Varicose veins are permanently dilated veins. These are predisposed to by hereditary factors, pregnancy, severe trauma to the legs, long periods of standing or even heat and tight girdles i.e. these are the effects of back pressure on the weak walls of the venous blood vessels.
Varicose veins are not only of cosmetic importance – they may bleed, cause pain, leg swelling, inflammation, skin hardening and breaks leading to a chronic wound, venous leg ulcer. Moreover, varicose veins, especially in the setting of excess body weight and obesity, increase the risk for venous thromboembolism (blood clots) which may be fatal.
The disease is common, affecting up to 30% of the Western population, its prevalence increasing with age. There is a marked hereditary contribution to the disease. Over the past two decades the treatment of varicose vein disease has evolved from open surgery to less invasive procedures that can be performed in local anesthesia or even without anesthesia.
Surgical procedures are used to remove the prominent thick venous channels. These procedures have no beneficial effect on the small threadlike red and blue superficial spider veins.
Sclerosant injection treatment destroys the incompetent vein in 1-4 months while blood circulation continues through the normal channels. Sclerosant injection treatment is undertaken from the thighs downwards and may result in a very temporary burning pain for the duration of each injection but this settles rapidly. The cosmetic appearance of the leg tends to be improved only from 3 to 4 weeks following treatment. Treatment sessions take from 15-60 minutes, depending on the area to be treated and normal activities can be resumed directly afterwards.
Side effects of the treatment include a burning sensation with the introduction of the sclerosing solution. This is not experienced by all patients but the sensation disappears almost as soon as the injection is discontinued. Minor bruising at the site of the injection can occur; it is not serious and will disappear in 3 to 4 weeks should it have occurred.
Tender red inflammation of the veins may occur occasionally. Very rarely, slight brown staining may occur in the line of the vein. This pigmentation can last for many months until it fades.
If bandaging has been recommended, pay attention to the frequency of the application. Wearing shoes with relatively low heels promotes the action of the venous pump in the calf to avoid recurrence of fresh veins. Tight belts and girdles should not be worn.
- The first session of treatment includes an explanation of the sclerosant treatment, a general examination of your legs, followed by an actual treatment with a sclerosant solution.
- The usual appointment time is 1 hour and the area covered in this time will depend on the extent of the veins requiring treatment. Usually a large area can be covered in an hour.
- Treatments need to be at monthly intervals until clearance which could anything from 1 to 4 treatments.
- Do not shave your legs within two days prior to the sclerotherapy treatment;
- Avoid very hot baths immediately before and after treatments for 3 days;
- Do not sunbathe after treatment and use a good sunscreen with efficient sun blockers thereafter until bruising has gone (approximately 5 days).
- Avoid aerobic exercises (cardio vascular) for 3 days after treatment.
- Apply Arnica cream 1 to 2 times per day until bruising has disappeared.
One of the most efficient treatments is endoluminal radiofrequency closure (Closure FAST). With almost 98% success rate, the procedure is done with a catheter, placed into the vessel through a needle hole, then heating the inner wall of the vein causing its closure. Superficial varicose veins can be removed through tiny skin incisions (stab phlebectomies) or closed by foam sclerotherapy.
The list of possible treatment options is now long encompassing endoluminal laser ablation, mechanochemical closure, steam ablation and, very recently, closing the vein with cyanoacrylate glue. The latter method is done without anesthesia and may be a treatment of choice for certain patients. Whatever treatment is considered, the crucial step is proper diagnostic workup that includes the duplex ultrasound investigation of leg veins. With more than two decades of experience in minimally invasive procedures pioneered and perfected by Prof. Sanja Schuller in Vienna and Prof. Milos Pavlovic in Ljubljana resulted in many scientific publications and satisfied patients.