Varicose Vein Treatments
Surgical treatment ligation and stripping
Your surgeon makes an incision in the groin, or behind the knee,
at the top of the main affected vein. This vein is tied off
(ligation) and then carefully removed (stripping). Individual
varicose veins are removed using small incisions along the leg. You
may sometimes need to stay in hospital overnight after ligation and
stripping. Your legs will be bandaged and you will need to wear
elastic stockings for three weeks. You will also need to plan time
off work, usually one or two weeks and avoid strenuous exercise for
several days, although plenty of walking is good for you. You
should refrain from driving until you are confident that you can
perform an emergency stop without discomfort (this will probably be
about 1 week).
A guide to general care and procedures
The main disadvantages of conventional surgery for varicose
veins have been the need for hospital admission, general
anaesthesia and the extent of bruising and discomfort post
operatively requiring time off work as well as restricted
activities. Although considerable efforts have been made to refine
surgical as well as anaesthetic techniques to increase the
proportion of cases performed in the day unit, nevertheless most
surgeons still recommend at least 1-2 weeks off work.
New techniques
New techniques have been developed to treat major incompetent
superficial venous trunks (long or short saphenous vein). These
fall broadly into three categories. The first, (EVLA) uses a laser
fibre fed up the main saphenous vein to destroy the inner lining of
the vein. The second, (The VNUS Closure™ Procedure) uses radio
frequency energy to achieve a similar objective. The third is
rather different and involves development of conventional injection
treatment (ultrasound guided foam sclerotherapy).
EVLA/The VNUS Closure™ Procedure
These procedures close the thigh vein without stripping from the
body. No groin incision is needed and the operation can be
performed under local anaesthetic. A laser (EVLA) or radiofrequency
fibre (The VNUS Closure™ Procedure) is passed along the abnormal
vein under ultrasound guidance and then heated to destroy the
vein.
What are the advantages?
- No scarring
- No incision in the groin
- Less bruising
- Faster recovery
- Can be done under local anaesthetic
- No overnight hospital stay needed
Endovenous laser ablation (EVLA) and The VNUS
Closure™ Procedure are both recognised by the
National Institute of Clinical Excellence (NICE) as
an effective treatment for varicose veins.
What are the drawbacks of EVLA/VNUS?
The adverse events have been relatively few. The vein has to be
isolated from surrounding tissue which involves injecting about
500 ccs of fluid which can be painful. Occasionally, patients
get some redness of the skin of the thigh. Immediately after the
operation the vein in the thigh is occasionally felt through the
skin like a tender ‘cord’. This settles over the course of a few
weeks as the inflammation subsides. Rarely, some patients get a
feeling of numbness or altered sensation over the vein. In some
cases neither EVLA nor VNUS treatments can be performed because of
the tortuosity of the vein preventing passage of the guide wire. In
most cases the prominent below knee veins require separate
treatment either by surgical removal or foam injection. The
treatment is useful for recurrent veins.
Foam Injection
Previously, injection therapy for large veins had limited
success but this has changed with the development of micro foam
injections. By converting the solutions normally used for injection
treatment into a foam the results have improved. Instead of mixing
with the blood the ‘foam’ displaces it allowing the undiluted
solution to gain direct contact with the vein wall. A bandage and
stocking is then applied to the leg and further review carried out
a week later. The treatment is not usually painful although
sometimes a little aching is felt for a few minutes. Some
discoloration may develop along the line of the treatment vein, but
this usually disappears during the next few months. Once you have
seen the surgeon you will have the opportunity to discuss all these
options. By offering all the available current therapies for
varicose veins we are able to tailor the treatment to best suit
your specific needs.
For more information please call:01372 221 444