Varicose Veins, Thread Veins, Spider Veins, PhotoDerm, Sclerotherapy, Surgery, Thrombosis
Varicose Veins, Thread Veins, Spider Veins, PhotoDerm, Sclerotherapy, Surgery, Thrombosis
Varicose Veins, Thread Veins, Spider Veins, PhotoDerm, Sclerotherapy, Surgery, Thrombosis
Introduction
What are They?
Investigation of Varicose Veins
Ultrasound Guided Foam Sclerotherapy
Surgical Treatment
Thread Veins & Sclerotherapy
Painful Veins
New Treatments
Traveller's Thrombosis
Photoderm Treatment
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New treatments for vein problems

Introduction

Recently several new techniques have been reported in the medical literature. The main aim of these is to avoid surgical removal of varicose veins. The idea is to avoid the need for general anaesthetic, incisions in the legs and a hospital operating theatre. Some of the methods summarised below only partially succeed in this aim.

Treatments for large varicose veins

VNUS closure

VNUS Closure (http://www.vnus.com) uses a wire passed along the vein from the knee or calf towards the groin to treat large varicose veins in the thigh. The progress of the wire is monitored using ultrasound imaging. When the wire is in position the end of the catheter is heated electrically and the vein is destroyed. Gradually the wire is removed from the leg until all of the diseased vein is destroyed.

Good points

Stripping of the vein is avoided and there is less discomfort and bruising after the operation.

Bad points

This technique involves heating the vein which is painful unless local anaesthetic is injected around the vein or the operation is done under general anaesthetic.
In the UK this procedure is usually done under general anaesthetic in an operating theatre.
The cost is considerably greater than for varicose vein surgery due to the extra expense of the equipment.
This method can only be used to treat the major superficial veins. Incisions must still be made in the leg to remove prominent varicose veins.
VNUS Closure is generally unsuitable for the treatment of recurrent varicose veins following previous surgery.
Thermal damage to nerves in the skin may occur due to the heating effects of the treatment.

Endo-venous laser treatment (EVLT) of varicose veins

This method is similar to the VNUS Closure technique, but this time a laser fibre is passed along the vein from the knee or calf towards the groin to treat large varicose veins in the thigh. The progress of the wire is monitored using ultrasound imaging. When the laser fibre is in position the laser is fired to heat the vein. The vein near the end of the laser fibre is destroyed. Gradually the wire is removed from the leg until all of the diseased vein is destroyed.

Good points

Stripping of the vein is avoided and there is less discomfort after the operation. There is less bruising than following surgery, but more than after the VNUS Closure method.

Bad points

This technique involves heating the vein which is painful unless local anaesthetic is injected around the vein or the operation is done under general anaesthetic.
In the UK this procedure is usually done under general anaesthetic in an operating theatre.
The cost is considerably greater than for varicose vein surgery due to the extra expense of the equipment and fibre.
This method can only be used to treat the major superficial veins. Incisions must still be made in the leg to remove prominent varicose veins.
EVLT is generally unsuitable for the treatment of recurrent varicose veins following previous surgery.
Thermal damage to nerves in the skin may occur due to the heating effects of the treatment.

Ultrasound guided foam sclerotherapy

This method is used as an alternative to surgery for large varicose veins. The main surface is vein is injected with a special foam under ultrasound guidance. The foam destroys the lining of the vein and a firm bandage is applied to the leg. This type of injection is suitable for treating the main surface veins as well as varicose veins. The procedure does not require an operating theatre and is usually carried out in a consulting room or treatment room. The injection causes only trivial discomfort.

Good points

Stripping of the vein is avoided and there is little or no discomfort after treatment.
There is less bruising than following surgery.
There is no need for general anaesthetic, incisions in the leg or an operating theatre.
Re-treatment for further varices is simple.
The cost of treatment is much less than for surgical treatment or for either VNUS Closure or Laser treatment.

Bad points

Stripping of the vein is avoided and there is little or no discomfort after treatment.
There is less bruising than following surgery.
There is no need for general anaesthetic, incisions in the leg or an operating theatre.
Re-treatment for further varices is simple.
Recurrent varicose veins following previous surgery are readily treated.
Most varicose veins can be managed in this way.
The cost of foam treatment is much less than for surgical treatment or for either VNUS Closure or Laser treatment.

