Treatment Options

Microsclerotherapy

Microsclerotherapy involves injecting a sclerosing agent into abnormal surface veins using a fine needle. This procedure is usually reserved for the treatment of small, blue superficial veins (reticular veins), spider veins and sometimes for small visible varicose veins. Successfully treated veins will fade as the body gradually removes them. In many patients, sclerotherapy can relieve the symptoms caused by varicose veins. With this procedure, veins can be dealt with at an earlier stage, helping to prevent further complications.

Some veins may need to be injected more than once for optimum results. Generally, normal activities can be resumed straight after sclerotherapy. Medically prescribed compression stockings are essential to achieving the best outcome, and may need to be worn for several days or weeks to assist in resolution of the veins.

The procedure is performed in the doctor’s office and usually causes minimum, transient discomfort. Microsclerotherapy is considered the gold standard in treatment of spider veins of the legs.

 

Ultrasound Guided Sclerotherapy (UGS)

UGS is a modern technique that is reserved for treating advanced varicose veins that are hidden beneath the skin. UGS is a versatile procedure that can treat saphenous veins, perforating veins, and other hidden varicose veins.

The ultrasound precisely displays the abnormal veins, as well as adjacent structures such as deep veins and arteries. With ultrasound guidance, the phlebologist can inject the hidden abnormal veins while observing the process on the ultrasound monitor. Once injected, the treated vessel will be gradually absorbed by the body and will disappear with time. A number of injections will be required along the length of the vein to achieve complete closure. Another significant advantage of this method is that it allows the phlebologist to monitor the effect of each injection, while ensuring the safety of all adjacent structures. The use of sclerosant as foam, rather than solution, has made this procedure much more effective.

The treatment may take up to half an hour. Following the procedure, patients are fitted with graduated compression stockings and asked to go for a 30-40 minute walk to promote blood flow in the deeper veins.

 

Catheter Guided Sclerotherapy (CGS)

CGS involves using a long catheter to deliver the sclerosing agent. This technique is used to seal off the incompetent saphenous veins. A local anaesthetic is used to numb the area and a catheter is inserted into the abnormal vein under ultrasound guidance. The sclerosing agent is then injected as the catheter is slowly withdrawn from the vein.

This technique increases the safety of the treatment, because the placement of the catheter ensures that the solution is injected only into the abnormal vein, away from other structures. This method involves minimal injections and therefore is more comfortable than some other techniques. This technique is also called Extended Long Line Echosclerotherapy (ELLE), and was first developed by Australian phlebologists.

 

Endovenous Laser Ablation (EVLA)

EVLA is the latest method for the treatment of large saphenous veins that would previously have been subjected to surgical stripping under general anaesthetic.

EVLA involves a combination of laser and ultrasound technology, and does not require admission to hospital or general anaesthesia. Published research of the technique performed on more than 1000 patients has shown a low risk of complications and superior results when compared with surgery and UGS (excellent results in over 90% of patients).

EVLA is used to treat the main trunks of abnormal saphenous veins. A fine laser fibre is inserted into the target vein, under local anaesthetic. Laser energy is then delivered into the vein, causing the vein to collapse and seal shut. Following the procedure, compression stockings are prescribed and a daily walk is advised.

To treat the remaining abnormal branch veins, UGS or phlebectomy (see below) may be required.

 

Ambulatory Phlebectomy

Ambulatory phlebectomy is the surgical removal of superficial varicose veins. This is usually done in the office, using local anaesthesia. Incisions are tiny (stitches are generally not necessary) and scarring is minimal. After the vein has been removed, a bandage and/or compression stockings are worn for a short period of time.

 

Surgery

Surgical techniques include ligation (tying off the vein), stripping (removal of an extensive segment of vein by pulling it out) and phlebectomy (removal of veins through tiny incisions). Surgery may be performed using local, spinal or general anaesthesia, with most patients returning home the same day as the procedure. Surgery has traditionally been used to treat large varicose veins, but recent studies indicate a poor long-term success rate.

 

Vascular Lasers & Intense Pulse Light

These techniques have proved disappointing in treating spider veins of the leg. Light-based treatment is generally only suitable for small veins above the waist, and is best used to treat vascular lesions such as birth marks (such as port-wine stains) and facial veins.

 

Sclerotherapy remains the gold standard for treatment of superficial leg veins.