Varicose veins are unsightly, often painful, and major confidence drainers. They are also surprisingly common- up to 30% of the population will suffer from the condition at some point in their lives. So what can be done?
Well, the good news is quite a lot, actually.
Up until about ten years ago, options were limited. For almost a century procedure was the same, with high levels of accidental nerve damage and long recovery times. But not anymore.
Advances in technology mean there are a plethora of options available for the treatment of varicose veins, and all of them are ‘minimally invasive’- that is, they are done under local anesthetic, just like anything executed at the dentist.
Endovenous Laser- EVLT- is when a thin laser fiber is passed up the main faculty vein in the leg, with laser energy closing the leaky vein by burning it. EVLT is executed with the patient fully awake, and though is not completely painless is markedly less painful than messier traditional procedures. Radiofrequency ablation is similar to EVLT but uses electrical energy over laser energy to seal the leg vein.
With EVLT and the radiofrequency recurrence rate is incredibly low, and up to 85% of vein patients are suitable. Exceptions are usually patients with recurrent veins from previous ‘high tie and strip’ operations, women who have leaking veins from the pelvis, and leg veins that need filling after pregnancy.
For them, sclerotherapy is a good alternative. Sclerotherapy uses sclerosant to seal veins by creating a chemical burn on the inside of the vein. Sclerotherapy has been used for decades to treat veins, but new developments mean that the drug is now used as a foam, rather than liquid, and so can access veins that lasers can’t- meaning more patents are eligible- especially those who have ‘twisty’ veins from recurrences after the traditional ‘high tie and strip’.
Sclerotherapy is performed without painful injections, but after the fact patients are required to wear compression bandaging for longer than with lasering. The recurrence rate is higher after sclerotherapy, too, with ‘phlebitis’– vein inflammation and tenderness- possible, as well as leg discoloration that can persist for some weeks after the operation.
New treatments are being developed all the time, with the emergence of Clarivein combining sclerotherapy with a mechanical device that irritates the vein and potentiates the action of the drug. It’s almost completely painless. The use of steam as a method of closing the vein is also being investigated.
But the key test for any new development is recurrence rate- if veins come back, how quickly, and if further treatment in the years after initial surgery is needed. We know that the recurrence rate is high for traditional stripping and foam sclerotherapy, and low for the lasering and radiofrequency, but for newer techniques like Clarivein and glue, only time will tell.