you from the risks associated with general anaesthesia.
- The procedure involves mild bruising, which normally disappears in days.
- It may cause thigh numbness. This also resolves after a few days.
- You may experience a pulling sensation in your leg for up to a week.
- The procedure may result in deep vein thrombosis. However, this is a rare complication and can be prevented by wearing compression stockings or bandage. Walking after the procedure can also help to prevent deep vein thrombosis.
- Since the treatment involves incisions, it exposes you to infections.
- You may develop skin tenderness and redness that lasts up to a full week.
2. Ultrasound-guided Foam Sclerotherapy
This type of treatment is usually used to treat large varicose veins in cases where endovenous laser ablation fails to work. Doctors apply this technique in treating both varicose and prominent surface veins. It usually occurs in a treatment room or doctor’s office; hence, a theatre is unnecessary.
Your doctor will administer a local anaesthetic drug to numb the treatment site in this treatment. He will then inject special foam into your varicose vein under the guidance of an ultrasound imaging. The foam treats the vein by scarring and sealing it. As a result, the varicose vein will completely disappear, and the remaining healthy veins will function in the body.
- You can resume your normal daily duties almost immediately because the procedure involves no downtime.
- The procedure does not cause vein stripping.
- It is pain-free, and you may not experience discomfort after the procedure.
- Ultrasound-guided foam sclerotherapy is safe because it does not involve general anaesthesia or incisions. While incisions may result in infections, general anaesthesia may cause breathing problems and other complications.
- The treatment is relatively cheap.
- If you have had ultrasound-guided foam sclerotherapy, you can easily undergo further varicose vein treatments in future without any major complications.
- It involves minimal bruising that resolves in a few days.
- The doctor can treat several varicose veins in one session. This saves time.
- This treatment may not be suitable for patients previously suffering from deep vein thrombosis.
- Although a single treatment session may involve injecting several veins with the foam, you may need more than one session to complete your ultrasound-foam-guided procedure. This is time-consuming.
- The procedure may not be effective because cases of recurrent varicose veins have been reported. The good news about them is that they can easily be treated.
- It may destroy your skin by causing brown patches.
- You may experience vision problems during your recovery. However, this side effect normally improves on its own.
- You may experience pain in your lower back. Headaches and fainting are also possible.
- The blood in the adjacent veins may clot.
- This treatment may result in life-threatening complications, such as transient ischaemic attacks and stroke. However, these complications occur rarely.
A surgery to remove varicose veins is typically done in cases where laser ablation and ultrasound-guided foam sclerotherapy have failed to be effective. Although you can leave a hospital on the day of the procedure, your caregiver may advise you to stay there for a short while as a precaution. This technique may also involve more than one treatment session.
In most cases, the surgical removal of varicose veins involves ligation and stripping, and it is performed when a patient is unconscious: it involves general anaesthesia. You can be a candidate for ligation and stripping if:
- All other treatment techniques for varicose veins cannot work.
- Your varicose veins cause swelling and blood clots.
- Your varicose veins cause leg heaviness and pain.
- Varicose veins hinder proper blood circulation in your body.
- You develop sores on your skin due to extremely high pressure in the veins.
During ligation and stripping, the following will happen:
- You will receive either general anaesthesia or spinal anaesthesia. While general anaesthesia will make you unconscious, spinal anaesthesia will numb your entire lower body. Your surgeon may also prescribe sedatives to help your body relax.
- The surgeon will cut two or three incisions through your leg skin. The incisions are typically made near your varicose vein’s bottom, top, and middle.
- The surgeon will insert a flexible plastic wire into your body and thread the wire from the incision near the top of the varicose vein to the incision made at the bottom of the vein.
- Your surgeon will tie the wire to the vein and strip the vein from your body by pulling the wire through the incision made at the bottom of the vein.
- If there are any varicose veins near your skin surface, the surgeon will remove them through a procedure known as ambulatory phlebectomy.
- The surgeon will stitch the incisions and apply a bandage to complete the procedure.
After the procedure, your caregiver will advise you to wear a compression stocking for several days.
- The surgery does not affect the blood flow because your deep-lying veins will carry out the functions of the stripped varicose veins.
- It works in cases where other treatments are ineffective.
- You may bleed severely because of the incisions.
- You may experience anaesthesia complications.
- You may experience pain after the procedure. Your doctor may recommend using painkiller medications for relief.
- You may be unable to resume your daily activities immediately because the procedure involves a downtime of up to several weeks. However, this may depend on the nature of your work and your health condition. You can still perform light duties after a few days.
- Since the procedure involves incisions, you may develop infections. This will prolong your healing.
- Scar formation at the surgery site is highly possible.
- In rare cases, ligation and stripping may result in nerve damage near the surgery site.
- Some patients develop deep vein thrombosis, a condition resulting from forming a blood clot in a deep-lying vein.
4. Radiofrequency Ablation
This is a treatment procedure in which varicose veins are destroyed using radiofrequency energy. During the process, your physician will first numb the area that needs treatment to ensure you don’t feel any pain during the treatment session. He will make an incision slightly below or above your knee and insert a catheter into your skin through the incision. The catheter will be directed into the varicose vein under ultrasound imaging guidance.
The doctor will insert a probe with radiofrequency heat into the catheter. The heat will destroy and collapse the lining of the varicose vein, causing the vein to seal. The blood that enters the varicose vein will enter the adjacent healthy veins to ensure that your blood circulation continues uninterrupted.
- It is a quick and pain-free procedure.
- It is minimally invasive.
- The procedure does not involve downtime; hence, you can return to your normal routine immediately after treatment.
- The procedure may result in temporary thigh numbness.
- Since it involves incisions, there are chances of infection.
- Anaesthesia complications may occur
5. Transilluminated Powered Phlebectomy
This minimally invasive treatment is typically applied as an alternative to ambulatory phlebectomy. In this procedure, your surgeon removes a varicose vein using an endoscopic transilluminator, a special light. The procedure does not require general anaesthesia; hence, it is safe.
During the procedure, the doctor will do the following:
- Use a surgical marker to map the site that needs treatment.
- Clean the site with an antiseptic cleaner to prevent a possible infection.
- Inject the marked area with a local anaesthetic. The injection is important because it prevents pain and expands the veins for easy access. It also prevents bleeding after the procedure. You may need a sedative to help you remain calm during the treatment.
- Make two incisions in your leg. To see your veins, the doctor will insert the endoscopic transilluminator into one of the incisions, which acts as a light source.
- Insert a tube fitted with a blade into the second incision.
- Pieces your varicose vein by turning on the suction device. The device will suck the pieces into the tube.
- Remove the tube and light source from your body.
- Close the cuts with stitches.
- Dress the wounds to speed up healing.
After the procedure, you must wear a compression stocking for a few weeks. Although you can walk around immediately after the procedure, too much movement is discouraged. Heavy lifting and pulling tasks should be avoided for a few weeks.
- You will recover from transilluminated powered phlebectomy faster than from surgery.
- The procedure involves minimal complications and side effects.
- The procedure may cause bruising.
- You may also suffer from an infection due to the cuts.
- Temporary leg numbness and tingling may occur.
Since there is no single best varicose vein treatment method, it is essential to discuss with your vascular surgeon about your health condition before selecting a treatment that suits your case. You may also need to discuss with your doctor the pros and cons of each treatment.
- Treatment of Varicose Veins Without Surgery
- Recovery After Varicose Vein Treatments
- Can Varicose Veins Go Away On Their Own?
- NICE Guidelines on the Diagnosis and Managemnet of Varicose Veins
- Minimally Invasive Treatments for Varicose Veins