Treatments for varicose veins
Special elastic stockings (compression stockings) are a very effective treatment. They support the veins, stop them from getting worse, and relieve discomfort. They produce maximum pressure at the ankle, and the pressure diminishes up the leg. They are particularly useful if your main symptom is aching or ankle swelling, or if the varicose veins are likely to be temporary (for example during pregnancy).

Modern compression stockings are much lighter and look nicer than the old types. In the UK, compression stockings (though not support tights) are available under the National Health Service; however, for a pair, you have to pay two prescription charges. For men, there are ribbed, below-the-knee stockings that look more like ordinary socks.

How to put on your elastic stockings

The usual surgical operation involves tying off the vein (ligation) above the varicose section, usually just before it joins the deep vein. The vein can be removed by ‘stripping’; this involves attaching one end of a tiny wire to the varicose section and threading the other end through the vein to a small incision at the calf or ankle where the wire, along with the varicose section of vein, is pulled out. Alternatively, the vein can be removed in small pieces through tiny incisions.

The body does not miss veins that are removed by surgery. The legs have many other veins for the blood to flow through.

Varicose vein surgery used to cause horrendous bruising, but now that doctors use fine instruments that need only tiny incisions, there should be little bruising. However, some surgeons still make big cuts in the legs, so ask about this before you decide to have the operation. You can usually leave hospital on the day of operation or the following morning and then go back to work 1–2 days later (unless your work involves standing, in which case you would need 1 week off). The leg is bandaged for the first 12 hours, and then a heavy elastic stocking is worn. You may need painkillers for a few days after the operation.

After surgery, there is a 1 in 5 chance that you will develop more varicose veins within the next 5 years.

In the UK, varicose vein operations are performed under the National Health Service, though some hospitals are rationing this surgery and operating only on people who are developing eczema-type skin changes at the ankle or other problems. This is because a varicose vein operation can take 2–3 hours, using a lot of the surgeon’s and operating theatre time. If the main reason is that you are conscious of the appearance of the veins, you may have to have the operation done privately.

Laser treatment is a newer technique that is becoming very popular. It is usually called EVLT, short for ‘endovenous laser therapy’. It does not need a general anaesthetic, and you do not have to stay in hospital overnight. A tiny laser fibre is inserted into the vein. This generates steam, which damages the vein and makes it close up completely. Afterwards, the treated vein(s) may be somewhat thickened with a sensation of tightness for a while, but this resolves with time. According to a report in the Medical Journal of Australia (2006;185:199–202), it has an 80% success rate; some other studies report better results. It would be a good treatment for an elderly person wishing to avoid surgery, and for anyone else wanting a good cosmetic result.

Foam sclerotherapy is an injection of a special foam into the vein. It spreads rapidly along the vein after it is injected, and also fills the adjoining smaller veins. The injection is guided by an ultrasound scanner. The foam causes irritation, inflammation and eventually scarring, which permanently blocks the vein. The body absorbs the accumulated blood from the varicose vein and the lumps flatten out over time. It is 90% successful, but some people will need more than one injection to achieve a satisfactory result (British Journal of Surgery 2006;93:969–74).

Radiofrequency ablation (sometimes called ‘VNUS’ after the US company that developed the technique, or the ‘closure procedure’) is a ‘keyhole’ treatment. It involves inserting a narrow tube up through the length of the vein from a tiny cut in the ankle, guided by an ultrasound scanner. As the tube is pulled out, high-frequency radio waves are then sent along it, causing a high temperature that makes the vein close up. There is no bruising or discomfort afterwards. The success rate seems to be 80–90%.

Liquid sclerotherapy is similar to foam sclerotherapy, but an irritant liquid is used. This was a common treatment in the past, but is no longer used much because the results are not long lasting. This is because it does not spread as effectively as the newer foam type, which makes better contact with the wall of the vein.