Blood flow in varicose veins is usually in the wrong direction and eliminating diseased veins improves the circulation. Most blood returns through deep veins. All forms of modern treatment are well tolerated. The best treatment is selected from the clinical examination and the ultrasound study. This is influenced by where disease is located, how bad it is, age and medical condition. Treatment may be conservative with no intervention. If intervention is recommended then it consists of one or more of the following:
- Microsclerotherapy is highly effective for residual smaller surface veins.
- Ultrasound-guided sclerotherapy (UGS) is used as an outpatient procedure for small to medium sized refluxing saphenous veins or tributaries.
- Endovenous Laser Ablation (EVLA) is very well suited as an outpatient procedure for selected patients with large refluxing saphenous veins.
- Ambulatory phlebectomy refers to excision of large surface veins through small incisions under local anaesthetic as an outpatient.
- Surgical ligation or stripping is effective and is particularly indicated for extensive large veins. It requires inpatient treatment in hospital.
The results from treatment are very good. However,
- Treatment is not effective in every patient. Perfection cannot be guaranteed.
- Treatment is rarely completed in one or even two sessions. We are keen to finalise management as soon as possible but some perseverance may be required to control all veins.
- Recovery from any treatment is not immediate. There is usually persistent tenderness or lumpiness of the veins that can last for several weeks and bruising that may take months to fade. It will settle down.
- Pigmentation is a source of legitimate anxiety, for very occasionally it can persist although it continues to fade for up to two years. It is unpredictable and treatment is difficult. If this is a major cause for future concern, then you should seriously consider whether you should have any treatment. However, even the worst persisting pigmentation generally looks better than the original veins.
- It is important to understand that varicose veins are a chronic progressive disease. Although we can treat them, maintenance to control small veins and clinical and ultrasound surveillance for new varicose veins is almost always needed.
Pregnancy brings out veins but they tend to improve after delivery so that we do not intervene during pregnancy or lactation. For women, it is not necessary to wait to “finish your family”, for non-surgical treatment is easily repeated. It is no longer necessary to keep the vein for arterial bypass grafting for a weak, fibrosed, dilated vein is of no use as an arterial bypass and cardiac surgeons now prefer arm and chest wall arteries.
