Varicose veins are a common manifestation of venous insufficiency or chronic venous disease (CVD). They are characterized by impaired capability of transporting blood back to the heart against gravity. The twisted, swollen and enlarged structures on the leg are often a major cosmetic concern to the sufferer. However, as disease progresses symptoms can arise which require professional medical treatment.
Why surgery and sclerotherapy are commonly recommended
Historically, surgery in form of stripping has been the only varicose vein treatment available for many years and some physicians still consider it the “simple” treatment option. Only about 2 decades ago other treatment alternatives including sclerotherapy emerged. Sclerotherapy, which treats by injection of a medication which destroys the vein walls and thereby leads to their closure, has proven as a quick, easy and low-cost treatment alternative.
Nevertheless, both surgery and sclerotherapy can lead to serious side effects. Surgeries lead to either wound infections, bleeding, pain or discoloration of the skin in approx. 15% of all treated patients. More serious side effects like thrombosis or nerve damage are possible, even though they happen rarely. Sclerotherapy also bears considerable side effects such as the formation of blood cloths in other leg veins, lower back pain, headaches, discoloration of the skin and even fainting or temporary vision problems.
Treatment alternatives beside surgery and sclerotherapy
In recent years many treatment alternatives beside surgery and sclerotherapy have been developed and tested in clinical studies. Especially endothermal ablation techniques have established in routine clinical practice and are even recommended treatment alternatives by official authorities like the NHS in the UK. Currently there are three ablative techniques available: Radiofrequency ablation, endothermal laser ablation and echotherapy (HIFU – High-Intensity Focused Ultrasound).
Radiofrequency ablation is a method using a wire-like catheter to introduce direct heat to the inner vein wall of the diseased vein. For this therapy a cut is necessary to allow the catheter to be inserted into the vein. The tip of the catheter then releases controlled radiofrequency energy that heats the wall and causes a collapse and closure of the varicose vein when pulled back.
Endothermal laser ablation
Endothermal laser ablation works similarly to radiofrequency ablation and also requires a cut in order to insert a catheter into the varicose vein. By emitting bursts of energy through the laser, the vein walls are heated up and collapse subsequently.
Echotherapy (SONOVEIN) treats varicose veins with therapeutic ultrasound and is the most recent innovation in varicose vein treatments. Multiple intersecting beams of ultrasound are concentrated on a target area which generates a temperature rise at the focus point. Similar to laser and radiofrequency the varicose vein will close due to the temperature rise but the need to insert a catheter into the leg is eliminated with this technique which treats from outside the body. Also no sclerosant chemical product is injected.Are genetics linked to varicose veins?
Other treatment alternatives
Other, non-thermal procedures include glue being injected into the vein to close the vein – mechanochemical endovenous ablation, which uses a combination of physical destruction and sclerotherapy to close the vein.