Varicose veins are dilated, twisted veins often found in the legs. They result from weakened vein walls and faulty valves. Blood pooling in the veins causes them to enlarge and become visible under the skin.
The harley street vascular
Endovenous procedures for varicose veins
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The harley street vascular
What are Endovenous Procedures?
Endovenous procedures represent a group of minimally invasive treatments designed to address varicose veins without the need for traditional surgery. These procedures are conducted within the veins (“endo” meaning inside and “venous” relating to the veins).
These treatments aim to close off the diseased varicose veins, thereby redirecting blood flow through healthier veins. This helps alleviate symptoms associated with varicose veins, such as pain, swelling, and fatigue and also improves the appearance of the legs.
Overview of Varicose Veins
What are Varicose Veins?
Symptoms
Seek treatment if you experience any of the following symptoms:
- Leg pain and swelling
- A heavy or aching sensation in the legs
- Itching around the vein
- Skin discolouration near the affected area
- Ulcers that form around the ankle
Causes
Varicose veins occur due to various causes:
- Genetics
- Age
- Standing or sitting for long periods of time
- Obesity
- Pregnancy
- Deep vein thrombosis or clots in the deeper veins
Indications for Endovenous Procedures
Endovenous procedures are recommended for people with varicose veins who experience symptoms impacting their quality of life or have complications arising from venous insufficiency.
- Symptomatic Varicose Veins
Presence of pain, aching, swelling, or cramps in the legs associated with varicose veins. - Venous Insufficiency
Poor blood flow in the veins, leading to skin changes such as discolouration, eczema, or ulcers. - Thrombophlebitis
Inflammation of the veins due to blood clots, causing pain and swelling in the affected area. - Cosmetic Concerns
For patients seeking relief from the visual appearance of varicose veins. - Failed Conservative Management
Patients who have not found relief through conservative measures such as compression stockings, lifestyle modifications, or medication.
Types of Endovenous Procedures
Two main types of endovenous procedures are available – thermal ablations like radiofrequency or laser that use heat to seal the diseased vein; and non-thermal ablations like Cyanoacrylate vein glue, Clarivein therapy or Foam sclerotherapy.
Radiofrequency Ablation (RFA)
Radiofrequency ablation involves delivering controlled radiofrequency energy to the vein wall through a catheter, causing the vein to heat, collapse, and seal shut, and is typically used to treat large varicose veins. It is our preferred thermal ablation technique over endovenous laser therapy (EVLT) since laser temperatures are very high at the tip (around 600 degC),and multiple trials have shown greater pain and bruising after EVLT.
Procedure Steps:
- Local or General Anaesthesia: The treatment area is numbed with local anaesthesia to minimise discomfort or a short general anaesthetic is needed.
- Vein Access: A small incision is made near the knee or lower leg, and a catheter is inserted into the vein under ultrasound guidance.
- Catheter Positioning: The catheter is advanced to the correct position within the vein, as confirmed by ultrasound.
- Radiofrequency Energy Application: The radiofrequency device is activated, delivering controlled energy that heats the vein, causing it to collapse and seal shut.
- Withdrawal of Catheter: As the catheter is slowly withdrawn, it continues to apply heat, ensuring the entire targeted segment is treated.
- Closure of Incision: The incision site is then closed with a small bandage, eliminating the need for sutures.
Foam Sclerotherapy
Foam sclerotherapy involves injecting a sclerosant foam into the varicose vein, causing the vein walls to stick together and the vein to close. This method is particularly effective for smaller veins and those that are difficult to treat with laser or radiofrequency.
Procedure Steps:
- Vein Mapping: Duplex ultrasound may be used to precisely identify and map the veins to be treated.
- Site Preparation: The skin over the vein is cleaned and sterilised to reduce the risk of infection.
- Local Anaesthesia: Depending on the patient’s comfort and the extent of the treatment, local anaesthesia may be applied.
- Foam Preparation: The sclerosing agent is mixed with air or another gas to create foam before the injection.
- Injection: The foam sclerosant is injected into the targeted vein under ultrasound guidance, ensuring precise delivery and effectiveness.
- Vein Closure: The foam causes the vein walls to stick together and collapse, stopping the blood flow in the diseased vein and leading to the eventual absorption of the vein by the body.
