Are you feeling embarrassed at the prospect of the warmer months and exposing your legs?
We are researching the new treatment that promises to get rid of varicose veins for good…
Varicose Vein Treatment: What Causes Varicose Veins?
Afraid that in just a month or two you’ll need to ditch your pants and opaque tights and show the world those unwanted leg veins again?
If so, you are not alone. Varicose veins, which, despite what we’ve been led to believe, have very little to do with pregnancy, sitting cross-legged or poor circulation and are far more likely to be hereditary, affect 40% of the population. They occur because the underlying veins have lost their one-way valves, so instead of blood being pumped upwards through the superficial veins, gravity causes it to fall downwards (this is called venous reflux). Over time, the walls of the superficial veins stretch, which makes more room for the blood to fall, but also makes the veins visible above the skin.
Treatment of varicose veins: Traditional treatment
For many years, the focus has been on removing these unsightly superficial veins. This was done by making incisions on the top and bottom of the leg and “pulling” the vein out. It sounds brutal, and it was, with several weeks of recovery time required and, most depressingly, a high chance of the vein regrowing and becoming varicose once again. This is because it wasn’t the superficial vein that was the problem, but the non-functioning valves in the connected veins. NHS treatment was widely available and while you may still be referred for treatment of varicose veins if they cause pain, discomfort or leg ulcers, it is not available on the NHS for cosmetic reasons.
In the majority of private clinics and the NHS, the most common way to treat varicose veins is now laser and radiofrequency ablation followed by foam sclerotherapy.
Treatment of varicose veins: Endothermic ablation
The National Institute for Health and Care Excellence (NICE) recommends that people who have varices with confirmed regurgitation in the larger veins of the trunk below be offered endothermic ablation as a first option. Performed under local anesthesia, this procedure is less invasive than stripping. It involves feeding wires through the vein. Once at the far end where treatment is needed, water is injected around the vein and the wire is heated from within to 85°C, using electricity or a laser. It is then slowly withdrawn, maintaining the temperature to seal the vein.
Evidence suggests that in at least 90% of cases, the great saphenous vein—one of the most common veins involved—is immediately occluded by the procedure. Overall patient satisfaction is high, with fewer than one in 20 continuing to have symptoms (leg pain, leg fatigue, ankle swelling and visible varicose veins) after the procedure.
Treatment of varicose veins: Sclerotherapy with foam
For people not suitable for endothermic ablation, NICE recommends ultrasound-guided foam sclerotherapy. This involves the destruction of the lining of the vein, leading to scarring, which blocks the vein. The sclerosant foam (an irritant) is injected under ultrasound guidance using local anaesthetic. Compression bandages should be worn for one to four weeks after the procedure.
Although some people find it helpful, studies show it is less effective than surgery or endothermic ablation. But now, Professor Mark Whiteley, a consultant vein surgeon for more than 20 years and a former lecturer in surgery at the university of oxford, has become the first doctor in the UK to offer Sonovein, a new treatment that is non-invasive and requires no recovery time. Evidence shows that treating a vein with heat (thermostomy) has the lowest chance of recurrence of all techniques. Sonovein uses a focused, high-intensity ultrasound beam to deliver heat energy directly into the vein, causing it to shrink and seal. It is the only treatment developed so far that can treat a vein outside the body. Foam sclerotherapy is only needed if there are residual varicose veins that need treatment.
Treatment of varicose veins: Non-invasive treatment
If it sounds super simple, that’s because it is, but it’s the result of 15 years of research and development.
However, while there is no chance of scarring or risk of infection because there is no invasive surgery with Sonovein, there are still a few things worth noting. It’s certainly a breakthrough treatment, but the precision it requires means it can be slow. Each treatment cycle removes a volume of tissue about the size of a grain of rice, and the sonographer moves the beam manually between cycles to ensure the circumference of the vein is targeted. Early versions took 1 minute to treat 3.5 mm vein tissue – this time has now been reduced to 8 seconds, so the process is much faster than in our case study. Although the thermal energy used creates a temperature of 90°C, it is only for a second or two at a time. This means that many people do not need a local anesthetic, and certainly much less than for other techniques.
But a percentage of women still need foam sclerotherapy to treat residual varicose veins. For them, bandages and a support stocking must be worn day and night, usually for three weeks. However, swollen veins often disappear within weeks of Sonovein treatment, so for many, bandages are not needed.
But that seems a small price to pay to get rid of unsightly veins without surgery. As this treatment is non-invasive, patients can leave the clinic immediately.
Varicose veins treatment: The cost
The biggest price tag is that of the treatment itself, which starts at £3,500 The Whiteley Clinics in London, Guildford and Bristol, compared to laser ablation and radiofrequency ablation, both at £2,300. But it might be worth considering if it means regaining your legs, avoiding going under the knife and no longer living in fear of shorts.
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