ECHOTHERAPY
FOR VARICOSE VEINS

the non-invasive treatment

Do you have aching legs or cramps? Are your legs often tired and heavy, or do you have itching, tingling sensations or swollen or tender areas in your legs? You may suffer from varicose veins (also called varices or varicosities). You are not alone. Varicose veins in legs affect about 30 million people worldwide¹. Surgical stripping, radiofrequency ablation or laser ablation are common options in varicose vein treatment.

Echotherapy, the only non-invasive ablation therapy that is delivered by a system called SONOVEIN®, now allows treatment without catheters, chemical injections or incisions.

The treatment using high-intensity focused ultrasound (HIFU) takes place in a session of 20 to 60 minutes without general anesthesia. You can usually resume your daily routine directly afterwards. Personal experiences of patients who had their varicose veins treated with echotherapy can be read here. For more information or an appointment for echotherapy for varicose veins, simply fill out our contact form.

¹L. H. Rasmussen et al., Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins, BJS, Volume 98, Issue 8, 2011

What causes varicose veins?

Healthy leg veins have valves that open and close to assist the return of blood back to the heart. Varicose veins develop when those valves no longer function properly. As a result, the blood also flows in the wrong direction “downwards” and often pools in the lower part of the legs, increasing venous pressure. This is called venous reflux.

Varicose veins are the result of veins no longer properly transporting blood from the legs to the heart due to vein insufficiency. Normally, surrounding muscles, the elastic structure of the vein walls and so-called vein valves help to transport the blood from the lower into the upper part of the body against gravity. If the valves of the leg veins no longer function properly or the elasticity of the vascular walls diminishes, a backlog of blood occurs in the legs, which leads to an expansion of the vein walls. This venous reflux then leads to varicose veins.

Venous reflux may cause symptoms like pain, swollen limb, heavy legs, skin changes or ulcers. It is a progressive disease and symptoms may worsen over time if left untreated. Your physician can easily determine whether you have venous reflux using a diagnostic ultrasound device.

Who is a candidate for varicose veins?

Venous reflux disorders are widespread diseases and there are some risk factors that can contribute to the development of varicose veins. An inherited connective tissue weakness favors varicose veins. Since particularly female sex hormones play a role in the softening of the connective tissue, women are twice as likely to be affected as men. During pregnancy, the risk of venous reflux increases because of hormone changes and elevated pressure in the abdomen. Lack of exercise, obesity and long standing or sitting are risk factors, too. Another cause of varicose veins is the aging of tissue in general: Just like skin, veins become flabby over time – and expand.

Varicose veins are a chronic condition: once veins have expanded, they usually do not recede. Varicose veins developed during pregnancy are an exception: They usually disappear on their own in the months following the birth.

Diagnosis
of Varicose Veins

When should I go to the doctor?

If you experience significant discomfort or tortuous veins become visible, you should consult a physician specializing in vascular disease.

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This can be a vascular surgeon, a phlebologist, an angiologist or a dermatologist. They can clarify the progress of the venous disease and, if necessary, suggest appropriate therapy to avoid complications and reduce discomfort.

Which symptoms are related to venous reflux – and are varicose veins dangerous?

In the early stage, varicose veins are often visible as blue veins or spider veins on the leg. At that time, normally no symptoms are noticeable and the varicose veins might rather be disturbing for aesthetic reasons.
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Due to poor functioning blood flow, skin and tissue changes may occur. In advanced disease stages, even leg ulcers can develop from venous reflux. Further possible complications include vein inflammations and thromboses.

However, non-treated venous reflux can significantly affect quality of life and cause medical problems in the long run: Heavy legs, a feeling of tension and pain, severe itching and cramps at night are among the first symptoms of progressive varicose veins. At an advanced stage, water retention might occur because fluid is pressed from the veins into the surrounding tissue. Further, leg ulcers can develop and result in tissue death. Severe complications include phlebitis and thrombosis.

How are varicose veins diagnosed?

A discussion with your doctor about your medical history, duration and the nature of your discomforts as well as an ultrasound scan (also called sonography) will clarify the nature and extent of the disease.

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In most cases, a so called “Doppler” ultrasonography is used to determine the direction and flow speed of blood in the veins. The examination is a simple and painless way to identify possible reflux, e.g. blood flowing back to the lower part of the limb.

Treatment 
& Effectiveness

How are varicose veins treated?

In most cases, compression with stockings or bandages is recommended in the early stages. The pressure generated supports the muscles and vein valves in transporting blood towards the heart. In cases of advanced varicose vein disease, however, treatment of the vein concerned is recommended in order to resolve symptoms and avoid further complications.

