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Varicose Veins Treatment

The below content has been medically reviewed and approved by Consultant Interventional Radiologist Dr. Mark Bratby (MBBS, MRCP, FRCR), Medical Director and Head of the Medical Advisory Committee at Veincentre.

Last reviewed 28th July 2021.

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Varicose Veins

Varicose veins are a medical problem that occurs because of an underlying cause that can be treated using modern, minimally invasive techniques. They are enlarged veins that have a twisty appearance, usually found in the legs and feet. They can be blue or purple in colour and can cause significant pain. Around 1 in 3 of us will get varicose veins in our lifetime and treatment on the NHS is becoming limited only to extreme cases. Sufferers are instead choosing to turn to private providers to treat their condition.

Healthy legs need healthy veins. We treat the cause, not just the symptoms. All our vein treatments are minimally invasive, meaning that there is no general anaesthetic and no surgery needed. You walk in and walk out within a couple of hours and no time off work is required.

Varicose Veins Treatment

Living with varicose veins is possible, although symptoms and appearance do worsen over time. Taking regular exercise, eating a good diet and giving up smoking might help manage the condition, but these lifestyle changes alone will not fix the underlying cause. To relieve any existing symptoms, you will need to treat the underlying cause, which is best achieved through a minimally invasive procedure.

The specific type of varicose veins treatment we’ll recommend to you will differ depending on the results of a duplex ultrasound scan (to determine if there is an underlying cause for your veins). From that scan, like a baby scan but on your legs, we can recommend the procedure that best suits your condition. If you have definite varicose veins, we would recommend endovenous laser ablation (EVLA) to fix the underlying cause, and foam sclerotherapy to treat the visible veins.

In some instances, we would recommend foam sclerotherapy as the primary treatment for varicose veins, but it is ordinarily used as a secondary treatment following EVLA, in most cases to treat smaller residual veins.

For many years, treatment for varicose veins would have been a surgical operation called stripping, to remove the problem vein. This surgery is an invasive procedure (involving incisions and stitches) that requires general anaesthetic and several weeks off work for rest and recovery.

Although many patients had good results from this form of varicose vein surgery, the recurrence rate was reported to be as high as 7 in 10 patients experiencing further problems.

NHS treatments are limited to patients with severe symptoms or leg ulceration, and although endovenous approaches are used, sometimes limited resources mean patients will be offered foam sclerotherapy only and/or compression bandages as treatment.

Treatment Type: Endovenous Laser Ablation (EVLA)

Endovenous refers to ‘inside the vein’, and ablation is a medical term meaning ‘to destroy’. Therefore, endovenous laser ablation (EVLA) is the procedure of destroying the affected veins, from the inside, with a laser. Under local anaesthetic, an ultrasound scan is used to guide the laser into place, which is then slowly pulled along the faulty valves, delivering heat to seal the vein. This is repeated on all of the veins that have been identified as causing your varicose veins. On average, you will be in and out of treatment in 2 hours.

EVLA is the gold-standard treatment for varicose veins, as recommended by NICE (the National Institute for Health and Care Excellence).

Treatment Type: Foam Sclerotherapy

Foam sclerotherapy is most commonly used as a secondary treatment to EVLA to treat the visible veins and improve the cosmetic appearance of the legs. For patients with smaller varicose veins, foam sclerotherapy may be the only treatment required.

It is carried out on an outpatient basis, and usually takes no more than 30-45 minutes, depending on how many veins need treating. Foam sclerotherapy uses a drug which destroys the lining of the vein walls, causing them to shrivel up and be absorbed naturally by your body.

Although some doctors treat large veins by foam sclerotherapy, the results are not as effective or as durable as EVLA, and we do not recommend this as a primary treatment for the majority of patients.

Treatment Type: Avulsions

Avulsions, often called Phlebectomies, are used to physically remove the visible varicose veins. They are an alternative treatment to Foam Sclerotherapy either alongside or following EVLA.

Avulsions involve tiny skin incisions and use a little crochet hook to grasp the surface veins and physically remove them. They are performed under local anaesthetic. The nicks in the skin require no stitches but are sealed with steristrips. Avulsions don’t treat the underlying cause of the vein problems.

Home Remedies

Living with varicose veins is possible, although symptoms and appearance are highly likely to worsen over time and can be debilitating to sufferers.

As would be expected for such a common condition, there are a whole host of different alternative remedies proposed. Unfortunately, there is no good evidence that any of the other treatments work, and some may cause harm through allergies and side effects. These include butcher’s broom (box holly, knee holly, pettigree, sweet broom), witch hazel, gotu kola, water therapy, flavonoids and a high-fibre diet.

