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TRADITIONAL TREATMENTS

Although the latest minimal invasive procedures can be offered to most patients there will still be the occasional one who, given the choices, will opt for traditional treatment. Although we strongly advise against this, it can be arranged following consultation. We always accept that the final decision is the patient's. It is very important however to be presented with all the options with their risks and benefits. Sadly many patients are still only offered surgical stripping and not told about minimally invasive methods to remove their varicose veins.

Before looking at the different types of traditional treatment there are a number of simple, generally sensible, steps that you can take that may ease your symptoms or prevent them from getting worse. These include:

1. Try to maintain a healthy weight
2. Take regular exercise
3. Eat a balanced diet, including plenty of fibre to prevent constipation
4. Avoid long periods of sitting or standing
5. When resting, keep your feet up
6. Avoid very tight clothing around the waist and thighs

None of these however will make existing varicose veins disappear. The traditional treatments which have been used for the treatment of varicose veins include:

1. Support stockings
2. Injections
3. Surgery
4. 'Alternative treatments'

Support Stockings
Support stockings are elastic stockings designed to be worn all the waking day. They apply compression to the leg in a graduated way, i.e. greater at the ankle than the thigh, thus helping blood pass back up the leg. They must be fitted correctly to have any chance of helping. Although support stockings cannot make varicose veins disappear some patients do get relief from their symptoms whilst wearing them and are happy with this solution. Most patients however do not like the way they look or feel. Your legs can get hot and sweaty and can blister. Some patients are allergic to the latex. They can be difficult to put on especially for the elderly or infirm. There is little research about support stockings for varicose veins but that which does exist does not show much benefit, although in one study 1 in 4 people who tried support stockings before surgery decided to do without the surgery so presumably they must be doing some good!

Injections
The following description does not apply to foam sclerotherapy.

Injections of irritant chemicals into varicose veins to close them off has been used for many years and although not in vogue in the United Kingdom is still used extensively in Europe. Injections are quick and usually painless but do not work as effectively as surgery. Most people having injection treatment will need further treatment within 5 years. You have to wear support stockings or bandages for 2 weeks following each injection session and may need up to 3 sessions in succession.

Injections can have side effects: your skin can become discoloured and this can take a long time to recover. Inadvertent injection into arteries can lead to serious ulceration. Bruising is common but does not last long. Blood clots are common and can cause sore lumps but these can be dealt with fairly easily by squeezing them out through a small needle puncture like a zit. Some patients are allergic to the chemical but this is rarely serious. Despite, or perhaps, because of the fact that injections have been used for so long there has been little good research on their value. It has been shown that most people having injection therapy need another treatment within 5 years and that laser and RF are far more effective treatments with less recurrence.

Alternative Treatments
As would be expected for such a common condition there is a whole host of different alternative remedies proposed. These include Butchers broom (box holly, knee holly, pettigree, sweet broom) witch hazel, gotu kola, water therapy, flavanoids and a high fibre diet.

A high fibre diet is likely to be generally helpful to your health and may prevent you straining through constipation but it has not been proven to help varicose vein symptoms. There is no good evidence that any of the other treatments work and some may cause harm through allergies and side effects.

Surgery
Surgery is still the main stay of active treatment of varicose veins in the United Kingdom. In most parts of the country however it is not available to patients on the National Health Service unless they have obvious signs of skin changes or ulceration. Most surgery is undertaken under a general anaesthetic. The commonest operation involves a cut about 2.5 to 5 centimetres long in your groin at the top of your thigh and another cut about 1.5 cms long inside your knee or at your ankle. The major venous branches in the groin are tied off with sutures. The main surface vein running down the inside of your thigh is then stripped out with a special stripping tool. Many smaller cuts are also often made along the leg especially in the calf to pull out smaller varicose veins. Most such surgery is carried out as a day case. You will need to wear tight bandages and stockings for several weeks and may need injections to treat any residual veins not adequately dealt with by the surgery. You will need some time off work but this varies widely from patient to patient. Despite surgery for varicose veins being so common there is little good research to tell how well it works. It is fairly well accepted that surgery is the most effective traditional means of dealing with varicose veins and most patients are pleased with the results. However, there are problems which include: scars; bruising; pain; time of work; risk of DVT (deep venous thrombosis); nerve injury (patches of skin numbness); and recurrence,which is usually quoted as 10% but is almost certainly much higher.

MODERN TREATMENT >