All our treatments are minimally invasive and guided by accurate medical imaging, including colour duplex ultrasound.
SURGERY vs MINIMALLY INVASIVE TREATMENTS
The main difference in technique between our minimally invasive treatments and surgery is that in the latter the main superficial vein (great saphenous) is stripped out and removed altogether whereas in our methods the vein is totally destroyed ‘in-situ’ (where it lies). The outcome is the same but the destruction of a vein can be achieved very much more easily than its removal.
EVLA & RF ABLATION
We now use three main methods of vein destruction; Laser Ablation (EVLA), RF ablation (VNUS Closure®, and Olympus RFITT) and Foam Sclerotherapy. Although the medium and long term results of RF ablation (RFA) and laser ablation (EVLA) are identical there are some minor differences which mean that some patients are best suited to either one or the other. There is almost no bruising with RFA whereas with laser expect some for up to 2 weeks. There is almost no pain after the procedure whereas with laser some patients do experience some discomfort usually at 5 days but this is very rarely significant or bad enough to prevent all normal activities. The disadvantages of RFA are that it is not suitable for some patients especially those with tortuous or short veins and it costs more than laser. It is important for vein clinics to be able to provide both laser and RFA to optimize treatment to individual patients requirements.
Although some doctors treat large veins by injections (foam sclerotherapy) the results are not as effective or as durable as either EVLA or RFA and we do not recommend this for the majority of patients. We do use foam sclerotherapy for any residual varicosities remaining at follow-up after either the EVLA or RFA treatment. Some patients with recurrence of varicose veins after surgery may just need some foam sclerotherapy.
WHAT HAPPENS WHEN YOU ATTEND FOR TREATMENT
Both techniques, EVLA and RFA rely on accurate preop mapping of anatomy and blood flow by colour duplex ultrasound and use of ultrasound to guide the instruments during the procedure.
A full explanation of the treatment options including potential complications and success rates will have been given at your initial consultation. You will have been asked to sign to give your consent to the proposed treatment, you will be introduced to the nurse who will be at your side throughout the procedure, which will take place in a small treatment room. Music of your choice will be available. You can bring your own music on an MP3 player if you wish.
You lie down on a couch with head up slightly, the skin over your leg is cleaned with antiseptic solution and sterile drapes placed over your leg. A small injection of local anaesthesia will be given to numb the skin over the inside of your knee. A small sheath (thin walled plastic tube) is inserted into the vein to be destroyed usually just below the knee. Using an ultrasound image to guide the instruments the doctor then places a laser fibre or the RF catheter through the sheath and up to the vein in the groin. Local anaesthetic solution is then carefully injected around the vein along its whole length. The power is then turned on and the fibre or catheter slowly withdrawn. Once the length of the vein has been treated the sheath is withdrawn, a compression stocking will be applied and after a cup of tea you are allowed to leave, take a fifteen minute walk and get back to normal activities.
You will have to keep your stocking on for 1 week in total. You may take a bath after 3 days and then every day. Let us know if you want to order more than one stocking per leg. Many patients find a second pair of stockings helpful.
Over the next few weeks you may experience some tautness as the vein shrinks. You may also get some bruising but this is unlikely to be severe. You are asked to come back for assessment around 6 weeks following treatment. A check is made to see if the main vein is blocked as intended.
Do not be surprised if the varicose veins are still there at this stage. They are usually reduced in size but rarely will have entirely gone and not infrequently look just as large as they did before treatment. Don’t panic and think the treatment has not worked!
Any varicose veins remaining are usually symptomless but if you do feel they are still unsightly then, having dealt with the reflux, we can simply ablate these remaining with an injection of a foam sclerosant or microavulsions under local anaesthetic. You need to wear compression stockings again for 1 week following such treatment.
Very few complications have been described. Potential problems include deep vein thrombosis, deep vein trauma, skin burns, nerve injuries and laser eye injuries. In practice these are all very rare or have never yet been reported. See RISKS page for more details.
A problem common to all interventional radiological procedures is that occasionally it proves impossible to get access to the vein and the procedure needs to be cancelled and rescheduled. This is a nuisance but no lasting damage will have been done. As this is very unlikely in our hands (no such need in last 500 cases) you would not be charged for the repeat procedure. Clinics with little experience are quite likely to have to abandon the procedure and bring you back a second time.
TRLOP is a rather unfortunate acronym for Transluminal Occlusion of Perforators. It is a technique using RF (radiofrequency) or EVLA to cook shut troublesome perforator veins. We used to use RF but now usually use EVLA as it is more effective. Perforators connect the deep and surface veins to each other and when the valves in these break down high pressure can be transmitted to the skin and to varicose veins just under the skin. This is usually in the lower leg. They can cause residual problems after EVLA but usually the presence of these perforators can be detected before EVLA treatment and the need for additional treatment anticipated. Sometimes they only come to light after the initial treatment. Occasionally incompetent perforators can cause ulceration of the skin. Treatment of incompetent perforators with TRLOP can speed the healing of ulcers and can get rid of varicose veins being fed by them.
TRLOP is, like all our treatments, undertaken on an outpatient basis under local anaesthesia. There are few risks but there is a small chance of nerve damage, DVT (thrombosis) and skin burns.