Varicose veins are enlarged, swollen veins which usually occur on the lower limbs, especially in the superficial veins of the legs, which are under high pressure when standing. They are produced by a condition called venous insufficiency, in which the blood circulating around the lower limbs is not able to return to the heart, due to the valves in the veins being damaged. The blood then pools in the distended veins which become varicose.
Not only are varicose veins an unsightly cosmetic concern, they can also cause the patient pain, especially when walking or standing. The veins can often feel itchy, and scratching them can cause ulcers; they may cause the ankles and calves to become swollen, but serious complications are rare. Varicose Veins never go away without treatment, however they frequently progress and worsen over time.
Varicose veins can occur in people of any age and gender, however, women are much more prone (especially those who have had children), along with those who have a family history of varicose veins or people who spend a great deal of time standing.
Investigation of Varicose Veins
A full and thorough clinical history including details of pregnancies, medication, exercise and dietary habits will enable your surgeon to determine the possible underlying causes for your varicose veins, and thus determine possible treatment options. In particular you will be asked about any history of deep vein thrombosis (DVT) as this can sometimes be a contraindication for varicose vein treatment.
At the Specialist Medical Clinic we offer a Varicose Vein Package. The package includes a consultation with the general surgeon and an accurate assessment of the full anatomy of the leg’s venous system by the radiologist, using a venous Doppler ultrasound scan. With the results of the Doppler scan, the surgeon is able to suggest corrective treatment which is tailor-made to each individual’s requirements.
Treatment options for Varicose Veins
There are several treatment options available for varicose veins. The most suitable option is dependent on the severity of the venous insufficiency. With advances in medical technology, preconceived ideas of varicose vein treatment being severe and painful, with a lengthy recovery period and marked bruising are fading. These days treatment is straight forward, much less painful with walk-in, walk-out procedures.
VNUS® ClosureFAST™ (now Venefit™) Minimally Invasive Technique
This is the latest technology in varicose vein treatment and along with endovenous laser treatment (EVLT), has made vein stripping in the USA virtually obsolete.
Physicians using the VNUS® ClosureFAST™ catheter, the only radiofrequency device on the market today for the treatment of venous reflux, report that most patients return to normal activity almost immediately following the procedure, with little or no post-operative pain.
Under local anaesthesia and ultrasound guidance, a device is inserted into the diseased vein and advanced to the site of vein damage. The catheter then delivers radiofrequency (RF) power to heat and seal the vessel. The technique is extremely successful and far less painful and traumatic to the patient than vein stripping. Radiofrequency devices operate at far lower temperatures than laser to heat and shrink the vein walls, therefore limiting the impact on surrounding tissues and, according to a clinical study, causing significantly less pain and bruising than EVLT.
The Specialist Medical Clinic is proud to be the only clinic in Gibraltar and on the Costa del Sol to offer this technique to our patients.
Conservative Treatment (Injection Sclerotherapy)
This treatment is used mainly for the elimination of small isolated varicose veins or spider veins when there is no obvious evidence of underlying problems with the main veins. The treatment is performed by injecting an irritant solution, either concentrated saline or a specialised sclerosant solution, directly into the veins themselves.
The irritant damages the vein walls, causing them to swell, adhere and seal shut. The vein then slowly turns into scar tissue and gradually disappears over a period of weeks. Sclerotherapy is generally performed in the clinic in less than 30 minutes and is considered highly effective when performed correctly, although the same vein may require multiple injections and repeat treatments over time. The treatment can be painful, with a burning or stinging sensation common, but the discomfort usually passes in a few minutes. Side effects are generally mild and temporary, and can include skin sores, superficial phlebitis (inflammation of the vein), bruising and discoloration around the treatment site.
This is the traditional surgical approach to varicose veins which can still have its place as part of a treatment package. In this technique the varicose vein is physically removed.
Our surgeon does not use this to treat large veins in the thigh as it requires general anaesthesia and produces significant post-operative pain and bruising with an associated lengthy and uncomfortable recovery period.
However, the technique is highly effective for the remove of small veins in the lower leg, under local anaesthetic.
EndoVenous Laser Treatment (EVLT)
Endovenous Laser Treatment is a similar technique to VNUS ClosureFast. It uses an optical fibre to deliver extremely high heat – over 700 degrees centigrade – which boils the blood in the vein to create a clotting effect which seals the vein as the device is withdrawn. The increased heat generated by this technique seems to result in more pain than our preferred VNUS method. Patients can not only suffer from more pain and bruising, there is also a significant chance of some vein staining appearing on the treated leg, which is difficult to eliminate.
(This procedure is not currently available at the Specialist Medical Clinic)