Treatment for varicose veins

When you might need an operation

• You’re bleed­ing from a varicose vein that has broken down.
• You have pre­vi­ously bled from a varicose vein and are at risk of this hap­pen­ing again.
• You have a varicose ulcer that is get­ting worse and/or is pain­ful des­pite treatment.
• You have a varicose ulcer or pro­gress­ive skin changes that your doc­tor thinks could bene­fit from surgery.
• You’ve had sev­eral epis­odes of inflam­ma­tion, pain and swell­ing caused by your veins.
• Your veins are caus­ing trouble­some symp­toms and you and your doc­tor feel they are hav­ing a severe impact on your qual­ity of life.

Not every­one with varicose veins will require treat­ment for their con­di­tion. If you have no symp­toms and your varicose veins do not cause you dis­com­fort, then you do not neces­sar­ily need to have treatment. There are some instances when treat­ment may be necessary:

• To ease symp­toms. If your varicose veins are caus­ing you pain or discomfort.
• Com­plic­a­tions. You may require treat­ment if your varicose veins cause you to develop com­plic­a­tions, such as leg ulcers, swell­ing or skin discolouration.
• Cos­metic reas­ons. Des­pite hav­ing no symp­toms, some people want their varicose veins removed for cos­metic reasons.

If your varicose veins do require treat­ment, the type of treat­ment you will receive will depend on your gen­eral health, and the size, pos­i­tion and sever­ity of your varicose veins. Some of the avail­able treat­ments for varicose veins are out­lined below. Your doc­tor will be able to advise you about the most suit­able form of treat­ment for you.

Com­pres­sion stockings

Com­pres­sion stock­ings are spe­cially designed stock­ings which stead­ily squeeze your legs to help improve your cir­cu­la­tion. They may help to relieve pain, dis­com­fort or swell­ing in your legs which is being caused by your varicose veins. It is not yet known whether com­pres­sion stock­ings can help to pre­vent your varicose veins from get­ting worse, or if they pre­vent new varicose veins from appearing.

Com­pres­sion stock­ings are avail­able in a vari­ety of dif­fer­ent sizes and pres­sures. Most people with varicose veins will be pre­scribed a class 1 (light com­pres­sion) or class 2 (medium com­pres­sion) type of com­pres­sion stock­ing. They are avail­able in dif­fer­ent colours.

It is import­ant that your com­pres­sion stock­ings fit you prop­erly oth­er­wise they may not be effect­ive. Your doc­tor or phar­macist will need to meas­ure your legs in sev­eral places to make sure that your stock­ings will be the right size. If your legs are often swollen, they will usu­ally need to be meas­ured first thing in the morn­ing, when any swell­ing is likely to be minimal.

Com­pres­sion stock­ings usu­ally have to be replaced every three to six months. If your stock­ings become dam­aged in any way, speak to your doc­tor because they may no longer be effective.   

You should also be pre­scribed two stock­ings (or two sets of stock­ings if you are wear­ing a stock­ing on each leg), so that one stock­ing can be worn while the other is being washed and dried. Com­pres­sion stock­ings should be hand washed in warm water and dried away from dir­ect heat.

When should I wear my com­pres­sion stockings?

You will nor­mally have to put your com­pres­sion stock­ings on as soon as you get up in the morn­ing. You can then take them off when you go to bed. Com­pres­sion stock­ings are often tight­est at the ankle and get gradu­ally looser as they go fur­ther up your leg to encour­age your blood to flow upwards towards your heart.

Wear­ing com­pres­sion stock­ings can be uncom­fort­able, par­tic­u­larly dur­ing hot weather, but it is import­ant to wear your stock­ings in the right pos­i­tion for you to get the most bene­fit from them. 

You may find that wear­ing com­pres­sion stock­ings can cause the skin on your legs to become dry. When you take your stock­ings off before going to bed, you can apply an emol­li­ent (mois­tur­ising cream) to help keep your skin supple and moist. Speak to your doc­tor if you find that the skin on your legs is becom­ing dry after wear­ing com­pres­sion stockings.

Sclero­ther­apy

Sclero­ther­apy is usu­ally suit­able for people who have small to medium-sized varicose veins. This treat­ment involves a spe­cial chem­ical being injec­ted into your veins. The chem­ical works by scar­ring the veins, which then seals them closed.

