Varicose veins are enlarged, swollen veins which develop in the superficial veins of the legs, which under high pressure when standing.
Varicose veins develop because of a condition called venous insufficiency, in which the blood circulating through the lower limbs is unable to return to the heart in an efficient way because the valves in the leg veins are either congenitally absent of have been damaged. Blood then pools in the lower leg veins which gradually distend veins which and become varicose.
As well as being an unsightly cosmetic concern, varicose veins can also cause ache, ankle swelling, heaviness, itchiness, and discomfort towards the end of the day or when standing for long periods.
Left untreated blood cells pools in the small vessels around the ankle and leak out into the tissues under the skin where they are broken down leading to discolouration and eventually ulceration.
Varicose Veins never go away without treatment, however they frequently progress and worsen over time.
Varicose veins occur in men and women of any age however are much more common in women who have had children (because pressure by the baby on the pelvic veins raises the pressure in the leg veins).
Some people inherit their varicose veins particularly when men in the family have varicose veins.
Other risk factors include pregnancy, being overweight, frequently standing for long periods of time (shop assistants) and following a sedentary life style.
Investigation of Varicose Veins
Before treatment can be recommended, it is necessary to take a full clinical history and perform a thorough examination which should include a Doppler ultrasound scan to determine the extent of the disease and assess the health of the venous valves in the groin, lower thing and behind the knee.
Having had a previous deep vein thrombosis (DVT) is significant so it is important that you mention this during your consultation as it can sometimes be a contraindication for varicose vein treatment.
Our Varicose Vein Packages include a consultation with one of our venous surgeons and a Doppler ultrasound scan by our the radiologist to assess the anatomy of the venous system in the affected leg. These will enable our team to offer you a tailor made solution to your varicose vein problems.
Treatment options for Varicose Veins
Many varicose vein treatments are available and depend on the severity of the venous insufficiency. Our team will discuss the most suitable option for your veins with you
These days varicose vein surgery is much less painful and have a shorted recovery period than previously.
Injection & Foam Sclerotherapy
This treatment is used to treat small isolated varicose veins and or spider veins when the Doppler scans have shown any evidence of underlying problems with the main veins.
Basic injection sclerotherapy is typically performed by our aesthetic team however if foam is required this is usually done by one of our specialist doctors.
Treatment involves injecting an irritant solution (or foam) directly into the veins which inflame the vessel walls, causing them to swell, stick together and close the vein or capillary after which the vein turns into scar tissue and gradually disappears.
Sclerotherapy is generally performed in the clinic in less than 30 minutes and is highly effective, however the same vein may require multiple treatments over time. Patenst sometimes experience a burning or stinging sensation however this usually passes in a few minutes.
The technique does have some temporary side effects which include skin ulceration, inflammation of the vein (phlebitis), bruising and discoloration around the treatment site or along the vein.
Whilst some complex cases do still require open groin (or posterior knee) surgery, modern advances in medical technology enable surgeons to treat most varicose veins using minimally invasive techniques which are much less painful and can be performed as short stay day case procedures.
This traditional to varicose vein treatment still has its place as part of a treatment package. The procedure physically removes the whole veins from the groin to the knee. The technique has a vein recurrence rate of up to 60% at 5 years. Sometimes open surgery is required for re-do operations when previous surgery to the main thigh vein has failed, and new varicose veins have developed.
The procedure requires a regional or general anaesthetic and often produces significant post-operative pain and bruising. Recovery can be prolonged and uncomfortable.
Our surgeons do not perform these operations very often preferring instead to treat major truncal disease using one of the minimally invasive radiofrequency or laser techniques outlined below .
Small varicose veins in the lower leg are often removed by “stripping” or “avulsion”. This technique is highly effective and is most often performed under a local anaesthetic.
Minimally invasive surgical treatments
Radiofrequency V-NUS® Venefit™ vein closure
This along with endo-venous laser treatment (EVLT), has made vein stripping virtually obsolete in the Europe and the USA.
Venefit™ is the only radiofrequency device on the market today for the treatment of venous reflux.
The procedure is performed under spinal or local anaesthesia under ultrasound guidance. A thin catheter is placed into the inserted into the diseased vein via a small needle puncture at the knee and the tip advanced to the treatment site (usually in the groin).
The catheter uses radiofrequency to heat the catheter and vein walls which stick together and seal the vein closed. The technique is extremely successful and is associated with a vein recurrence rate of between 5-10% and far less painful and traumatic to the patient than vein stripping.
Radiofrequency devices use less power and operate at lower temperatures than lasers thereby limiting the impact on surrounding tissues. Some clinical trials suggest the technique cases less pain and bruising than EVLT.
Most patients return to normal activity almost immediately with little or no post-operative pain.
The Specialist Medical Clinic is proud to be the only clinic in Gibraltar and on the Costa del Sol to offer this technique to patients.
Endo-Venous Laser Treatment (EVLT)
Endo-venous Laser Treatment is a similar technique to VenefitTM but uses laser light delivered via an optical fibre (instead of radiofrequency) to deliver the heat to the vein.
The light boils the blood in the vein and damages the vein walls which sticks the vein walls together thereby seals the vein closed.
Recurrence rates following EVLT are similar to those of VenefitTM at 5 years. Some research suggests that the increased heat generated by the technique might cause more pain that VenefitTM however both techniques are much less painful than open surgery and vein stripping.
EVLT is performed as an ambulatory day-case procedure under spinal, general or local anaesthetic.
Both minimally invasive techniques carry the risk of some pain and bruising in the inner thigh following treatment and there is a ,small risk of staining appearing along the line of the vein after treatment which can take some time to eliminate.
If you are concerned about your varicose veins or have ankle swelling or ulceration you should contact your doctor or make an appointment to see one of our specialist vein surgeons at the Specialist medical Clinic