Besides support stockings (hosiery), the most common form of treatment is surgical ligation and stripping. At least two incisions are required, allowing the surgeon to tie off and pull out the faulty vein. It requires general anaesthesia, hospitalisation, leaves scars and requires 2-4 weeks recovery. Another form of treatment is ultrasound-guided sclerotherapy— the injection of an irritant to close the vein. Although sclerotherapy is effective with larger veins there is a risk of veins coming back.
This is usually undertaken under a full general anaesthetic. When asleep a cut is made over the top of the main varicose vein and it is tied off just where it joins the deep vein in the groin. This cut is closed with stitches, which are hidden under the skin. The main vein under the skin is removed by passing a fine wire down it - either to just below or just above the knee ("stripping" the vein). This helps to guard against varicose veins forming again. Blood flows up the many other veins in the leg after this vein has been removed. Varicose veins marked before the operation are removed through tiny cuts in the skin. These cuts can be closed with stitches or adhesive strips. Other veins under the skin with important connections to the deep veins may need to be dealt with - in particular one just above and behind the knee. If important veins other than the one on the inner side of the leg need to be tied off, this may require special scans before the operation, and we will explain this to you.
This means support stockings or tights, which can be effective in relieving symptoms of aching and heaviness caused by varicose veins. They can be bought from many different outlets. Stronger support hosiery ("graduated compression stockings") are even more effective. Above or below knee lengths are available in three different "Classes" of compression (Class 1 are a little stronger than ordinary support tights; Class 2 are most often advised by doctors for patients with vein problems; and Class 3 provide very firm compression when there is a particular need). Graduated compression stockings can be obtained by a doctor’s prescription, although a wider range (in a variety of colours) is available for purchase from specialist surgical supply outlets. If worn regularly each day graduated compression stockings need to be renewed every three or four months.
This is performed in the outpatient department with the patient able to walk out immediately treatment is completed. A small area of skin is numbed with local anaesthetic at the knee. Using an ultrasound machine to help guide treatment, a small tube is inserted into the vein in the thigh. The leg is then supported in a sling and foam injected to fill the varicose vein. Each injected area will be covered with a pad and a stocking or bandage will then be applied from the foot to the groin. The chemical substance injected into the vein works like a glue. For the glued surfaces to become firmly and permanently fixed, they must be clamped together until the glue has set. In the case of your veins, bandages and stockings act as a "clamp" to hold the vein walls together.
Immediately after treatment patients can walk from the clinic room without any discomfort. The injections of foam are painless. After about 6 weeks the results are assessed. The varicose veins in the calf which are invariably present often shrink considerably with just treatment to the thigh vein. If they persist they may be treated with further foam injections or be removed, after the injection of local anaesthetic into the skin over the veins, through tiny little incisions (multiple phlebectomies). Whichever treatment is used recovery is immediate.