Taking regular exercise, eating a good diet and giving up smoking might help manage the condition, but sadly these lifestyle changes alone will not reverse the effects of unhealthy valves in the affected veins.

To relieve any existing symptoms, you will need to treat the underlying cause, which is best achieved through a minimally invasive procedure. Wearing a compression stocking may help ease symptoms.

Varicose Veins Treatment at Veincentre

We adopted our treatment pathway on how to diagnose and treat all types of leg veins in 2003, and it is now firmly established and recognised by the National Institute of Health and Care Excellence (NICE). We have over a 99.5% success rate at fixing the underlying cause of varicose veins.

 

Stage 1 – Consultation

A veins consultation includes a Colour Duplex Ultrasound Scan, which is necessary to determine if you have an underlying cause of your vein problems. We will explain the results of the scan to you there and then, along with a tailored treatment plan that will be based on your preferences and desired outcome.

 

Stage 2 – Primary Treatment

In order to treat the source of your vein problems, and restore healthy blood flood to the legs, the most common primary treatment required is Endovenous Laser Ablation (EVLA).

For patients with minor varicose or thread veins, EVLA treatment may not needed and the primary treatment is likely to be Foam Sclerotherapy. Depending on the scan results, alternative treatments to EVLA may be available.

Stages 1 and 2 can be done in the same visit. This service is called See & Treat, if you are interested please read more about it here or ask our patient advisers for more information.

 

Stage 3 – Follow up – Cosmetic Treatment

Once the source of the problems has been fixed, the visible varicose veins (which branch off this source) may reduce in size. However, in order to achieve the desired cosmetic results, it is normal for further direct treatment to be needed. The vast majority of patients (over 99%) require treatment at follow-up.

The most common follow-up treatment required is Foam Sclerotherapy and Microsclerotherapy, but some patients with larger varicosities are best treated with Avulsions/ Phlebectomies.

The follow-up is usually around 6-8 weeks post EVLA.

 

Stage 4 – Cosmetic Finishing Touches

After the destruction of the source, the varicose veins visible on the outside of your legs (which branch off this source) may disappear, or get smaller, but it is normal for further direct treatment to these to be required.

This is normally undertaken using Foam Sclerotherapy and Microsclerotherapy but some patients are best treated with Phlebectomies/ Avulsions.

Around 10% of patients need to attend for further treatment after their initial follow-up. This does not indicate that the first session of injections has not worked; it is just that some patients require more than one treatment. If you do need more than one session there will be an additional fee for these. There is a safety limit as to how much of the foam chemical can be injected in one session, once the limit has been reached the clinician must stop injecting.

Varicose Vein Treatment Aftercare

Following any vein treatment, you will need to wear a surgical support stocking for a week; however, this should not restrict your movement although will prevent you from swimming.

We strongly encourage you to continue with your normal activities following treatment (unless your normal is sitting down all day or running a marathon). Exercise should be guided by how your legs feel – don’t push your body too far. Although the procedures are minimally invasive, your body is still in a period of recovery and is busy absorbing all the veins we’ve treated. We advise that you go on a walk for at least 20 minutes each day. The only exercises we universally restrict are horse riding and heavy weightlifting for 4 weeks post-treatment. Your consultant will advise if there is anything else, lifestyle-wise, that you may be best avoiding for a while.

You are not able to drive on the day of treatment, but you are fine to drive the next day. Long-haul flights (more than 4 hours) are restricted for 4 weeks post-treatment.

Post-treatment discomfort varies from patient to patient. The vast majority of our patients describe the procedure itself and the recovery period as uncomfortable or mildly painful, and any pain is managed effectively with over-the-counter painkillers. There is a small minority who suffer from worse pain than most, and a few patients have reported that they needed to take a day or two off work.

Varicose Vein Treatment Prices

We want our prices to be as clear possible, so we outline the total costs involved in the diagnosis and treatment of varicose veins if the primary treatment required is EVLA or foam sclerotherapy.

Our prices are upfront and fixed. We charge per leg, not per vein. There are no “from” prices and no hidden fees. Consultant fees and clinic fees are included in all of our prices. We promise that our prices will never inflate once you’ve attended a consultation. If you have medical insurance, please disregard our self-funding prices.

Treatment Risks

With all medical treatments it’s important to weigh up the benefits versus the risks. With that in mind, we have provided you with a full outline of the known vein treatment risks.

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