Lar­ger veins may require foam sclero­ther­apy. Instead of the liquid chem­ical, a spe­cial type of foam is injec­ted into the affected vein. The injec­tion is guided to the vein using an ultra­sound scan. Although this treat­ment has been proven to be effect­ive, it can cause side effects, including:

• blood clots in other leg veins,
• head­aches,
• faint­ing, and
• tem­por­ary vis­ion problems.

Your doc­tor will advise you whether foam sclero­ther­apy is a suit­able form of treat­ment for you.

Fol­low­ing your sclero­ther­apy treat­ment, your varicose vein should begin to fade after a few weeks. This is because stronger veins take over the role of the dam­aged vein, which is no longer filled with blood.

You may require sclero­ther­apy more than once before the vein fades. How­ever, sclero­ther­apy is not always per­man­ent, and there is a chance that the vein may reappear. Both stand­ard sclero­ther­apy and foam sclero­ther­apy are usu­ally car­ried out under local anesthetic. 

Sur­gery

Large varicose veins may some­times have to be sur­gic­ally removed. Varicose vein sur­gery is usu­ally car­ried out under gen­eral anaes­thetic, and you will nor­mally be allowed to go home the same day. How­ever, in some cases, you may require an overnight stay in hos­pital, par­tic­u­larly if you are hav­ing sur­gery on both legs.

Most sur­geons use a tech­nique called lig­a­tion and strip­ping, which involves tying off and then remov­ing the affected vein in the leg.

Two small cuts (incisions) will be made, approx­im­ately 5cm in dia­meter. The first cut is made near your groin, at the top of the varicose vein. The second cut is made fur­ther down your leg, usu­ally around your knee or ankle. The top of your vein (near the groin) is tied up and sealed.

A thin flex­ible wire is passed through the bot­tom of the vein, which is care­fully pulled out and removed through the lower cut in your leg.  

The blood flow in your legs will not be affected by the sur­gery. This is because the veins which are situ­ated deep within your legs will take over the role of the dam­aged veins. You may need between one and three weeks to recover before you return to work, although this will depend on your gen­eral health and the type of work that you do.

Other treat­ments

A num­ber of new treat­ments have recently been developed to treat varicose veins:

Radi­ofre­quency ablation

Radi­ofre­quency abla­tion involves heat­ing the wall of your varicose vein using radio-frequency energy. The energy is emit­ted from a small probe that is inser­ted into your vein. The vein is heated until its wall col­lapses, clos­ing the vein and seal­ing it shut.

The vein is accessed through a small cut made just above or below the knee. Once the vein has been sealed shut, your blood will nat­ur­ally be redir­ec­ted to one of your healthy veins. This treat­ment rarely causes any dis­com­fort and is car­ried out under local anaesthetic.              

Endoven­ous laser treatment

Dur­ing endoven­ous laser treat­ment, a nar­row tube, known as a cath­eter, is put into your vein, using an ultra­sound scan to guide it into the cor­rect pos­i­tion. A tiny laser is then passed through the cath­eter and posi­tioned at the top of your varicose vein.

The laser emits short bursts of energy, heat­ing the vein up and seal­ing it closed. The laser is slowly pulled along the vein, using the ultra­sound scan as a guide, allow­ing the entire length of the vein to be closed.

Endoven­ous laser treat­ment is car­ried out under local anaes­thetic. After­wards, you may feel some tight­ness in your legs, and the affected areas may be bruised and painful.

Trans­il­lu­min­ated powered phlebectomy

Dur­ing a trans­il­lu­min­ated powered phle­bec­tomy, one or two small incisions are made in your leg. Your sur­geon will place a spe­cial light, called an endo­scopic trans­il­lu­min­ator, under­neath your skin so that they are able to see which veins need to be removed. The affected veins are then cut and then removed through the incisions using a suc­tion device.

Trans­il­lu­min­ated powered phle­bec­tomy can be car­ried out under gen­eral anaes­thetic or local anaes­thetic. As with endoven­ous laser treat­ment, you may notice some bruis­ing afterwards.

 When you might need an operation

• You’re bleed­ing from a varicose vein that has broken down.
• You have pre­vi­ously bled from a varicose vein and are at risk of this hap­pen­ing again.
• You have a varicose ulcer that is get­ting worse and/or is pain­ful des­pite treatment.
• You have a varicose ulcer or pro­gress­ive skin changes that your doc­tor thinks could bene­fit from surgery.
• You’ve had sev­eral epis­odes of inflam­ma­tion, pain and swell­ing caused by your veins.

Your veins are caus­ing trouble­some symp­toms and you and your doc­tor feel they are hav­ing a severe impact on your qual­ity of life.