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ASSESSING VARICOSE VEINS
Varicose veins can be treated at any stage and at any age, provided the appropriate assessments have been performed beforehand.
Consultation and clinical examination is therefore usually followed by Ultrasound Duplex Colour Scanning of the veins. This painless procedure objectively assesses the circulation in the legs and will pinpoint damaged or leaky valves, any blockages or sites of thrombosis.
Treatment can then be targeted to restore the state of the legs to normal, using the most appropriate techniques.
TREATING VARICOSE VEINS
The 3 main aims when treating varicose veins are:
TREATING THE CAUSE OF VARICOSE VEINS - LEAKY VALVES
This procedure normally requires some form of surgical intervention, often on a day case basis. Sealing the leak from a valve is usually performed as an open surgical technique, via a small incision placed in the skin crease of the groin or behind the knee. Rarely, other sites are involved which may require attention - these will have been highlighted by a Colour Duplex Scan and your venous surgeon will advise you on whether they will require treatment using keyhole surgery.
Leaky valves usually lead to damage to the associated superficial vein, the internal or external saphenous vein, which will then require treatment. This was traditionally performed by 'stripping', an effective but potentially traumatic procedure. Modern approaches to these veins include inversion stripping, pin stripping, radio-frequency ablation and endo-venous laser treatment. The latter two techniques are recent developments, and are still the subject of trials to determine their safety and long-term efficacy. All techniques have their benefits and particular complications - your venous surgeon should be able to advise you on the treatment best suited to you and to your veins.
TREATING VARICOSE VEINS - LUMPY OR BULGING VEINS
The main aim of management is to remove these unsightly veins and restore the leg to its normal appearance. In minor cases, this may be a primarily cosmetic procedure, but varices eventually may lead to local damage from pressure or stasis, and in extreme cases to phlebitis (clotting in the varicose vein, associated with a painful, reddened area of surrounding skin). Consequently, most surgeons recommend removal of any varicose veins at the same time as treating the underlying cause. Treatment takes place in one sitting and does not require multiple attendances.
A safe, tested cosmetic procedure for the removal of superficial varicose veins is by Multiple Cosmetic Phlebectomies. This procedure removes a vein via a tiny (1mm) incision placed over the vein, which is then removed using a keyhole technique. It requires no suturing, and may be performed under local anaesthetic (if a few veins are present) or sedation (if many veins require removal).
Previously, attempts at Sclerotherapy of varicose veins were hampered by a failure to eradicate the veins (the development of staining which could last for years , or in severe cases the development of an ulcer in the skin.
The advent of Foam Sclerotherapy has reduced these problems, and offers an attractive alternative to surgery in some cases. The technique allows greater volumes of chemical to be used without increasing the overall dosage. It is particularly useful in congenital venous conditions, but should not be confused with microsclerotherapy.