Treatment of varicose veins
The possible treatment options include the following. The appropriate one for you will depend on the site of varicose veins, whether the junctions are leaking and whether you want surgical or non-surgical treatment. Your consultant will discuss these options with you.
 | Do nothing - especially if you have minor varicose veins which are not causing any symptoms and the tests show that the veins are working properly. Follow the general advice which all patients with venous problems should follow. |
| Compression stockings - these are tighter than the support stockings you can buy at the chemist. They will need to be prescribed. To be effective they have to be worn during the daytime forever. Many patients find they cannot tolerate them because of the constant squeeze they exert on the leg and also because they make the leg feel hot and itchy during the summer. The stockings are available in different classes, below or above knee, open or closed toes and in skin tone or black. The class of the stocking refers to the pressure it exerts at the ankle: |
Class 1 18 - 21 mm mercury
Class 2 25 - 32 mm mercury
Class 3 36 - 46 mm mercury
Class 4 59 + mm mercury
| Laser therapy - this is only for certain types of thread veins. It counts as cosmetic treatment and is not available on the NHS. Laser ablation of the long saphenous vein can be done under local anaesthetic - the leg is then bandaged for 2 weeks. This is known as EVLT (endovenous laser treatment). It is not widely available yet. |
| Injection sclerotherapy - this refers to the injection of a substance (sodium tetradecyl sulphate) into the varicose veins. It is poisonous to and destroys the inner lining of the veins and causes inflammation. Because the vein will be made empty by compression bandaging, the walls of the veins stick to each other. This obliterates the vein. This technique works best for veins below the knee and where one of the main junctions (sapheno-femoral and sapheno-popliteal) are not incompetent (leaky). There are potential complications from injection sclerotherapy. A number of treatments may be needed. Newer techniques involve the injection of foam into the varicose veins. |
| Varicose vein surgery - this involves dealing with the incompetent junction, the long or short saphenous vein and the varicosities you can see. The highlighted phrases will take you to sections with pictures. |
The sapheno-femoral junction is tied off by a small cut in the groin and the sapheno-popliteal junction is tied off by a small cut at the back of the knee. The long saphenous vein is stripped from the groin to just below the knee. The short saphenous vein can also be stripped but using a special technique called 'inversion stripping'. This way damage to the sural nerve (runs along with the short saphenous vein and supplies the skin at the back of the ankle and into the sole of the foot) is avoided. The varicosities can be pulled out (avulsed) through small stab incisions.
The wounds are then closed with dissolving stitches or sticking tape dressings (steristrips). The leg is wrapped in a sticky bandage which stays on for 1 week. Once the bandages are removed, the steristrips will soak off in the bath/shower. You will be supplied with some white stockings - these should be worn during the daytime for 4-6 weeks whilst the bruising settles.
| VNUS Closure - this is a new technique. You can see from the above description of open surgery that the sapheno-femoral junction needs to be tied and the long saphenous vein stripped. These are the most painful parts of the operation. They can be replaced with this technique which destroys the vein from the inside without a cut in the groin and without stripping the vein. At the moment the equipment used is expensive and, therefore, the technique is only available in the private sector. Click here for more information: VNUS closure. |
| Perforator surgery - this is controversial as not all surgeons believe that perforator problems are a major problem on their own. If the perforator veins do not work properly (i.e. allow blood to flow from deep to superficial veins) then the calf muscle pump cannot work effectively. For more details on perforator surgery (SEPS), click here. |