why your varicose veins need a surgeon

Among the leg issues you most often ask us about – especially on our Facebook forum, The Happy Legs Club – is varicose veins: you want to know how to treat them? So, let’s talk veins…

First, why/how do they form? Varicose veins are a common condition where veins in the legs weaken, then gradually swell and become twisted. While the prevalence of varicose veins differs widely from country to country, a widely-cited study published in the journal angiology indicates that the global prevalence is 7%.

Are they a danger to your health? While visible varicose veins are usually no more than a cosmetic nuisance, sometimes they cause symptoms like pain, leg cramps, swelling in the ankles and feet and itchy skin. Although a group of British researchers have found that among a group 800 patients they treated, all of the therapies available to treat varicose veins – sclerotherapy, laser ablation therapy and surgery – relieved these symptoms to a similar degree.

Where do I start to get treatment? Vascular surgeon, Professor Mark Whiteley, is my mentor on this important area of leg care, so I asked him for his top tips on what you should know before booking your first procedure. “Certain procedures suit certain veins so before you do anything you need the correct diagnosis,” says Professor Whiteley, “To make sure you’re getting the right treatment, first see a consultant and get a clinical diagnosis. Then have a venous duplex ultrasound scan with a vascular scientist (not your original consultant) then a follow-up consultation to discuss the results.”

Are there different types of varicose vein? There are three main types, and I’ve outlined these – and the recommended treatment – below:

1. Spider veins/thread veins AKA Telangiectasia

Professor Whiteley says: “11% of these can be treated directly but 89% have underlying hidden varicose veins which is why you need an expert duplex ultrasound scan first. They are best treated with micro-sclerotherapy – injections of detergent sclerosant solution into the veins under a magnifying glass”.

Pain rating: This is performed using a tiny needle – many patients say they don’t feel it, others will just feel a little pinprick.

2. Blue/Green veins that don’t bulge AKA Reticular Veins

Professor Whiteley says: “After investigating any underlying problems with a venous duplex ultrasound scan, these are usually treated with injections of foam sclerotherapy into smaller veins, guided by ultrasound. This technique is not used on larger veins as they tend to come back if using this procedure alone”.

Pain rating: You won’t feel the ultrasound but will feel the injections! The level of discomfort depends on what veins are treated and what sclerotherapy solutions are used to make the foam.

3. Veins, either green or skin coloured, that bulge when you stand and disappear when you lie down with your legs up AKA Varicose Veins!

Professor Whiteley says: “It’s tricky to get rid of these veins, but popular procedures include endogenous laser ablation (which puts a laser inside the vein and pulls it back at a set rate) and venaseal glue (a medical superglue that sticks the vein together – a favourite with patients who don’t want too many injections)”.

Pain rating (endovenous laser ablation): One local anesthetic injection is performed lower in the leg then a further five, six or seven injections are performed up the leg which help to numb certain areas. The actual treatment is then performed without any discomfort.

Pain rating (venaseal glue): Only one anaesthetic injection, unless other procedures are performed at the same time. However, the cost of the glue is many times that of the laser fibre and so patients have to weigh up the extra cost against fewer injections.

What kind of results will I see? Generally most surgical techniques take two weeks to start improving at all, six weeks to start seeing a good improvement, three months to get a very good improvement and eighteen months to look perfect.