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New treatments for vein problems

Removal of Varicose Veins without Surgery

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 - radiofrequency ablation

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 of varicose veins

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.

Help! All these treatments! Which is the one for me?

Mr Philip Coleridge Smith DM FRCS
Reader in Surgery, UCL Medical School, London .
Consultant Vascular Surgeon BVI Medical Director
The West London Vein Clinic: Tel 0870 609 2389

 

 

 
 
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