Varicose veins – Medical Treatments

Varicose veins do not require invasive interventions in most cases. Your doctor may prescribe you over-the-counter medication such as ibuprofen or paracetamol to alleviate painful symptoms of this condition. However, if you have persistent pain that does not have obvious physical signs or if you notice the discoloration in the area around the varicose vein, there may be deep vein involvement.

After the vascular surgeon diagnoses varicose veins, conservative options will be explored in the beginning. These options include home remedies, such as exercise, changes in diet, leg elevation, and avoiding standing or sitting for long durations, that improve blood circulation in your lower body. You may also be prescribed compression stockings or socks/ wraps of a certain grade, depending on the level of pressure required.

If your condition is still not improving, the next course of action may be to perform a procedure to correct the venous reflux.

How are varicose veins treated?

Like tributaries/ smaller channels feeding the main waters of a river, shorter veins connect to a longer, larger, and deeper main vein called the saphenous vein. Most varicose veins connect to the saphenous vein directly or indirectly through tributaries/ branches. That is why complete treatment of varicose veins cannot happen until the reflux within the saphenous vein is not corrected; doing so would be like trimming the ends of tree branches when trying to fix the whole tree.

All veins with reflux, including the tributaries, the saphenous, and the affected varicose veins must be treated systematically in planned phases or at once during treatment sessions. The deeper and the largest veins need to be treated first.

Various medical procedures are conducted to treat varicose veins depending on the depth and severity of the condition.

Medical treatment procedures for varicose veins

Endovenous thermal ablation (laser and radiofrequency therapy):

For treating the saphenous (main trunk) vein a procedure called endovenous thermal ablation is recommended. This is also known as endovenous laser therapy (ELVT) when a laser is used and radiofrequency ablation (RFA) when a radiofrequency is employed. A small incision is made to insert a laser fibre (for ELVT) or a catheter (for RFA) into the vein. The laser or radiofrequency is then used to heat up the refluxing vein, causing it to collapse and seal. The heat energy does not affect or harm the surrounding area. This treatment usually requires multiple procedures.

RFA is used to treat varicosity in the larger saphenous veins. ELVT is used to treat spider veins or smaller varicose veins.
Sclerotherapy (injection therapy):

To treat the tributaries and varicose veins sclerotherapy injections are recommended. Over time, sclerotherapy has become one of the most common procedures to treat varicose veins. These procedures are conducted, at times with ultrasound guidance, by injecting a solution into your veins. The solution irritates the walls of the vein, making them stick together. The vein collapses and turns into scar tissue, eventually fading away.

Micro sclerotherapy:

Very small varicose veins or spider veins are treated using micro sclerotherapy. A very fine needle is used to inject the spider vein with a chemical substance called a sclerosant. The sclerosant scars the inner lining of the spider vein, causing the vein to closes off.

Ambulatory phlebectomy:

Prominent varicose veins can be treated with a procedure known as ambulatory phlebectomy. Ambulatory phlebectomy is most commonly used to remove varicose veins closest to the surface of your skin. Here, the vascular surgeon makes a series of very small cuts or incisions into the skin to remove varicose veins. This procedure can be performed in combination with sclerotherapy or endovenous thermal ablation procedure or in a combination of both. This treatment requires no stitches and is conducted in regular office settings.

Vein stripping and ligation

The vascular surgeon may choose to tie off the varicose veins to stop the pooling of blood and arrest the build-up of pressure. This is known as ligation. The veins may also be removed (or stripped) to prevent the varicose veins from reappearing.

What is the outlook after the endovascular medical procedures treating varicose veins?

These procedures are conducted under anaesthesia and are not painful.
A compression sock will most probably be put on each leg.
The treatment areas may be itchy or appear bruised for a few days after the treatment – this is normal. The veins themselves may appear darker or more pronounced after the treatment. However, this will pass over a few weeks.
To avoid side-effects of the procedures, you are advised to wear the compression garments/ socks as instructed by your doctor. Most patients are advised to wear compression socks for 1-2 weeks. You are also advised to go on daily walks and undertake light exercise as advised by your doctor.
In most cases, both the medical and cosmetic outcomes of the procedures for treating varicose veins have high success rates.

Advantages of endovascular surgery procedures for varicose veins

Treatment is walk-in walk-out.
You can return to work and most daily activities within 3 days.
Most procedures do not leave scars and are painless.
The chance of recurrence, though not zero, is minimal.
The procedures are in daycare and can be performed in a clinic. They do not require you to be hospitalised.
Procedures do not require you to be put under the influence of general anaesthesia.

Do varicose veins reappear after treatment?

Endovascular treatment for varicose veins is highly effective. However, varicose veins can return post-treatment.

There is a higher risk of varicose veins reappearing if:

You have a sedentary lifestyle or if you are overweight.
You become pregnant after a treatment procedure.

The results you want to see largely depend on the expertise of the endovascular surgeon treating you. Many medical advances have been made in endovascular surgery and simply stripping away varicose veins is not just the only treatment anymore. Though many cases of varicose veins get treated with conservative therapy options, some cases may require the intervention of medical procedures for long-lasting treatment. Endovascular surgeries provide this service safely with a high success rate. For more information about varicose veins, consult the best vascular surgeons in Bangalore at the Department of Vascular and Endovascular Surgery in Sagar Hospitals.