Varicose Vein Treatment

First, our specialist vascular scientist and General Practitioner team will carry out a full duplex ultrasound of the affected area and advise you on your treatment options

Depending on the outcome of this consultation, we’ll book you in for a return visit where we’ll carry out treatment. We only carry out minimally invasive treatments, so you’ll be able to walk in-and-out the same day. Six to eight weeks after your treatment, we'll arrange to see you again, to ensure the veins we have targeted have been properly closed

We focus exclusively on specialised, minimally invasive thermal treatments using radio waves, namely Radiofrequency Ablation. We do so because these treatments have been proven to offer the best available outcomes for patients (as recognised by the National Institute of Clinical Excellence)
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Another minimally invasive technique available at the UK Vein Clinic is Sclerotherapy or, more specifically, Foam Sclerotherapy. It consists of a harmless foam solution being injected into the varicose vein, blocking off blood flow to the vein and allowing the vein to dissolve into the body

All our treatments are minimally invasive so you can walk in and walk out the same day. A typical treatment session generally takes between 30 and 45 minutes

Most patients report only slight discomfort, if any, during the procedures (although everyone’s response to treatment and threshold for pain will vary)
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Radiofrequency Ablation is carried out under local anaesthetic - small injections are given in the affected area until it becomes completely numb. The treated area can feel tender or numb immediately after treatment, and some patients report feeling the vein as a sore line or string inside the skin for a few days afterwards
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It's also common for the treated area to start to feel more sore in the second week after treatment. Any discomfort like this can be managed using simple over-the-counter pain relief (such as Paracetamol, Aspirin and Ibuprofen)
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Sclerotherapy does not require general anaesthetic either. Very well tolerated by the vast majority of patients, it’s a brief injection to close each vein: similar to having a blood test or flu jab

We only use non-invasive treatments that minimise the risk of complications and post-op pain. However, all procedures can lead to minor adverse effects such as bruising, redness, and tenderness in the treated area. Some patients find the area feels numb for a few days; others experience some minor discomfort that is usually managed using over-the-counter pain relief. Very occasionally, some patients experience a slight staining of the skin that will mostly clear up over time

If you’ve had varicose vein treatment on your leg(s), we will ask you to wear compression stockings continuously for the first 48 hours post-treatment and then keep these on during the day for the next 2 weeks, or for as long as you can tolerate them

Yes

You can have your scan and consultation, but we may recommend waiting until after the birth to undertake treatment

Yes

While there are various treatments available to manage and remove varicose veins, it's important to remember that these treatments are designed to alleviate symptoms, improve the appearance of varicose veins, and prevent complications. However, for many people, once varicose veins develop, they typically do not go away completely on their own.

The main goal of varicose vein treatments is to close off or remove the affected veins, improving blood flow and reducing discomfort for those suffering with them. Once treated, the appearance of the affected area (predominantly the legs) often improves, and symptoms like pain, swelling, and itching are relieved. These treatments for varicose veins have been known to significantly improve a person's quality of life and prevent the development of more severe complications, such as blood clots, although the progression to more serious issues is rare.

Varicose veins are a common vascular issue that, once developed, typically require medical intervention to manage and eliminate. At UK Vein Clinic our world class treatment pathway has been designed by Professor Stephen Black, who is one of the UK’s leading vascular surgeons.

We advise patients who have had radiotherapy on larger varicose veins to avoid long-haul flights for 6 weeks after treatment, because of the increased risk of thrombosis in a pressurised plane cabin. You can choose to drive again as soon as you feel comfortable enough to perform an emergency stop. How soon you start exercising again will depend on the speed of your recovery, but you can carefully resume exercise as soon as you’re happy to do so

A world class care pathway starts with a comprehensive history and 'Aberdeen' questionnaire, which looks at the presentation of symptoms and how they affect our daily lives. This assessment is followed by a detailed investigation using a duplex scanner. In some cases, a patient will also be referred for an MRI scan in order to identify problems above the groin area in the abdomen and pelvis.  A reason for scanning the pelvis and abdomen may be  early, aggressive recurrence of varicosities, a predominantly left sided problem or if you have had deep vein thrombosis (DVT).  A severe leg ulcer that hasn’t responded to treatment may also need an MRI scan. Syndromes such as May-Thurner syndrome or pelvic congestion syndrome can be identified in this way.

‍Ultrasound ‘duplex’ scan
‍The introduction of vascular ultrasound (a duplex scan) has been a game changer for patients in terms of the quality of treatment they can expect to receive. Visible varicose veins are just the tip of the iceberg; the ultrasound scan looks at everything else. Improvements in diagnostic assessment have been central to explaining why traditional surgery did not provide consistent results. The surgeon simply didn’t have a sufficiently accurate map or any way of knowing that all the necessary vein had been removed

Ultrasound provides that detailed map of the venous system, specifically the size and location of problems in the veins. The scan also confirms the health of the deep vein system. This is important because if there is a blockage or damage in the deep veins it may alter treatment plans for the superficial veins.

