Hollywood Private Hospital
Part of Ramsay Health Care

Treatments for varicose veins

Jun 25, 2018

Varicose veins are swollen, twisted veins that usually appear in the legs. They’re very common, but thanks to modern medicine they can be treated successfully.

Where do varicose veins develop?

When you think of varicose veins, you might picture enlarged, lumpy, purple-coloured veins travelling down the thigh or the calf. The lower extremities are the most commonly afflicted, but they can also occur in other areas of the body.

What causes varicose veins?

There are several causes of varicose veins.

There is what’s known an ‘incompetent valve’ and this is the most common cause. Veins have tiny valves that prevent blood travelling backwards, but sometimes these valves fail and instead of blood flowing to the heart, it pools in the veins and stretches them.

The second cause is obstruction or compression of the main vein. Treatment is different for this type and will be discussed later. You may also experience both types of varicose vein at the same time, with obstruction sometimes contributing to incompetence.

Most of the time, varicose veins don’t spontaneously get better. In fact, in around 60% of cases, they get bigger or may become more symptomatic over time. On the other hand, varicose veins in the pelvis that have been triggered by pregnancy can disappear once the baby has been delivered. In many women, however, large varicose veins in the pelvic area persist and can cause symptoms such as pelvic pain or ache, discomfort during or after intercourse, chronic vaginal discharge and irritable bladder. This is called Pelvic Congestion Syndrome.

Varicose vein treatment and recovery

The most appropriate method will depend on severity, bodily location, vein size and your age. All options involve recovery in the form of compression stockings, walking every day, and rest from heavy lifting and strenuous exercise. The appearance of varicose veins may be worse immediately after treatment but will subside in time.

Common treatment options include:

Sclerotherapy
The most popular intervention for small veins or ‘spider veins’. The vein is injected with special solution that makes it shrink and therefore less visible. Sclerotherapy can sometimes be used for slightly bigger veins too.

Thermal ablation
This minimally invasive technique is frequently recommended, particularly in the case of larger veins. There are two methods that fall under thermal ablation: endovenous laser therapy and radiofrequency ablation, and they involve applying heat inside the vein to make it shrink and disappear. Both procedures take around 40 minutes with a local anaesthetic used on the area, so you remain awake and alert but with minimal pain. You can go home on the same day regardless of whether you received the laser or radiofrequency ablation.

Recovery requires resting from work for a day or so (more if you have a physically demanding job), in addition to the previously mentioned steps.

Surgical removal: vein stripping
This is an older style of treatment that, while safe and common, isn’t recommended as often as other methods. This is primarily because of a longer recovery time and slightly lower long term success rates. The procedure is performed under general anaesthetic and your surgeon will make incisions in the groin, knee and in intervals along the vein to surgically remove the problem vein. Because of the anaesthetic and incisions, you will need to be observed by hospital staff for several hours afterwards.

Recovery time varies considerably, but patients are advised to take one week off work. Long term success isn’t quite as high as thermal ablation, and varicose veins may also be more likely to come back after vein stripping surgery, although not to the same extent as before.

When ‘typical’ varicose vein treatment isn’t advisable

The veins in your arms and legs are part of both deep and superficial vein networks. The types of varicose vein treatments mentioned earlier are known as primary varicose veins and are part of the superficial vein network, which is why they’re visible on the surface of the skin. Secondary varicose veins look the same, but the cause is very different: obstruction in the main (deep) venous system. Therefore, these require a different approach and treatment.

A common example is deep vein thrombosis (DVT). This is a clot that forms in a deep vein and blocks blood flow. The blood must find another way around and has no choice but to go through the superficial system. In this way, the ‘varicose vein’ is helping the patient because it is draining the blood from the leg. More complex veins assessment and even reconstruction of the deep veins is necessary in some cases. Removal of such varicose veins might not help and, in some cases, can cause harm.

If varicose veins are troubling you, request a referral for a vascular surgeon to find out the best treatment option for you.

Clinical Professor Patrik J. Tosenovsky is a vascular and endovascular surgeon at Hollywood Private Hospital. He completed his medical training in Europe and has practised as a consultant since 2000. He has a PhD in diabetic foot and is a Fellow of the European Board of Vascular Surgeons and the Royal Australasian College of Surgeons.