Thread veins and small varicose veins

Creams and pills

A range of creams to rub on thread veins and pills to treat vein problems is advertised from a number of sources.

Good points

Some of the pills may reduce aching from varicose veins.

Bad points

No medication of any type removes varicose veins - whatever the suppliers may say!

Laser treatment for thread veins

This works well on the face and upper body. In the legs it is much less effective than injection treatment. The world’s leading vein experts do not use lasers in the management of thread veins on the legs.

Conclusions

  • There is no magic treatment for varicose veins!
  • Surgical treatment is an established, effective treatment for large varicose veins.
  • Microsclerotherapy is the best available treatment for thread veins and small varices.
  • VNUS Closure and Laser Treatment are alternatives for large varicose veins. These methods reduce the extent of incisions made in the legs as well as post-operative bruising. They are more expensive than surgical treatment.
  • Ultrasound guided foam sclerotherapy is useful in patients who wish to avoid surgery altogether. The final outcome will take a little longer to achieve but admission to hospital and general anaesthesia are not needed. This is very inexpensive compared to surgery.

Several of the new methods are available at our centres. Please ask for details.

 
 
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Arteries bring blood from the heart to the extremities. Veins contain one way valves and channel blood back to the heart. When there is obstruction of veins, or when prolonged pressure is placed on the veins, the valves stretch and no longer close properly. This allows blood to travel back down the veins towards the feet. The veins in the legs that are near to the surface of the skin enlarge and result in what is commonly called varicose veins. These can range from minor dilatations to large bunch of grape-like structures in the calf. Very small purple or blue veins in the skin of the legs are called "thread veins" or "spider veins" or dermal flares and often occur alongside large varicose veins. Some people are only affected by dermal flares. Both types of varicose veins are probably caused by the same factors. Varicose veins is a slowly progressive disease which if left untreated can lead to marked skin change damage or ulceration near the ankle. Why do varicose veins arise? Varicose Veins, Thread Veins, Spider Veins, PhotoDerm, Sclerotherapy, Surgery, Thrombosis Heredity is important in the development of varicose veins, thread veins and spider veins. Up to 20% of the adult population have varicose veins and experience discomfort as a result. Many people know of other family members with the same problem. A recent study showed that where both parents had varicose veins there was an 80% chance of their children developing varices. Environmental factors also play a large part in the development of varicosities, for example, prolonged standing - especially for workers such as nurses, sales assistants, flight attendants, waitresses and teachers, for example. Diet may also be a factor, and our Western diet with high content of fat and refined sugar with low fiber content may contribute to the development of varicose veins, spider veins and thread veins. Varicose veins may also become more frequent with advancing age, but may appear at any time of life and small varices are sometimes seen in school children. Although all factors such as puberty, pregnancy and the menopause also influence the course of the disease. As many as 70 - 80% of pregnant women develop varicose veins during the first trimester. Pregnancy causes an increase in hormone levels and blood volume which in turn causes veins to enlarge. Later in pregnancy, the enlarge uterus causes increased pressure on the veins in the pelvis. Approximately 60 - 70% of varicose veins due to pregnancy will disappear within a few months of delivery. Little research has been done to investigate the role of the pill and hormone replacement therapy (HRT) in the development of varicose veins. These probably have no influence on them. What are the symptoms Treatment of varicose veins and thread veins by injections sclerotherapy PhotoDerm and surgery Varicose veins may cause feelings of fatigue, heaviness, aching, burning, throbbing, itching and cramps in the legs. These symptoms are often accompanied by swelling of the ankle, which frequently appears after long hours of standing. Some people are very troubled by the aching that varicose veins produce. Even small dermal flares can result in severe aching which prevents standing for any length of time. What can I do to prevent them? Treatment of varicose veins and thread veins by injections sclerotherapy PhotoDerm and surgery Many of the things that seem to cause varicose veins are difficult to avoid such as a family history of Western way of life. Where possible standing still for long periods should be avoided. Walking is much better for the veins and helps the blood return to the heart from the legs. In occupations that require extended periods of standing then a few steps should be taken at regular short intervals to help circulation. Wearing support stockings may also reduce the likelihood of varicose veins. No creams or drugs are available to prevent varicose veins. The earlier varicose veins and dermal flares are treated the better the long term and cosmetic outcome.