New Methods of Treating Varicose Veins

Introduction

Recently several new techniques have been reported in the medical literature. The main aim of these is to avoid surgical removal of varicose veins. The idea is to avoid the need for general anaesthetic, incisions in the legs and a hospital operating theatre. Some of the methods summarised below only partially succeed in this aim. 

VNUS Closure (http://www.vnus.com/) uses a wire passed along the vein from the knee or calf towards the groin to treat large varicose veins in the thigh. The progress of the wire is monitored using ultrasound imaging. When the wire is in position the end of the catheter is heated electrically and the vein is destroyed. Gradually the wire is removed from the leg until all of the diseased vein is destroyed.

Good points.
Stripping of the vein is avoided and there is less discomfort and bruising after the operation.

Bad points.
In the UK this procedure is usually done under general anaesthetic in an operating theatre.
The cost is considerably greater than for varicose vein surgery due to the extra expense of the equipment.
Incisions must still be made in the leg to remove prominent varicose veins.
The long term outcome of this procedure has not been established.

Laser Treatment of Varicose Veins

This method is similar to the VNUS Closure closure technique, but this time a laser fibre is passed along the vein from the knee or calf towards the groin to treat large varicose veins in the thigh. The progress of the wire is monitored using ultrasound imaging. When the laser fibre is in position the laser is fired to heat the vein. The vein near the end of the laser fibre is destroyed. Gradually the wire is removed from the leg until all of the diseased vein is destroyed.

Good points.
Stripping of the vein is avoided and there is less discomfort after the operation. There is less bruising than following surgery, but more than after the VNUS Closure method.

Bad points.
In the UK this procedure is usually done under general anaesthetic in an operating theatre.
The cost is considerably greater than for varicose vein surgery due to the extra expense of the equipment and fibre.
Incisions must still be made in the leg to remove prominent varicose veins.
The long term outcome of this procedure has not been established.

Ultrasound Guided Foam Sclerotherapy

This method is used as an alternative to surgery for large varicose veins. The main surface is vein is injected with a special foam under ultrasound guidance. The foam destroys the lining of the vein and a firm bandage is applied to the leg. This type of injection is suitable for treating the main surface veins as well as varicose veins. The procedure does not require an operating theatre and is usually carried out in a consulting room or treatment room. The injection causes only trivial discomfort.

Good points.
Stripping of the vein is avoided and there is little or no discomfort after treatment. 
There is less bruising than following surgery.
There is no need for general anaesthetic, incisions in the leg or an operating theatre.
Re-treatment for further varices is simple.
The cost of treatment is much less than for surgical treatment or for either VNUS Closure or Laser treatment.

Bad points.
The treatment produces mild discomfort in the leg which may last for 2 - 4 weeks. It also produces mild bruising which may last for several months following treatment.
The final outcome may take several months to evolve following treatment, and this is longer than would be taken following surgery.
The long term outcome of this procedure has not been established.

VeinWave ä  is used exclusively for thread veins. It treats veins by thermo-coagulation using a high frequency electrical current. The results of a clinical series of 400 patients have been reported in the French journal, Phlebologie. The authors report excellent results. No clinical trial has compared the efficacy of this technique to microsclerotherapy, the most widely used treatment for thread veins.

Creams and Pills

A range of creams to rub on thread veins and pills to treat vein problems is advertised from a number of sources. 

Good points.
Some of the pills may reduce aching from varicose veins.

Bad points.
No medication of any type removes varicose veins - whatever the suppliers may say!

Conclusions

• There is no magic treatment for varicose veins!

• Surgical treatment is an established, effective treatment for large varicose veins.

• Microsclerotherapy is the best available treatment for thread veins and small varices.

• VNUS Closure and Laser Treatment are alternatives for large varicose veins. These methods reduce the extent of incisions made in the legs as well as post-operative bruising. They are more expensive than surgical treatment.

• Ultrasound guided foam sclerotherapy is useful in patients who wish to avoid surgery altogether. The final outcome will take longer to achieve but admission to hospital and general anaesthesia are not needed. This is very inexpensive compared to surgery.

• A limited range of the new methods is available at some of our centres. Please ask for details.