There are number of treatment options for varicose veins. That is why it is important to see a specialist like Dr Mahadevan who personally performs all of them. Majority of patients are treated with thermal ablation (laser) of their veins. However, there are specific cases where other modalities like sclerotherapy and surgery are best suited. In some patients, a combination of treatments is required to give the best functional and cosmetic result. Dr Mahadevan will guide you the pros and cons of each option and develop a treatment plan to give you the best possible long-term results. The treatment options can be broadly divided into four categories. They are described below:
Thermal ablation
This technique uses heat to seal the affected leg vein shut. The two main devices used are laser (EVLT) and radiofrequency (RFA). They both generate heat from their respective sources to seal the vein on the inside. Using an ultrasound machine, a catheter is placed inside the vein. Local anaesthetic is administered along the length of the vein prior sealing it. The procedure and after care for both EVLT and RFA are near identical. They both have been effectively used to treat varicose veins for more than 20 years. The long-term results with thermal ablation are excellent and is the most used modality to treat varicose veins.
Surgical removal
Surgery to remove varicose veins is effective and well-established procedure. Being practiced for more than half a century it has large number of studies and literature to support it. Over the last 10 years, it has gone further refinement from lessons learnt using thermal ablation, to being much less invasive. Surgery is performed under general anaesthesia or spinal anaesthetic. Small incisions are made, and the leg veins physically removed. It is still remains the best method for large and tortuous veins. It can be performed as day procedure or overnight hospital stay.
Sclerotherapy
Sclerotherapy involves the injection of small amount sclerosant to damage the inside of the leg vein. Compression bandage or stockings is then applied for two weeks to seal the vein shut. The sclerosant used is a detergent (Sodium Tetradecyl Sulfate), in different strengths. It has been successfully used since the 1960s to treat varicose veins. The procedure is simple and usually takes less than one hour in total. It has a higher recurrence rate than thermal ablation and surgery, therefore is usually used as an adjunct to them.
Adhesive (Glue) treatment
This novel technique that uses an adhesive glue (Cyanoacrylate) to seal the leg vein shut. A small amount of local is injected and a catheter placed using ultrasound. Cyanoacrylate is then injected into the vein and compression applied with the ultrasound to seal the vein. It is better tolerated than the other treatments as it usually only involves one small needle. Post procedure you can go home and resume normal activities. The initial results show effective treatment compared with thermal ablation. Long term results are still pending as the other treatments have been used for more than 20 years.