Varicose veins are a common problem in the general population. About 30% of people will suffer with varicose veins in some form during their lifetimes. Symptoms can range from the relatively mild cosmetic dissatisfaction through problems with aching and soreness and swelling of the legs at the end of the day through to the more serious issues with skin damage at the ankle and eventual venous ulceration.
However a lot of patients tend not to seek treatment for their veins until quite late in the day when the veins are really bad. One of the reasons for this is that a lot of patients still think that surgeons treat varicose veins with the ‘stripping operation’ that their parents may have had. Many people tell us that they saw their Mum or Dad needed to stay in hospital for some days after surgery and were then in pain for several weeks after the stripping operation and that they were afraid the same thing might happen to them!
Fortunately treatment for varicose veins has moved on massively in the last 10 years. The old style ‘High tie and strip’ operation where the offending vein was literally ripped out of the leg using a plastic rod passed down the vein from a cut in the groin crease should now be a thing of the past as it has been superceded by more modern techniques. Sadly however, at the time of writing this, the stripping operation is still the commonest treatment for varicose veins carried out in most NHS hospitals.
The more modern treatments for varicose veins are ‘minimally invasive’, requiring only a tiny nick in the skin usually at or around the level of the knee through which a fine laser fibre or similar device is passed up the vein from the inside. The vein is then sealed from within the leg rather than stripped out of the leg. These newer treatments can be done completely under local anaesthetic with the patient fully awake and are a bit like going to the dentist – although patients who are really scared of needles can be sedated if necessary. Patients do not stay in hospital overnight and most treatment can be done on a walk in / walk out basis within 30 minutes in the treatment room.
Pain and discomfort are limited to a couple of days of taking painkillers and the majority of patients are back to all normal activities within a week or so of treatment. Serious complications are very few and far between and the incidence of problems such as injury to sensory nerves in the leg and wound infection is very low indeed – these problems were quite common after the ‘stripping procedure’.
In addition the recurrence rate of varicose veins is lower after the newer types of treatment than after the stripping operation – the high tie and strip was notorious for causing vein recurrence – up to 30% of patients would get their veins back again within 5 years of the stripping procedure – with the newer laser type treatments the recurrence rate is closer to 5% after 5 years.
Laser type treatments for varicose veins have now been in use for over 10 years and there is excellent follow up data to show that they are superior to the old style stripping operation in virtually every way.
Further advances in vein treatment include the latest Clarivein system which is one step on from the laser type procedures and can seal the vein from within without needing any significant injections in the leg – making it a virtually painless way of fixing varicose veins.
Other developments include the assessment of various types of tissue sealant to ‘glue’ the veins closed from within – although it should be stressed that these are at a very early stage of development and assessment at present and not in general use within medical practice in the UK
Other ‘non surgical’ treatments include the use of ‘foam sclerotherapy’ where the smaller veins in the leg can be sealed by use of a chemical foam injected into the leg by inserting a small needle into the vein which seals the vein up without needing to remove it physically from the leg. Finally the tiny ‘thread veins’ that are too small to be removed from the leg can be ‘tidied up’ by using a very fine needle to inject them and cause them to collapse – all of these injection treatments can be carried out in the consultation room rather than in an operating theatre.