Traditional Treatment for Varicose Veins

Traditionally, varicose veins are treated by one of the following 3 methods.

1) Support Stockings

"Treating" varicose veins with support stockings is not really a treatment but is rather a way of trying to reduce the inflammation in the legs due to the vein pump failure. As the blood falls down the leg, by the stocking pressing the outside part of the leg, the inflammation is reduced. Therefore, the support stockings do not treat the veins but do reduce the severity and may well reduce the speed of deterioration of the varicose veins.

There are many different sorts of support stockings and it is important that, for venous disease, properly measured graduated pressure stockings are used. These are tightest at the foot and ankle and the compression reduces up the leg encouraging blood flow back towards the heart. It is essential when ordering these foot stockings, that a specialist examines the patient first to make sure that the arterial flow (circulation) is good enough to use the high levels of compression on the leg.

If somebody has poor circulation or low blood pressure in their legs, and a tight stocking is used, it is possible that gangrene of the foot or toes could be caused by the stocking reducing the blood low to critical levels.

All in all, although graduated pressure stockings are very useful for people who are too unfit for surgery (which is very rare), those awaiting surgery or used in people getting over varicose vein surgery. However, they have no role as a treatment of varicose veins in modern practice.

2) Sclerotherapy Injections

Traditionally, veins have been injected using a poison (called a "sclerosant") to kill the vein wall. This has been a very popular treatment in many countries and comes and goes in popularity.

Traditionally liquid sclerosant is used. Unfortunately this not only kills the vein wall, but also kills the blood cells causing clots in the veins themselves. To try and reduce the amount of blood in the veins and therefore clot formed by the sclerosant, several techniques are used. The leg can be elevated or tight bindings can be placed around the legs before the sclerosant is injected into the veins. Other techniques include injecting air, large volumes of the fluids to push the blood out of the way or, more recently, making the poison (or sclerosant) into a foam, like shaving foam.

Although there is a place for foam sclerotherapy in some smaller or winding veins and a place for liquid sclerotherapy in thread vein, treatment of major varicose veins with foam sclerotherapy or liquid therapy is very much a second rate solution compared to some of the new thermo-ablation techniques that are now available and will be described in this website.

Basically, veins smaller than 3 mm in diameter can be treated very well by sclerotherapy, particularly foam sclerotherapy. Those at about 4 mm and 5 mm diameter have poorer long term results and those larger than 5 mm in diameter tend to have very poor medium to long term results.

With new ultrasound techniques, new techniques of giving foam and compressing the veins afterwards, there certainly is a place for sclerotherapy in the treatment of varicose veins but this has to be mixed with the other techniques available for the bigger veins and venous trunks to ensure the best results.

3) Tying and Stripping of Veins Under General Anaesthetic

Traditional varicose vein surgery is performed under general anaesthetic - 80% of the operations are on the Great Saphenous Vein (GSV). This entails cutting into the groin, tying the vein at the top where it joins the major vein in the leg, called the femoral vein, and then passing a wire down the inside of the vein to strip it out, usually at the knee.

Approximately 20% of people need Small Saphenous Vein (GSV) surgery. In this situation, there is a cut made to the back of the knee, the vein is tied at this point where is goes into the popliteal vein (the main vein of the lower leg) and the vein is then stripped down to the Achilles tendon.

For the last hundred years, tying and stripping the veins has been regarded as the only way to treat veins and therefore has become thought of as the "gold standard".

However, recent research at The Whiteley Clinic has shown that, by damaging the patient this way, not only is it very painful and causes considerable bruising in the leg, but approximately a quarter of the patients grow the vein back to a greater or lesser extent within one year.

This is because the body doesn't understand that it has had surgery. As far as the body is concerned, it has had trauma. The blood in the tissue (bruising or haematoma) stimulates the ends of the veins to grow back again. As far as the body is concerned, it has received an injury such as a bite or a stabbing so naturally tries to grow back.

Therefore, not only is the old style of surgery painful, it also has very limited success.

Fortunately, in the late nineteen-nineties, new techniques were developed which can be controlled under local anaesthetic and, more recently, have been redeveloped to be performed under local anaesthetic to allow effective vein surgery with excellent long term results to be performed under local anaesthetic in the office or clinic setting.

If you, or someone you know, are concerned about Varicose Veins then please contact us for more information, or to book an appointment to see one our specialists.