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So far, possible treatment methods included classical varicose vein surgery (“stripping“) or a minimally invasive radiofrequency ablation or laser treatment.  A venous ablation by radiofrequency or laser requires the insertion of a catheter (long wire) into the vein. Although marketed as minimally invasive, these procedures are carried out in a sterile environment such as an operative theater. Because they are invasive, there is a risk of infection and a more or less long recovery period.¹

Foam sclerotherapy may be another alternative for you, but it often requires repeated injections of sclerosant chemicals, especially for larger veins. ²

Because of the postoperative pain³ and other unwanted side effects caused by these methods, medical research is constantly searching for ways to improve the existing treatment options and develop alternative therapies.

The innovative echotherapy, delivered by SONOVEIN, is now the first and only non-invasive varicose vein treatment: No catheters, no chemical injections and no incisions. This results in treatment without any scars and without risk of infection. Unlike surgical or minimally invasive vein treatments, echotherapy allows an immediate return to normal daily activities.

¹Minimally invasive techniques in the treatment of saphenous varicose veins, Tamar Nijsten et al.
²THE VEIN BOOK » J.J. Bergan, MD, FACS,- CHAPTER 21 – Sclerofoam for Treatment of Varicose Veins  J-J Guex

3A. C. Shepherd et al., Pain following 980-nm endovenous laser ablation and segmental radiofrequency ablation for varicose veins: A prospective observational study, Vascular & Endovascular Surgery, Vol. 44 Issue 3, 2010

Treatment 
& Effectiveness

How are varicose veins treated?

In most cases, compression with stockings or bandages is recommended in the early stages. The pressure generated supports the muscles and vein valves in transporting blood towards the heart. In cases of advanced varicose vein disease, however, treatment of the vein concerned is recommended in order to resolve symptoms and avoid further complications.

Learn more +

So far, possible treatment methods included classical varicose vein surgery (“stripping“) or a minimally invasive radiofrequency ablation or laser treatment.  A venous ablation by radiofrequency or laser requires the insertion of a catheter (long wire) into the vein. Although marketed as minimally invasive, these procedures are carried out in a sterile environment such as an operative theater. Because they are invasive, there is a risk of infection and a more or less long recovery period.¹

Foam sclerotherapy may be another alternative for you, but it often requires repeated injections of sclerosant chemicals, especially for larger veins. ²

Because of the postoperative pain³ and other unwanted side effects caused by these methods, medical research is constantly searching for ways to improve the existing treatment options and develop alternative therapies.

The innovative echotherapy, delivered by SONOVEIN, is now the first and only non-invasive varicose vein treatment: No catheters, no chemical injections and no incisions. This results in treatment without any scars and without risk of infection. Unlike surgical or minimally invasive vein treatments, echotherapy allows an immediate return to normal daily activities.

¹Minimally invasive techniques in the treatment of saphenous varicose veins, Tamar Nijsten et al.
²THE VEIN BOOK » J.J. Bergan, MD, FACS,- CHAPTER 21 – Sclerofoam for Treatment of Varicose Veins  J-J Guex

3A. C. Shepherd et al., Pain following 980-nm endovenous laser ablation and segmental radiofrequency ablation for varicose veins: A prospective observational study, Vascular & Endovascular Surgery, Vol. 44 Issue 3, 2010

How does echotherapy for varicose veins work?

Imagine sunrays bundled together by a magnifying glass to intensely target a single point. Echotherapy works in a similar way but uses therapeutic ultrasound beams, so-called high-intensity focused ultrasound (HIFU):
Learn more +
During the treatment, ultrasonic waves are concentrated on the vein concerned. Due to the thermal energy being delivered, the vein shrinks and is sealed closed. In order to precisely control the position of the beam, an additional diagnostic ultrasound device is used for monitoring.

For whom is echotherapy particularly suitable?

As a particularly gentle treatment alternative, echotherapy is generally suitable for patients who wish or need to avoid (minimally invasive) surgery, e.g. due to a blood-clotting disorder
Learn more +
Thanks to its non-invasive character echotherapy is a treatment option not only for the treatment of straight or tortuous veins which are sometimes inaccessible with a laser or radiofrequency catheter. It’s also suitable for difficult to operate recurrences (i.e. newly formed varicose veins) after previous surgical (stripping) or minimally invasive interventions such as radiofrequency ablation or a laser treatment. Echotherapy may also be an ideal option for the treatment of perforator veins, which connect the superficial system to the deep vein system – even in the presence of open ulcers.

How does echotherapy for varicose veins work?

Imagine sunrays bundled together by a magnifying glass to intensely target a single point. Echotherapy works in a similar way but uses therapeutic ultrasound beams, so-called high-intensity focused ultrasound (HIFU):
Learn more +
During the treatment, ultrasonic waves are concentrated on the vein concerned. Due to the thermal energy being delivered, the vein shrinks and is sealed closed. In order to precisely control the position of the beam, an additional diagnostic ultrasound device is used for monitoring.