- Compression: After the injection, a compression bandage or stocking is applied to the treated area to facilitate vein closure and healing.
Cyanoacrylate Glue Closure
Cyanoacrylate glue closure uses medical adhesive to seal the varicose vein. The glue is delivered through a catheter into the vein, instantly sealing it shut, and redirecting blood flow to healthier veins.
Procedure Steps:
- Local Anaesthesia: Local anaesthesia is applied to the entry point to minimise discomfort.
- Vein Access: A small puncture is made in the skin to access the varicose vein.
- Catheter Insertion: A catheter or small tube is inserted into the vein under ultrasound guidance.
- Glue Application: Cyanoacrylate glue is precisely injected into the vein through the catheter. The glue instantly adheres to the vein walls, sealing the vein shut.
- Compression: After the glue is applied, gentle pressure is applied to the vein to ensure closure and promote adhesive bonding.
- Catheter Removal: Once the vein is sealed, the catheter is removed, and the puncture site is covered with a small bandage.
Clarivein therapy or Mechanical-chemical ablation (MOCA)
Clarivein ablation uses a thin rotating wire to cause vein spasm and scrape the internal lining of the vein, whilst simultaneously delivering a low dose of sclerosant into the vein. The method is particularly suitable for patients of very slim build with little subcutaneous fat.
Procedure Steps:
- Short General Anaesthesia
- Vein Access: A small puncture is made in the skin to access the varicose vein.
- Catheter Insertion: A catheter or small tube is inserted into the vein under ultrasound guidance.
- Glue Application: The sclerosant medication is precisely injected into the vein through the catheter. This causes the vein walls to stick together and collapse, stopping the blood flow in the diseased vein and leading to the eventual absorption of the vein by the body.
- Catheter Removal: Once the vein is sealed, the catheter is removed, and the puncture site is covered with a small bandage.
Preparing for an Endovenous Procedure
Effective planning leads to a successful endovenous procedure. This involves several preparatory steps to ensure patient safety and optimal outcomes.
Medical History Review
The patient’s medical history, including any underlying conditions, medications, and previous treatments for varicose veins, will be assessed.
Undergo a Detailed Venous Duplex Ultrasound
A venous duplex ultrasound maps out the venous system, identifies the veins that require treatment, and plans the procedure.
Discuss Medications
Information about all medications being taken, as some may need to be adjusted or temporarily stopped, especially blood thinners.
Discussion of Treatment Options
The vascular surgeon will discuss the most suitable endovenous procedure options, considering the patient’s specific vein issues and overall health.
Pre-Procedure Instructions
These may include avoiding certain foods or drinks and not applying lotions or creams to the legs on the day of the procedure.
Wear Comfortable Clothing
Loose, comfortable clothing and easily removable footwear are recommended on the day of the procedure.
The Procedure Process
Initial Assessment
Upon arrival, patients complete any necessary paperwork and undergo a pre-procedure check.
This includes monitoring vital signs and assessing the treatment area. Patients have an opportunity to discuss any last-minute questions or concerns with their surgeon.
The Procedure
Endovenous procedures are typically performed on a day surgery basis, under local or a short general anaesthetic. The specifics of the procedure vary depending on the technique used:
- Radiofrequency Ablation (RFA) and Endovenous Laser Therapy (EVLT) involve inserting a catheter or fibre into the vein through a small incision and then applying thermal energy to close the vein.
- Foam Sclerotherapy involves the injection of a sclerosant foam into the vein, causing it to collapse and seal.
- Cyanoacrylate Glue Closure uses a medical adhesive to close the vein.
- Clarivein therapy uses a combination of sclerosant and mechanical injury to close the vein.
The procedure usually takes 30 to 60 minutes, depending on the number and size of the veins being treated.
Post-Procedure Care
After the procedure, patients can walk immediately or as soon as awake from the anaesthetic and are encouraged to do so to promote circulation. Compression stockings are often recommended for a period to support the treated veins and minimise swelling.
Patients are usually advised to avoid strenuous activities for a short period but can generally return to normal activities within a few days. Follow-up visits monitor the success of the treatment and address any complications.
