Treatment of varicose veins
Stockings
For patients who have symptoms, relief may be gained by the wearing of elastic support stockings obtained from the local chemist or hospital. Although these do not treat or reduce the varicose veins they can decrease the aching from them, and do not carry any harmful side-effects if properly fitted.
Injections (sclerotherapy)
Sclerotherapy is a treatment involving the injection of a small amount of liquid detergent into varicose veins with the intention of causing an inflammatory reaction which results in closure of the vein. This can be successful for smaller sized varicose veins and for more cosmetic thread or flare veins often seen around the thighs or ankles (microsclerotherapy). A bandage is usually required for a week but the patient can continue normal activities immediately and improvement usually seen by six weeks. Mixing the solution with air (“foam”) produces a more powerful solution but can lead to darkening of the overlying skin.
Keyhole (endovenous) surgery
If the veins are particularly large or visible then surgical intervention may be required. Previously the most common operation performed to remove varicose veins was the “stripping” procedure which required a general anaesthetic and overnight stay. Although this improved veins in the short-term it was associated with significant bruising in the thigh, pain lasting a few weeks and a risk of numbness down the inside of the leg. Patients usually needed to take a couple of weeks off work and driving, and approximately 20-30% of patients would require further surgery a few years later.
More recently “keyhole” alternatives to stripping have become available, the most popular of which is radiofrequency (VNUS) closure of the veins (see section below). These have now become the gold standard for treating varicose veins and were recently endorsed by NICE, the government advisory agency, as first-line treatment instead of stockings or stripping. There is also evidence from the EVRA trial published in 2018 that they should be considered for patients with leg ulceration due to venous disease.