For whom is echotherapy particularly suitable?

As a particularly gentle treatment alternative, echotherapy is generally suitable for patients who wish or need to avoid (minimally invasive) surgery, e.g. due to a blood-clotting disorder
Learn more +
Thanks to its non-invasive character echotherapy is a treatment option not only for the treatment of straight or tortuous veins which are sometimes inaccessible with a laser or radiofrequency catheter. It’s also suitable for difficult to operate recurrences (i.e. newly formed varicose veins) after previous surgical (stripping) or minimally invasive interventions such as radiofrequency ablation or a laser treatment. Echotherapy may also be an ideal option for the treatment of perforator veins, which connect the superficial system to the deep vein system – even in the presence of open ulcers.

Echotherapy for venous leg ulcers – treating the cause instead of the symptom

What is a venous leg ulcer also (also called open leg ulcer)?

The medical term for bad or non-healing wounds on the lower leg or inner ankle is open leg ulcer. These occur particularly among the older generation. In about 70% of cases, the disease is caused by venous insufficiency and therefore named as venous leg ulcer.¹

¹Nelzén, Olle et al., Leg ulcer etiology – A cross sectional population study, Journal of Vascular Surgery, Volume 14, Issue 4, 1991

How are venous leg ulcers and varicose veins linked? Both venous leg ulcers and varicose veins are caused by a vein which valves no longer close properly. This leads to a backlog of blood and puts a high pressure on the smallest blood vessels, the so-called capillaries. In the case of a venous leg ulcer these damaged capillaries make the skin fragile and can induce skin hardening over years. Ultimately, if the skin brakes, they can lead to poorly healing wounds.
Why is echotherapy suitable for treating varicose veins as well as for venous leg ulcers? Echotherapy delivered by the SONOVEIN® system is a suitable treatment method for leg ulcers caused by diseased perforator veins. Perforator veins connect the deep and the superficial vein systems and are difficult to treat with conventional treatment methods for varicose veins. Echotherapy now offers the possibility of treating the cause of the venous leg ulcers, i.e. the concerned perforating vein using high-intensity focused ultrasound. The HIFU treatment eliminates the cause of venous leg ulcers in the long term – without even touching the wound. By suppressing the source which fuels the ulcer, your body will be able to heal and close the wound.

Echotherapy is the first ever high-precision non-invasive treatment for varicose veins. This is a medical breakthrough which will completely alter the way we treat varicose veins and venous issues!“

Professor Mark Whiteley MS FRCS (Gen) FCPhleb, Consultant Venous Surgeon and Consultant Phlebologist, Founder of the Whiteley Clinic, London (UK) 

Three questions to echotherapy expert Professor Mark Whiteley

You were the first clinic worldwide to offer the treatment of varicose veins with echotherapy, delivered by SONOVEIN®. Which are your experiences so far?

SONOVEIN, the device which delivers echotherapy, in my opinion is the most progressive currently available technology for treating varicose veins and venous leg ulcers and is based on a technology which treats thyroid nodules and breast fibroadenoma since several years.

As a completely non-invasive and accurate treatment option for varicose veins, venous leg ulcers and other manifestations of venous reflux disease, SONOVEIN must be considered as the next potential disruptive technology in this field.

In your opinion, what are the key benefits of echotherapy?

Unlike previous treatment methods using endovenous laser, radiofrequency and even foam, this treatment is 100% non-invasive. There is no other technique that is without incisions and can treat the vein from outside the body. Long-term results of echotherapy might therefore show that we don’t experience the downsides of current techniques such as nerve injury or skin indurations. We also see that patients don’t experience the post-operative pain, generally related to minimal-invasive or invasive treatments and appreciate the fact that we don’t have to inject large amounts of tumescent anesthesia in their legs, as opposed to radiofrequency or laser techniques. Our patients resume their normal daily life immediately after the treatment.

For which patients do you think echotherapy is particularly suitable?

Echotherapy, delivered by the SONOVEIN system, can treat straight or tortuous veins. Sometimes veins are too tortuous for a laser of radiofrequency ablation catheter to pass through without damaging the vein – whereas with echotherapy we can treat those veins easily. In particular recurrent varicose veins are sometimes difficult to treat with laser or radiofrequency, but can often be treated with echotherapy.

Patients with severe varicose veins issues such as recurrent varicose veins and those with brown skin stains or even venous ulcers often have incompetent perforator veins, which again, often are difficult to access with other techniques. The fact that echotherapy treats “through the skin” makes it very easy to access this type of vein.

You want to learn more about echotherapy? Let us help you.

Please simply fill out the contact form and we will get in touch with you by email or by phone.

Please note that the Whiteley Clinic is an independent facility that is not funded by the NHS.

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