The scan also helps to manage expectations as to the likely symptomatic and cosmetic success from treating the superficial veins. If reflux is present in the deep veins, we may still be able to treat the superficial veins, but the symptomatic improvement and cosmetic results may not be as good. It is important to remember that the scan is not to confirm the presence of varicose veins, but to understand how these smaller veins are fed by failures in the bigger, deeper veins.

Modern treatments are divided broadly into thermal (those that use heat) and non-thermal (those that use chemicals like sclerosants and glue), All treatments, thermal or non-thermal are minimally invasive, which means faster recovery, lower complication and recurrence rates compared to the traditional (and now largely outdated) method of stripping.

Both methods of applying thermal energy to the affected areas work effectively. The contention is over the way in which laser delivers energy, relying on surgeon accuracy in contrast to the systematic capability of radiofrequency ablation. This factor opens up the potential for variability in the outcomes a surgeon can predictably deliver over time. For example, if a surgeon wants to treat a 10cm section of vein, delivering 80 joules per centimetre the surgeon will manually pull back the catheter, guided by a metronomic bleeping sound that is emitted.  After 10cm the surgeon will try ensure that a total of 800 joules has been delivered giving an average of 80J/cm but that may not have been delivered as precisely to each centimetre of the vein; sometimes starting too fast and slowing toward the end or vice versa. This variation is predominantly caused by human factors, tiredness at the end of the list, a bad day, surgeon experience or just the list running behind and it’s the 10th patient of the day.

Radio frequency on the other hand is a staged treatment in which the surgeon treats segments at a time rather than continuous pull back. This means the delivery of energy is more consistent and in addition the machine gives feedback as to how well the treatment is working indirectly via the measurement of how much energy is required to heat the vein to the treatment temperature. This generally means that treatment using Radiofrequency is more consistent and ensures more predictable results. From a patient perspective, there is evidence that radio frequency is less painful for the patient following treatment

‍Non thermal treatments for varicose veins
‍The primary non-thermal treatment for varicose veins is foam sclerotherapy, based on the Tessari technique, invented in France.  A small amount of sclerosant is mixed with air to create foam which is injected into the vein.  The foam pushes the sclerosant into contact with the vein wall displacing blood.  The chemicals damage the vein wall, causing it to “block off” the vein.

Complications with foam treatment are rare. If a patient has a predisposition towards migraine then the chemicals in the foam can bring this on. Also, occasionally some patients experience temporary and minor visual impairment.

This treatment is effective for tidying up small veins, but data suggests it is less effective than radiofrequency ablation, which is why we don’t use it for everything. Foam sclerotherapy comes in a range of concentrations and the surgeon will not know which concentration will deliver the best results, so will start at 0.5%, using stronger formulas in follow-up sessions if required. There is a limit to the amount of foam the body can accommodate so typically foam treatment is completed over a series of visits. Using too high a concentration can lead to staining on the skin, so it’s important to start with lower concentrations of foam.

There are additional techniques that combine the use of sclerosant with a catheter that enhances the efficacy of the sclerosant (Clarivein or MOCA) and also the use of glues that stick the vein shut. These techniques all have the advantage of not needing an infusion of the local anaesthetic tumescence but appear to (for MOCA) have slightly higher rates of recurrence and in the case of glue reported issues with allergic reactions.  

‍Treating varicose veins with Avulsion (micro-phlebectomy)
‍This is a surgical process, that can be performed under local anaesthetic, requiring a number of incisions along the leg.  At each incision, the surgeon will remove a small proportion of the vein. After the procedure, small cuts along the leg that require simple dressings that heal well with time.

This practice is effective for larger veins. If ,however you treat the larger veins with ablation first, in around 70% of cases the remaining veins will get better by themselves and avulsions are not required.

‍Moving on from the past
‍Whilst there is still a reasonable amount of vein stripping occurring in the NHS, this really shouldn’t be the preferred method for treating varicose veins. Indeed, for recurrent varicose veins, the latest guidelines from  international societies and organisations such as NICE suggest that other methods of treatment, especially for recurrent veins, should be prioritised.

Overall, this procedure carries with it a 1% chance of serious complication, such as DVT, pulmonary embolism (blood clot in the lungs) or neurovascular damage. There is also a 15% chance of minor complications such as infections, seroma (build-up of fluid under the skin), nerve damage or bleeding. The surgery also requires general anaesthetic and results in prolonged recovery 7/14 days to drive, and 14/21 days off work.

Actually, the process can appear to be quite brutal and when not guided by ultrasound, the surgeon would have no way of knowing if the entire vein had been removed. This is why outcomes are so poor with 26% of patients complaining their veins were no better after surgery. Overall, 34% of patients will not be happy with the outcome.