Traditional vein surgery
People have been suffering with varicose veins and chronic vein diseases for thousands of years but until recently the treatment options have been limited.
Vein surgery for varicose veins in more recent years has involved ‘vein stripping’ where the entire greater saphenous vein of the leg is removed under general anaesthetic. The surgery involves many incisions and ligation and subsequently has an extended recovery period. Despite these shortcomings, it was the gold standard of surgery for varicose veins through the 20th century.
Minimally invasive procedures
Varicose vein treatment has advanced rapidly in recent years with the evolution of non-surgical and minimally invasive procedures. The procedures carry fewer risks and equivalent outcomes can be expected in both the sort-term and long-term.
Clinical guidelines around the world are increasingly recommending non-surgical or non-invasive treatments for varicose veins. For example, the European Society for Vascular Surgery advises that laser surgery such as EVLA is recommended in preference to surgery for patients with great saphenous vein reflux and chronic venous disease. Similar guidelines exist in the UK and US where minimally invasive procedures have become the norm.
Endovenous Laser Ablation (EVLA)
EVLA is an office-based procedure that involves the introduction of a laser fibre within the incompetent vein under the guidance of a Doppler Ultrasound. Again, general anaesthetic is avoided and local anaesthetic is achieved with a solution that is injected to numb the vein and surrounding area.
The procedure targets the water component of the vein wall and blood within its lumen (a hollow passageway through which blood flows) with a high-energy laser.
Ultrasound Guided Sclerotherapy (UGS)
Larger veins are treated using a sclerosant solution, which is injected directly into the vein. Upon contact with the vessel lining, the material reacts with the blood vessel and ultimately closes it off.
Direct Sclerotherapy (Microeclerotherapy)
Smaller veins such as spider veins can be treated with direct injections of a sclerosant solution that ultimately leads to the closure of the injected vessels.
Complementing these non-surgical procedures are non-invasive diagnostics such as a Doppler Ultrasound Scan which uses sound wave technology to build an image of the veins in order to properly assess the vein structure and blood flow within a patient.
Advantages and benefits
The advantages of non-surgical procedures versus traditional vein surgery are well documented and the recommendations from various clinical guidelines around the world are both evidence-based and definitive.
The benefits to patients include:
- No general anaesthetic (and associated risks)
- Minimal incision size
- Less scarring
- Minimal downtime
The treatment of varicose veins is a rapidly evolving space. Recent technological advancements have made it possible to mitigate the risks associated with traditional vein surgery whilst minimising the overall impact on patients.