For most people with varicose veins, either an abnormal vein in the thigh (the great saphenous vein) or an abnormal vein behind the knee (the small saphenous vein) or both, are responsible for the development of the varicose veins. Unlike the bulging varicose veins, these veins are usually not visible and are examined using ultrasound. Therefore successfully treating varicose veins not only requires removal of the visibly abnormal bulging veins, it also requires removing or closing off these aforementioned veins which are the cause.
Ligation and Stripping procedures: This was the ‘classic’ operation for varicose veins, requiring a surgical incision and dissection in the groin or sometimes behind the knee, ligating or ‘tying off’ the problem vein in the groin or at the back of the knee, and removal (or stripping) of the great saphenous vein from the body. These procedures though sometimes still the best treatment option, are largely replaced now by Endovenous Thermal Ablation procedures, which are associated with less risk of nerve damage and infection, and less post-operative pain.
Endovenous Thermal Ablation Techniques: This encompasses Endovenous Laser Ablation (EVLT) and Endovenous Radiofrequency Ablation (RFA). With these techniques heat energy is applied to the lining of the saphenous vein (great or small or both), damaging the vein irreversibly, so that it blocks off and does not open again. These techniques are minimally invasive, performed through a needle hole or tiny skin incision. Comparing Endovenous Laser Ablation (EVLT) and Endovenous radiofrequency ablation (RFA),both treatments are similarly effective and have similar risks of complications (1-2%).
Sclerotherapy: This can be effective treatment for large varicose veins, but is more commonly used for smaller veins and thread veins (spider veins). A special liquid known as a sclerosant is used neat, or mixed with air, and is injected into the vein. This damages the lining of the vein causing the vein to become permanently blocked, eventually shrinking and becoming scar tissue. Smaller veins or residual varicose veins present following other treatment are best treated by sclerotherapy.
Avulsions: This refers to the removal of varicose veins though small skin incisions (microphlebectomy). Often a long length of vein can be removed through a single tiny incision, but usually multiple small incisions are made. Although occasionally performed as an independent procedure, avulsions are usually performed at the same time as the ligation and stripping procedure or the endovenous thermal ablation procedure.
Anaesthetic: Most varicose veins procedures can be performed under local anaesthetic, with shorter hospital stay and fewer risks. These are typically sclerotherapy procedures or Endovenous Thermal Ablation procedures or both.
Ligation and stripping operations with avulsions, or Endovenous Thermal Ablation procedures with avulsions are usually performed under general anaesthetic, though still as day case procedures.