Benefits of Endovenous Treatments
Endovenous treatments for varicose veins offer several advantages over traditional surgical methods, making them a preferred option:
- Minimally Invasive
These procedures involve small incisions or punctures, significantly reducing the risk of scars and infections. - Reduced Pain and Discomfort
Patients experience less pain and discomfort during and after endovenous procedures than traditional surgery. - Shorter Recovery Time
Most patients can resume normal activities within a few days, with minimal downtime. - Improved Cosmetic Results
Because these procedures do not involve large incisions, they often result in better cosmetic outcomes, which is an important consideration for many patients.
Risks and Considerations
While endovenous treatments for varicose veins are generally safe and effective, like all medical procedures, they carry certain risks and considerations:
Bruising and Swelling
Common side effects include temporary bruising and swelling around the treated area, which typically resolves within a few weeks.
Skin Discolouration
Some patients may experience temporary or, rarely, permanent skin discolouration along the path of the treated vein.
Nerve Damage
There’s a small risk of nerve damage, particularly with procedures involving thermal energy, which may result in temporary or permanent sensation changes.
Deep Vein Thrombosis (DVT)
Although rare, there is a risk of developing a blood clot in a deep vein, which can be serious if not treated promptly.
Recurrence of Varicose Veins
While endovenous treatments are effective, they do not prevent new varicose veins from developing in the future.
Comparing Endovenous Procedures to Traditional Surgery
Endovenous treatments and traditional surgery for varicose veins differ in several key aspects, each with its advantages and considerations:
Invasiveness
Traditional surgery, such as vein stripping, is more invasive, requiring larger incisions and the use of general anaesthesia. Endovenous procedures are minimally invasive and performed through tiny incisions under local anaesthesia.
Recovery Time
Patients undergoing traditional surgery typically experience longer recovery times, often requiring weeks before returning to normal activities. In contrast, recovery from endovenous procedures is usually swift, with most patients resuming daily activities within a day or two.
Pain and Discomfort
Traditional surgery generally causes more postoperative pain and discomfort. Endovenous treatments tend to result in less pain and a more comfortable recovery period.
Success Rates and Recurrence
Both traditional surgery and endovenous treatments have high success rates. However, the less invasive nature of endovenous procedures may lead to a lower risk of complications and recurrence of varicose veins over time.
Cosmetic Outcomes
Endovenous treatments offer better cosmetic outcomes due to the smaller incisions used, which is a significant consideration for many patients
Aftercare and Recovery
Proper aftercare is crucial to maximise the benefits of endovenous treatments for varicose veins and ensure a smooth recovery:
- Compression Stockings
Patients are often advised to wear compression stockings for a certain period after the procedure to support the treated veins, reduce swelling, and enhance blood flow. - Activity
While strenuous activities should be avoided for a short time, walking and light activities are encouraged soon after the procedure to promote circulation. - Monitoring for Complications
Any signs of complications, such as excessive swelling, pain, redness, or warmth in the treated area, should be reported immediately. - Follow-up Appointments
Attending follow-up appointments allows for assessment of the treatment and addresses any concerns. - Long-term Care
Adopting a healthy lifestyle, including regular exercise, maintaining a healthy weight, and avoiding prolonged periods of standing or sitting, can help prevent new varicose veins from developing.
Frequently Asked Questions
Can varicose veins return after endovenous treatment?
While endovenous treatments are effective in closing and eliminating treated varicose veins, they do not prevent the formation of new varicose veins in the future. Lifestyle modifications and regular follow-ups can help manage and monitor vascular health.
How long do the effects of endovenous treatment last?
The effects of endovenous treatments are typically long-lasting for the treated veins. However, new varicose veins can develop over time, necessitating potential future treatments.
Can I travel after undergoing endovenous treatment?
Patients are generally advised to avoid long flights or car rides for a period after the procedure to reduce the risk of deep vein thrombosis (DVT). If essential however, travel can be undertaken with appropriate medication and compression stockings to protect against a DVT. They should also consult for personalised advice based on the specifics of the treatment and their overall health.
Will I need more than one endovenous treatment session?
This is only rarely required, unless there is a recurrence of the varicose veins. The need for additional treatments is determined during follow-up visits.
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